Last week, an article appeared in the orthopedic peer reviewed literature reporting reasons for failure of Knee Replacement Prosthetic reconstruction within two years of the procedure. It is though such review and publications that we surgeons gain knowledge so as to offer the patient with arthritis, the most comprehensive informed consent. At the same time, it is only by reviewing our technology and surgical techniques that the surgeon is able to minimize unsatisfactory results and short lived outcomes. Understanding the cause of failure and type of revision knee arthroplasty procedures performed in the United States is essential in guiding research, implant design, and clinical decision making in Knee Replacement surgery. The most common cause of revision surgery is infection followed by implant loosening. Next comes malpositioning of components and failure of soft tissue balance leading to pain and limited motion. Patellar instability was also identified as a reason for patient dissatisfaction leading to an early revision.  The average length of hospital stay associated with a knee revision was 5.1 days; this does not take into account, the rehabilitation center stay or time lost from work. The average total charges were $57,600; again, this does not take into account the costs of rehabilitation, outpatient antibiotics and ongoing physical therapy.

As readers of this Blog are aware, I maintain a Data Base containing outcome measures for every patient I have treated since joining the Regenexx Network and the Cellular Orthopedic initiative 22 months ago using Bone Marrow Aspirated Concentrate derived Mesenchymal Stem Cells for the care and treatment of Grade two and three knee arthritis instead of a knee replacement procedure. Last July, I presented a comparison of patients one year following stem cell intervention for an arthritic knee with historical data for those who had undergone a knee replacement one-year prior. At one year after a procedure, the stem cell cohort had more functional outcomes than those patients who had undergone a knee replacement. The two populations studied had one thing in common, an arthritic, symptomatic, life-style altering arthritic knee. My interest was peeked by the scientific article published last week concerning why Total Knee Prostheses had failed at two years; so I decided to review the complications of stem cell interventions for an arthritic knee and report them here:

Nothing is listed because there are no adverse outcomes to report. To date, to the best of my knowledge, no stem cell recipient for an arthritic knee in my practice has undergone a knee replacement. That may not be the case after another year of follow-up; but there has not been an infection or reportable complication in 22 months. The only “revision” procedures I have had to perform were three patients with repeat stem cell interventions to achieve a higher outcome score and several patients who requested booster PRP between four and nine months. The rescue of a failed stem cell intervention is a primary knee replacement; but to date, none have been reported. For your arthritic knee, Total Knee Replacement or try Stem Cells first?

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