Regenerative orthopaedic medicine in India is viewed to be a future going by the rising  conditions like arthritis and accident-trauma cases. The biological knee replacements is intended for the younger patient (below 50 years) for whom a conventional knee replacement may not be appropriate.

Although several protocols for cartilage regeneration have been developed, the most common  procedure is the  Autologous Chondrocyte Implantation (ACI).  In this procedure, the  autologous cartilage cells derived from the patient are harvested from the joint during ‘key- hole’ surgery, from a non load bearing aspect of the joint after the surgeon has assessed the suitability of the patient for ACI, and accurately mapped the area and extent of the wear. The cells are cultured in highly specialized laboratories and multiplied and implanted by orthopaedic surgeons to replace the damaged area of the joint. As an extension of this technique, it is now also possible to perform a ‘biological knee replacement’, where all the worn aspects of the joint, including the damaged menisci are replaced, stated Dr Suresh Krishnamurthy, consultant orthopaedic surgeon, Rangadore Memorial Hospital, Bangalore told Pharmabiz in an interaction.

Various recent studies using this technique have reported 80-85 per cent success rates, with up to 5 years of follow up. Studies have also shown that this technique is most successful when performed in the younger patient, with focal damage to the cartilage in specific aspects of the joint, he added.

The main uses of regenerative medicine in orthopaedics has been to regenerate cartilage of  the joints.  This is specially suited for  large, weight bearing joints like the knee, in younger patients with localized damage to the cartilage.  The other main use is in the treatment of fractures that have failed to heal satisfactorily by conventional means, where stem cells may be used to achieve healing.

Further stem cells have also been used in the treatment of segmental bone loss and management of spinal injuries, to regenerate damaged nerve cells. As this science is still in its infancy, there has been rather limited experience with this technique.

Robert Jones and Agnes Hunt Hospital in Oswestry, UK group has  combined the techniques of ACI and AMT to replace the damaged cartilage by effectively replacing the whole knee with a biological knee replacement.

According to Dr Krishnamurthy,  there are certain aspects of the knee joint where ACI produces good results such as the far end of the thigh bone (Femur), and the undersurface of the patella (Knee cap). However, when the top of the shin bone (Tibia) is involved, there is usually degeneration of the torn cartilage.

In such situations, performing ACI alone is contraindicated. The Oswestry group combined the techniques of ACI and AMT to replace the cartilage and regenerate, thereby effectively adopting the biological knee replacement.

More experience is needed to confidently offer this procedure on a commercial basis, stated Dr Krishnamurthy.