| Eksisterende Patello-Femoral Behandlingsmetoder
vs. HemiCAP™
Marrow
Stimulation Techniques
"Abrasion arthroplasty"
In abrasion arthroplasty, a high-speed rotary burr or shaving
device is used to remove about 1mm of bone from the surface
of the lesion. This creates an exposed bone bed that will
bleed and this will initiate a fibro-cartilage healing response.
The fibro-cartilage then grows into and fills the hole or
lesion creating a new but inferior surface. This technique
can provide short-term (1-3 years) pain relief, but often
patients are unable to resume their desired activity levels.
"Microfacture/Microdrilling
Technique."
This technique is very similar to abrasion arthroplasty except
that the bleeding is initiated by impacting awls, picks or
drilling directly into the bone within the lesion.
Articular defects that are larger than 15mm
in diameter are generally believed to require a more aggressive
intervention and are typically treated using one of the following
approaches, most of which are performed as open surgery:
Autografts
MosaicPlasty
This technique was popularized in the mid-1990s. In MosaicPlasty,
a series of dowel cutting instruments are used to harvest
one or more cylindrical plugs or grafts of articular cartilage
and bone from the surrounding healthy tissue. These tube-like
grafts are then implanted into the defect site. A series of
these plugs placed in close proximity to one another is used
to establish a new grafted hyaline cartilage surface. A limited
number of surgical institutions are performing this procedure
as it is technically very challenging. Outcomes for these
patients have been reported as variable based on surgeon expertise,
and patient selection. In addition, pain relief has been found
to be inconsistent. A lengthy post-operative regime of non-weight
bearing (up to 2-6 months) and continuous passive motion has
also been identified as a major contributor to the success
of this procedure.
Autologous
Cell Transplantation
ACT
ACT is a therapeutic treatment whereby healthy
hyaline cartilage cells are harvested from the patient, the
cell counts are increased in vitro (outside the body) via
some type of bioreactor expansion technique, and then those
cells are injected back into the defect. This technique is
still considered somewhat experimental.
Total
Joint Replacement
"Total
Knee Replacement (TKR)"
For patients with large articular defects
a procedure known as "total knee replacement" is
often required. This procedure requires the removal of substantial
amounts of bone followed by the implantation of a prosthetic
device. Patients who undergo TKR often describe a restoration
of lifestyle/activity that is profound; however, rehabilitation
periods following this procedure are several months or even
longer. While the useful life of a TKR is generally claimed
to be up to 20 years, clinical evidence indicates that complications
can begin to arise at approximately 8 - 10 years. Each successive
TKR (commonly referred to as a "revision") has been
shown to have a shorter useful life than the previous implant.
With each revision, the amount of remaining good quality bone
stock into which the implants are anchored becomes an issue.
Bone loss as a result of tissue reaction, implant loosening,
implant preparation, etc., can lead to great challenges in
restoring a solid anchoring site for the implant. As the revision
or replacement of these devices can lead to increased morbidity
(complications) and result in a very difficult rehabilitation
for older patients, efforts are made to forgo the TKR procedure
for as long as possible. Therefore, there is a reluctance
to use TKR in patients under 60 years of age. Similar concerns
and issues are prevalent in total hip replacement procedures
as well.
Hemi
Replacement
Hemiarthroplasty is the replacement of only
one articular surface of a joint which means that only one
half of the joint is resurfaced and as such a smaller amount
of diseased tissue is being removed when compared to a total
joint.
The HemiCAP™ implant is a rounded,
cap-like implant made from a cobalt chrome alloy with a central
post on the implanted, or bone side. Cobalt chrome is a material
that has been used in total joint reconstruction devices for
over two decades. This material has proven to provide a safe,
effective and strong weight-bearing surface in joints. The
CAP™ system precisely aligns the surface of the implant
to the contours of the patient's articular cartilage surface,
thus filling the defect and restores a smooth and continuous
articulating surface.
Arthrosurface believes that the HemiCAP™
implant will offer the following clinical benefits:
-
Relief from current pain and swelling
-
Return to normal activity with rapid recovery time
-
Restoration of a smooth, continuous, articulating load-bearing
surface.
-
A simple and reproducible outpatient/ambulatory surgical
procedure
For more information on the Arthrosurface
HemiCAP concept such as brochures, articles, video etc., please
contact Ortotech
directly.
 
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