Cartilage Grafting…What is our experience?
Our previous blog (click HERE) explained some of the background around the use of cartilage and bone marrow cells and the current evidence. We felt it would be useful to provide an update on our experience. The Manchester Hip Clinic is a national centre for hip arthroscopy and we have carried out nearly 1400 in total. Of these, we have carried out over 110 complex surgeries using cartilage and bone marrow cells since we started in 2017.
The aim of the primative cells (which we harvest from the patients’ thigh bone and centrifuge to form Bone Marrow Aspirate Concentrate (BMAC)) is to regenerate damaged joint surface cartilage. When we first started, we simply combined it with Tisseal (a biological glue) and dripped it onto the damaged area (see previous blog). However, that does not give it structural stability, our technique then progressed so that we either combined it with a biological scaffold (Hyalofast) or used the patients own cartilage. While it is a more challenging procedure to do, recent research has suggested that the use of these scaffolds leads to improved and longer lasting patient benefit.
The ideal candidate seems to be someone with localised areas of damage and with good quality surrounding joint surface (see image). If the damage is too extensive, then the graft is not supported and is more likely to fail. Older patients (>55) and those with damage on the ball of the hip seem to do badly so we tend to recommend robotic assisted hip replacements (click HERE) to them.
The recovery period after a “normal” hip arthroscopy is usually up to six months. For patients who have cartilage treatment, that recovery can take up to 12 months with more extensive physiotherapy needed. This increased recovery period is probably due to the level of damage present and the muscle wasting/inflammation that patients develop before surgery. A useful way to think about it is that the surgery is to correct the damage, the physiotherapy is to strengthen the muscles afterwards and then we often recommend Pilates/Yoga to maintain that improved core/hip girdle strength and flexibility. The surgery/stem cell treatments seem to improve patients by 85-90% on average so it is more about improving a damaged hip rather than an absolute cure. After recovery, we normally recommend patients switch to non-impact cardio-vascular exercise afterwards such as cycling, swimming, cross-training or spin. The small number of patients that have remained symptomatic after treatment, tend to carry out impact exercise such as road running, squash, impact gym work etc. If we see these patients and they really wish to continue these activities, we often recommend Mako robotic hip replacement (click HERE) rather than hip preserving surgery.
