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What if there were an Alternative to Metal or Polymer Plastic Total Joint Replacement?


For adult reconstructive surgeons trained to replace joints utilizing metal and plastic interfaces, the thought of an alternative joint surface has seemed foreign and unattainable. However, with new technologies of preserving cartilage and matching geometries to coincide with a patient’s anatomic features, the day of a joint replacement using the God-given cartilage and bone tissues is now possible. Many moving parts had to come together to make this possible. One of the most important is preserving natural tissues. Because the transplants from donors have to be monitored for so long, the cell life and preservation has been a problem now. With new preserving options has extended the survival of cartilage. The second important feature is superior fixation of transplanted materials to provide better fixation and ingrowth. By using size based donors the patients original surface anatomy is replicated yielding a faster and more functional outcome.

The surgery and recovery is slightly different to that of the standard total knee replacement. Full weight bearing is not allowed until six weeks' time. Secondly, the surgical procedure has very strict indications and because of its technology can be at times a slower recovery.  Thirdly, the biological implant is not expected to be permanent. It is after all a human product, but we as humans do not last forever and so donors might have the risk of bringing to the patient the same condition eventually that the original pathology had, mainly that of arthritis.

What is most appealing to us as joint replacement surgeons is that we are not burning bridges. We do not like to see a lesser procedure ignored or abandoned if it would have served the patient's needs for the years in the future. To offer a biological replacement for what was previously thought to be only correctable by metal and plastic is a remarkable testimony to the advancement of modern science, once again meeting the needs at a less invasive and obtrusive fashion than previously imagined.

David R. Lionberger, MD – 10/19/2016