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IMPLANT FIXATION AND EVALUATION FOR FEMORAL AND TIBIAL ARTICULATE CATILAGE REPLACEMENT IN THE KNEE
CHAPTER ONE
INTRODUCTION
1.1 Background of the study
Articular cartilage is a remarkably strong tissue capable of enduring great loads over time but has a limited healing capacity intrinsic to its avascular nature. It has been suggested that full-depth cartilage lesions (International Cartilage Research Society, ICRS grade 3-4), often associated to sports or other intense activities, do not heal. While many of these lesions cause pain and disability, others remain asymptomatic but might still progress to osteoarthritis (OA).10 Some researchers therefore advocate that treatment is warranted both for symptomatic and prophylactic reasons.11 It has been suggested that even after various kinds of treatment these lesions might progress to OA. However, because not all untreated focal lesion evolve to symptomatic knee OA, the treatment algorithm for these lesions remains controversial. Modern treatment of focal condylar full thickness cartilage lesions include biological repair by autologous cartilage reimplantation, a technique that is technically demanding, requires sophisticated laboratory resources and comprises a meticulous rehabilitation programme. Another treatment pathway, so called focal knee resurfacing with metallic (FKRM) implants, is gaining popularity but still lacks conclusive scientific evidence to support its biological safety and efficacy for the whole patient group suffering full depth cartilage lesions. Based on our previous preclinical reports, we suggest FKRM as a safe treatment strategy for the symptomatic middle-aged active patient (35-60 years), where biological treatments have failed or are shown to be less effective.
We have previously evaluated FKRM in terms of osseointegration and positioning of femoral condylar implants and the resulting local wear on the opposing tibial cartilage, as well as the impact on general cartilage health of the sheep knee (joint cartilage homeostasis22). The first aim of the present study was to compare short-term cartilage alterations in knees with lesions immediately treated with FKRM implants with those where full depth cartilage lesions were left untreated. The second aim was to follow the natural history of the cartilage adjacent to the implants by evaluating the macroscopic and microscopic reaction of the cartilage to the implant. To the best of our knowledge, the cartilage health surrounding FKRM implants has yet not been evaluated.
Knee and Hip joints are the largest synovial joints present in the body. Nearly whole body weight of an individual is supported by these joints and so these joints are most vulnerable to acute injury and osteoarthritis. The need for total joint replacements arises due to several reasons which include arthritis, and accidental injuries. Arthritis is marked as one of the major orthopaedic problems in the world. The data given by “centre for disease control and prevention” showed an estimated 54.4 million arthritis patients in US alone. It is reported that arthritis itself affects about 15% of population i.e. more than 180 million people. More than 100 forms of arthritis are reported at present. Among these, two major form of arthritis are very commonly found: they are osteoarthritis and rheumatoid arthritis. In osteoarthritis, the cartilage of the joint is affected, which results in a decrease in its elasticity. When the cartilage becomes stiff, it increases the chances of getting damaged. The cartilage of the joint acts as a shock absorber, which gradually wears away in hip and knee joints. The damaged cartilages & ligaments become stretched, which results in pain and eventually leads to bone on bone contact in the joint, causing severe pain. This form of arthritis usually affects elderly patients. Rheumatoid arthritis is an inflammatory form of arthritis. It is commonly found in women, who are in the age group of 40-60 years. In this the synovial membrane is affected, causing swelling and pain in the joint. If this form of arthritis is not treated, it can lead to the deformity of the affected joint
1.2 Statement of the problem
Patients suffering from both forms of arthritis stand to benefit from total joint replacement. Accidental injuries may also lead to the need for joint replacement. Depending on the type of fracture and the amount of bone loss to the joint, during an accident, joint replacement or joint arthroplasty may be required. Total hip and knee joint replacement is one of the most significant research fields of orthopaedics. The use of implants came forth in the late 19th century followed by the first half of the 20th century. During this period, the implants which were inserted, resulted in failure due to their improper design, lack of wear and corrosion resistance. Thus it became necessary to use metals and ceramic with biocompatibility as their main property.
1.3 Objectives of the study
1. To understand the importance of implant fixation and evaluation in articulate cartilage replacement in the knee
2. To understand the relationship between implant fixation and healthy knee functioning.
1.4 Research Questions
1. What is the importance of implant fixation and evaluation in articulate cartilage replacement in the knee
2. What is the relationship between implant fixation and healthy knee functioning.
1.5 Research Hypothesis
H0: There is no relationship between implant fixation and healthy knee functioning.
H1: There is a relationship between implant fixation and healthy knee functioning.
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