UniCAP offers a long term treatment for middle-aged patients, who are not revised within the first 9 years

Laursen, Jens Ole; Mogensen, Christian Backer; Skjøt‐Arkil, Helene

doi:10.1007/s00167-019-05356-y

Cited by 13 publications

(14 citation statements)

References 23 publications

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“…This suggests that if symptomatic degenerative cartilage lesions are of limited size rather than an element of generalized OA, then resurfacing implant treatment can provide long-term improvement. The results of 70% not revised to knee arthroplasty after mean 9 years, indicate that resurfacing implants may limit the need for a UKA or TKA in elderly patients (> 65 years old) with symptomatic cartilage lesions or early degenerative knee pathologies [8,11,[15][16][17][18]. Thus far, the present study is the only and largest long-term case series, with 23 femoral resurfacing mini prostheses in elderly knee-patients with clinical and radiographic follow-up up to 11 years, including revision and survival rates.…”

Section: Discussionmentioning

confidence: 99%

A longterm prospective follow-up study of resurfacing miniprosthesis suitable for patients above sixtyfive years with localized cartilage lesions or early osteoarthritis in the knee

et al. 2020

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Purpose The aim of the study was to investigate the long-term outcomes of the Focal Femoral Condyle Resurfacing Prosthesis for treatment of localized cartilage lesion in patients > 65 years. Methods This was a prospective case series study. Non-reopererated patients initially treated with resurfacing condylar miniprothesis (HemiCAP/UniCAP) were evaluated clinically and radiographically at 7–10 years follow-up (mean 9 years). The clinical examination included the Knee Society Score (KSS) and Visual Analogue Scale (VAS) pain score and EQ5D. The radiographic examination included the Kellgren-Lawrence (KL) grade for investigate of OA progression. A comparison analysis of the preoperative and follow-up subjective outcome data and a Kaplan-Meier implant survival analysis were performed. Results Twenty-three patients were included in the study (9 HemiCAP and 14 UniCAP). There were seven revisions (one HemiCap and six UniCap respectively) (30%) and three patients had died. Follow-up examinations were performed on 10 patients. When comparing follow-up with the preoperative state, there were significant increases in the KSS objective (50.0 ± 8.3) vs. 90.0 ± 6.3)) and KSS function (45.0 ± 11.7) vs. 85.0 ± 4.7)) scores, a decrease in the pain VAS score (7.0 ± 0.9) vs. (4.0 ± 1.9)). Radiographic evaluation demonstrated increase in osteoarthritis development with a KL medial score (2.0 ± 0.6) and KL lateral score (1.4 ± 0.6) vs. (2.0 ± 0.9)).The EQ5D-score was 86 ± 8.4 and patients Health-score was 85 ± 18). Conclusions Resurfacing implant treatment for early OA in patients above 65 years can require revision to knee arthroplasty in 30% of patients. But in patients that are not revised long-term improvements in subjective clinical outcome was demonstrated. This suggests that even elderly patients with isolated cartilage lesions or early OA might benefit from the limited invasive resurfacing implant treatment. Level of evidence IV

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Section: Discussionmentioning

confidence: 99%

A longterm prospective follow-up study of resurfacing miniprosthesis suitable for patients above sixtyfive years with localized cartilage lesions or early osteoarthritis in the knee

et al. 2020

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“… 64 Long-term follow-up of FKRIs is scarce, and available long-term evidence from the first-generation metal FKRI raised concerns because of high failure rates based on OA progression. 46 Novel metal FKRIs with patient-specific surface geometries have resulted in very low failure rates up to 55 months. 38 , 55 Cartilage-mimicking polymers, such as in the study by Nathwani et al, 64 pose great potential for prevention of OA progression when using FKRIs.…”

Section: Discussionmentioning

confidence: 99%

“…There were 12 conversions to arthroplasty in patients aged 50 years versus 1 patient in the <50 years subgroup. Finally, Gille et al 28 compared 3 age groups (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46), and 47-65 years) after AMIC cartilage repair and found no significant differences in outcome across all age groups.…”

Section: Bone Marrow Stimulationmentioning

confidence: 99%

A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients

Jeuken

Hugten

Roth

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Focal cartilage defects are often debilitating, possess limited potential for regeneration, are associated with increased risk of osteoarthritis, and are predictive for total knee arthroplasty. Cartilage repair studies typically focus on the outcome in younger patients, but a high proportion of treated patients are 40 to 60 years of age (ie, middle-aged). The reality of current clinical practice is that the ideal patient for cartilage repair is not the typical patient. Specific attention to cartilage repair outcomes in middle-aged patients is warranted. Purpose: To systematically review available literature on knee cartilage repair in middle-aged patients and include studies comparing results across different age groups. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search was performed in EMBASE, MEDLINE, and the Cochrane Library database. Articles were screened for relevance and appraised for quality. Results: A total of 21 articles (mean Coleman Methodology Score, 64 points) were included. Two out of 3 bone marrow stimulation (BMS) studies, including 1 using the microfracture technique, revealed inferior clinical outcomes in middle-aged patients in comparison with younger patients. Nine cell-based studies were included showing inconsistent comparisons of results across age groups for autologous chondrocyte implantation (ACI). Bone marrow aspirate concentrate showed age-independent results at up to 8 years of follow-up. A negative effect of middle age was reported in 1 study for both ACI and BMS. Four out of 5 studies on bone-based resurfacing therapies (allografting and focal knee resurfacing implants [FKRIs]) showed age-independent results up to 5 years. One study in only middle-aged patients reported better clinical outcomes for FKRIs when compared with biological repairs. Conclusion: Included studies were heterogeneous and had low methodological quality. BMS in middle-aged patients seems to only result in short-term improvements. More research is warranted to elucidate the ameliorating effects of cell-based therapies on the aging joint homeostasis. Bone-based therapies seem to be relatively insensitive to aging and may potentially result in effective joint preservation. Age subanalyses in cohort studies, randomized clinical trials, and international registries should generate more evidence for the large but underrepresented (in terms of cartilage repair) middle-aged population in the literature.

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“…22 Studying the HemiCap Wave for patellofemoral defects, the authors found a revision rate of 28% after 6 years in 18 patients 22 and in 64 patients treated with UniCap (designed for larger defects), the authors found a revision rate of 56%. 23 Laursen et al . 22 reported that the subgroup of patients who did not require early revision had lasting clinical improvements, and no progression of osteoarthritis was seen, while patients suffering from osteoarthritis and patients who did hard, manual labor had a significantly higher risk of revision.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, some studies report a relatively high revision rate. 22-24 Therefore, our objective was to investigate the 10-year survival of resurfacing implants from a nationwide cohort registered in the Danish Knee Arthroplasty Registry.…”

Section: Introductionmentioning

confidence: 99%

Eighty Percent Survival of Resurfacing Implants in the Knee After 10 Years: A Nationwide Cohort Study on 379 Procedures from the Danish Knee Arthroplasty Registry

et al. 2021

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Objective Focal cartilage injuries are debilitating and difficult to treat. Biological cartilage repair procedures are used for patients younger than 40 years, and knee arthroplasties are generally reserved for patients older than 60 years. Resurfacing implants are well suited for patients in this treatment gap. The objective was to investigate the 10-year survival of resurfacing implants in the Danish Knee Arthroplasty Registry. Design In this retrospective cohort study, patients treated with resurfacing implants were followed longitudinally in the Danish Knee Arthroplasty Registry from 1997 to 2020. The primary endpoint was revision surgery. The survival of the resurfacing implants was analyzed by Kaplan-Meier method. Results A total of 379 resurfacing implant procedures were retrieved from the Danish Knee Arthroplasty Registry. The mean age and weight of patients were 50 years (SD = 11) and 84 kg (SD = 17), respectively. The indications for surgery were as follows: secondary osteoarthritis (42%), primary osteoarthritis (32%), and osteochondral lesions (20%). Within the follow-up period, 70 (19%) of the implants were revised to arthroplasties. The 1-, 5-, and 10-year revision-free survival estimation was 0.95 (95% CI 0.93-0.97), 0.84 (95% CI 0.80-0.88), and 0.80 (95% CI 0.75-0.84), respectively. The median time to revision was 2 years. Conclusion The 10-year revision-free survival rate for resurfacing implants was 80%. Based on the revision rates, this treatment offers a viable alternative to biological cartilage repair methods in patients aged 40 to 60 years with focal cartilage pathology. Improved patient selection could further improve the implant survival rate. Further studies are needed to investigate this treatment method.

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UniCAP offers a long term treatment for middle-aged patients, who are not revised within the first 9 years

Cited by 13 publications

References 23 publications

A longterm prospective follow-up study of resurfacing miniprosthesis suitable for patients above sixtyfive years with localized cartilage lesions or early osteoarthritis in the knee

A longterm prospective follow-up study of resurfacing miniprosthesis suitable for patients above sixtyfive years with localized cartilage lesions or early osteoarthritis in the knee

A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients

Eighty Percent Survival of Resurfacing Implants in the Knee After 10 Years: A Nationwide Cohort Study on 379 Procedures from the Danish Knee Arthroplasty Registry

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