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Published on: May 21, 2013
Treatment of full-thickness femoral cartilage lesions using condyle resurfacing prosthesis
Jens Ole Laursen1, Martin Lind2
1Department of Orthopedic Surgery, County Hospital of South Jutland, Sønderborg, Denmark.
Insights
Femoral resurfacing with the HemiCAP implant improved knee function and reduced pain for cartilage lesions. However, a significant 23% reoperation rate requiring arthroplasty was observed within seven years.
Area of Science:
- Orthopedic surgery
- Biomaterials science
- Regenerative medicine
Background:
- Cartilage lesions in the knee joint can lead to pain and osteoarthritis.
- Femoral resurfacing offers a potential treatment option for focal cartilage defects.
- The HemiCAP implant is a device designed for femoral resurfacing.
Purpose of the Study:
- To evaluate the outcomes of HemiCAP implant for femoral resurfacing in patients with trochleal and condylar cartilage lesions.
- To assess subjective outcomes, pain levels, and reoperation rates following HemiCAP implantation.
Main Methods:
- A prospective cohort study of 61 patients treated with HemiCAP implants between 2007 and 2012.
- Patients had symptomatic ICRS grade 3-4 cartilage lesions less than 4 cm².
- Follow-up included Knee Society scores (KSS), pain assessments, and radiographic evaluations for 2 years, with 7-year follow-up for complications.
Main Results:
- Significant improvements in mean KSS (52 to 90) and KSS function score (45 to 92) were observed at 2-year follow-up.
- Mean pain scores decreased from 7.1 to 1.8 at 2 years.
- Twenty-three percent of implants were revised to arthroplasty within 7 years due to lesion progression, osteoarthritis, or pain.
Conclusions:
- HemiCAP femoral resurfacing provides short-term improvement in subjective outcomes and pain for cartilage lesions.
- A substantial reoperation rate (23%) requiring conversion to arthroplasty highlights limitations.
- This treatment may serve as a temporary solution for younger patients or those not yet candidates for arthroplasty.
Purpose:
The HemiCAP® implant for femoral resurfacing treatment of cartilage lesions was introduced in 2003. We present outcome from a prospective cohort study of 61 patients with both trochleal and condylar lesions treated with the HemiCAP® implant.
Methods:
From 2007 to 2012, 61 patients were treated with femoral resurfacing using the HemiCAP implant. There were 36 femoral condyle implants and 25 trochleal implants. Indication for treatment with HemiCAP implant was symptomatic cartilage lesion at the femoral condyle demonstrated by MRI or arthroscopy, which was ICRS grade 3-4 and size less than 4 cm2. There were 24 males and 37 females with a median age of 49 (range 35-65) years. Patients were followed for 2 years with Knee Society subjective outcome scores (KSS), pain scores and radiographic evaluations and for 7 years with complications and reoperations.
Results:
At 2-year follow-up, mean KSS was improved from 52 (6.2) to 90 (7.9), mean KSS function score was improved from 45 (7.5) to 92 (8.3), and mean Pain score improved from 7.1 (0.7) to 1.8 (1.7). Twenty-three per cent of implants were revised within 7 years to arthroplasty due to progression of cartilage lesions, progression of osteoarthritis, or increased knee pain. No difference between females and males was found for reoperation rate.
Conclusion:
The present study demonstrated improved subjective outcome and reduced pain after femoral resurfacing using the HemiCAP implant in a relatively large cohort of patients with symptomatic cartilage lesions. A concerning 23 % reoperation rate with conversion to arthroplasty was found. Femoral resurfacing implantation treatment can be a temporary treatment for cartilage lesions expected to develop into osteoarthritis and for younger patients not eligible for arthroplasty treatment.
Level Of Evidence:
IV.
