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Newest Advances in Knee BioSurgery

We are busy trying to develop Cartilage replacement technologies to prevent the knee from wearing out and needing artificial replacement.  This article gives you the current update on what the future looks like for state-of-the-art knee surgery.    Much of this information is hot off-the-press from the Harvard Medical School sponsored Boston Cartilage Course 

 

 Watch the Fox5 TV News Health Watch Report with Beth Galvin and Dr. Hyman on cutting edge ACL Surgery using Osteocel Stem cells.

 

Orthobiologics and Biosurgery

 

Some of the more recent innovations in knee surgery: 

  1. Osteobiologics (OBI) TruFit Plugs  (Taken off the market in the US for cartilage use, 4/27/07 but put back on the market in 2008, with the packaging disclaimer that: 'the effectiveness on cartilage repair of this product is uknown.' -distributed by Smith&Nephew).  Here's some nice Pictures of OBI plugs and grafts.
  2. Genzyme/Carticel (ACI)
  3. Allograft  tissue transplantation
  4. Osteoarticular Transfer Systems (OATS), COR, SDS and Mosaicplasty
  5. Cascade Autologous Platelet System (MTF). Platelet Rich Plasma (PRP)

 See also this Google Book Result on OBI Tru Fit plugs, and excellent text by Dr. Riley Williams at HSS.

 

Some of the up and coming ‘in the works’ innovations- in clinical trials

  1. Verigen's Matrix Autologous Chondrocyte Implantation (MACI)
  2. Arthro Kinetics’ Cartilage Regeneration System (CaReS)
  3. Osiris Therapeutics’ Chondrogen Stem Cells 
    Osiris Reports Mixed Results from Chondrogen Trial. Read more...
  4. DeNovo Living Cartilage Implant (Zimmer, ISTO). US Trials proceeding

 By the numbers:

 Source:  What the Knee Needs, Forbes Magazine, November 13, 2006, and it's referenced bibliography.

 

What the article above does NOT go on to say is that your access to these innovations is not guaranteed.  Consider these important points.

 

  1. Many insurance companies don’t pay doctors or hospitals when they do these procedures.
  2. Even though these procedures are approved and recognized treatments, some insurance companies consider them experimental and won’t cover you for them
  3. the ones that do pay are substantially reducing their payments over time, making it not cost effective for hospitals and physicians to keep doing them
  4. insurance companies, following Medicare’s lead, will be slashing reimbursements for these procedures over the next 5 years, because as more patients get the surgeries, it becomes more costly to the insurance company; they deal with the increased cost by: denying coverage, increasing your premiums and lowering payments to surgeons and hospitals.
  5. as the ‘baby boomer population’ hits 77 million in the next couple of years, the demand for artificial knee prostheses will skyrocket and that means lot’s more Medicare subscribers will be stressing the system to get coverage for knee replacement
  6. there are A LOT of surgeons who perform knee replacements but VERY FEW who specialize in cartilage restorative surgery which is trying to prevent you from needing knee replacement.

As you can see,  there are a lot of competing forces.  Performing these biosurgical procedures takes specialized training that many orthopaedic surgeons don’t have, while at the same time, advances in technology are making biological solutions more available.  Unfortunately, increasing costs of research and development, and increasing utilization make these solutions unattractive to your insurance company.  The insurance companies plan to pass on their costs to you, the hospitals and the doctors…and in the end, the patients may not have the access they need to take advantage of these innovations – and fix problems before they become more catastrophic.

 

Cartilage Repair Center. Org MRI of Articular Cartilage

MRI of Articular Cartilage. Medscape

Cartilage Restoration Update 2000

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