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Coordinated Health

Four Alternatives to a Knee Replacement

By: Hannah Ropp   July 11, 2019
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Knee replacements are one of the most common surgeries in the United States. The American Academy of Orthopedic Surgeons estimates that nearly 4.7 million Americans have had their knee replaced and that number is expected to climb.

However, according to Coordinated Health Orthopedic Surgeon Wayne Luchetti, M.D. a knee replacement may not always be necessary. “It’s a rather invasive procedure and it’s something we don’t take lightly,” he says.

Dr. Luchetti claims that there are alternative treatments that may help people avoid knee replacements or at the very least put it off for several years.

  1. Microfracture
  2. Autologous Chondrocyte Implantation (ACI)
  3. Mosiacplasty
  4. Osteochondral Allograft Transplantation

 

Four Alternatives to a Knee Replacement

 

1. Microfracture

According to Dr. Luchetti the microfracture procedure is the oldest cartilage saving technique and has been around since the early 1980’s. During the procedure, which is done arthroscopically, several small holes are drilled into the bone. This causes bleeding and creates what is known as a ‘superclot’, which eventually forms into fibrous cartilage.  

Dr. Luchetti says this procedure has an 80% success rate in patients under the age of 45. While this procedure is minimally invasive, Dr. Luchetti claims it still requires a commitment. “After the procedure you would need to stay off your feet for six weeks to allow the cartilage surface heal over,” he says.

2. Autologous Chondrocyte Implantation (ACI)

ACI is actually two minimally invasive procedures aimed at regenerating the hyaline cartilage you are born with as opposed to fibrous cartilage. Like the microfracture procedure, it is aimed at younger patients under the age of 50.

Dr. Luchetti explains that during the first arthroscopic procedure, cartilage cells are harvested and sent to a lab where they are multiplied in a petri dish over five weeks. During the second surgery, the cartilage cells are implanted in the defected area.

Dr. Luchetti admits that ACI is less popular than other cartilage restoration treatments because it is actually made up two separate procedures, but says he still like to keep it ‘in his toolbox’.

3. Mosiacplasty

Mosiacplasty is actually used in patients who have both bone and cartilage loss and Dr. Luchetti refers to it as the ‘hair plug’ procedure. He explains that during the arthroscopic procedure cylindrical plugs of bone and cartilage from a non-weight bearing area of the knee and transferring it to the defected area of the knee.

According to Dr. Luchetti, the mosiacplasty is very successful in patients who have intact ligaments, normal alignment and a small, isolated defect in the cartilage.

4. Osteochondral Allograft Transplantation

Dr. Luchetti says that the Osteochonral Allograft Transplantation is a procedure that he has been using quite a bit over the last few years. The procedure uses bone or cartilage from a cadaver to replace cartilage and bone in the knee that is damaged or worn. According to Dr. Luchetti, the procedure is meant to restore the normal anatomy of the knee and can be used to correct large defects up to 5 cm.

Like some of the other knee replacement alternatives, the osteochondral allograft transplantation is most successful in younger more active patients.

If you are considering a knee replacement, Dr. Luchetti stresses the importance of being an informed patient. “Before having a knee replacement, you should talk to your surgeon about non-surgical options. You want a surgeon who has a lot of tools in their toolbox and you always want to ask the about minimally invasive techniques,” he says.

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Keywords

joint replacement, Dr. Luchetti, Knee Pain