1. Philip A. Davidson, MD Heiden Davidson Orthopaedics 2012
Treating Injured Knees and Shoulders: Cartilage Restoration and Joint Resurfacing offering solutions for patients of all ages
Philip A. Davidson, MD
Heiden Davidson Orthopaedics
2012

2. Cartilage Restoration and Joint Resurfacing A wide realm between…..
Arthroscopic debridement
Traditional TKA

3. The problem:
29 y.o. mother of 3
Former elite skier

4. Goals of Cartilage Restoration & Joint Resurfacing
Relieve pain
Optimize function, sport and activities
Improve mechanics
Long lasting
Prevent or limit future degenerative dhanges
Retain future options surgically
Principles extend to many joints

5. Debridement (clean up) Marrow stimulation Biological Restoration
Cartilage Restoration and Joint Resurfacing Treatments: …THE BIG PICTURE
Debridement (clean up)
Marrow stimulation
Biological Restoration
Biologic grafts
Biosynthetics
Scaffolds
Cellular therapy
Prosthetic Resurfacing
Metals and Plastics
Inlay Arthroplasty
Onlay Arthroplasty
Total Joint

6. Goal of Cartilage Restoration Restore Specialized Articular Cartilage

7. Marrow Stimulation
Techniques - Drilling - Picking - Abrasion - Microfracture
Marrow stimulation results: - Fibrocartilage
Limited potential with increased age, injury chronicity
Cheap, fast, easy
Short term efficacy seductive.

8. Biological Options Cell Therapy Osteochondral Grafts Autogenous
Limited use
Allograft
Juvenile Cartilage Grafts
Minced grafts
Biologically Active Scaffolds

9. Bone and Cartilage Grafts
Autograft (self donor)
No donor needed
Limited availability
Small lesions only
Repair Broken Cartilage
Allograft (OCA)
Human Donor
Very effective
Young patients
Handle Bone loss
Larger lesions
Generally > 2 cm²

10. OCA– When is this done? Larger defects Deeper defects Bone loss
Patellofemoral
Younger Patients
Osteochondritis
Otherwise healthy joint

11. OCA donor tissue Fresh Stored ( < 30 days) Germ Surveillance
Donor Testing/Screening
Limited Availability
Expensive
No game day decisions
No anti-rejection drugs

12. OCA- Procedure

13. OCA- Procedure

14. OCA- Procedure

15. OCA- Procedure

16. OCA- Procedure

17. OCA- Procedure

18. OCA- Procedure

19. OCA- Procedure

20. OCA- Procedure

21. OCA- Procedure

22. OCA- Procedure

23. OCA- Procedure

24. OCA- Procedure

25. OCA- Procedure

26. What if biologics will not or cannot work
What if biologics will not or cannot work? …too large, no longer “young”, obese, smoking, ……..Or just plain worn out Prosthetics - Joint Resurfacing

27. Biologic or Prosthetic Resurfacing ???? Key decision making point
Multifactoral decision
Lesion/Cartilage nearby
Patient Factors
Age (biological)
Comorbidities
Joint Status
Resources

28. Decision Making – Bio vs. Prosthetic Joint Shape
Biologic Solutions are less likely to work in joint which has lost shape or is “crooked”

29. Transitional thinking from biologics to prosthetics
Once planning progresses to resurfacing need conceptual framework
Inlay
Onlay
Bone sacrificing ( traditional)

30. Inlay Joint Resurfacing

31. Inlay Resurfacing Accommodates different shapes and sizes
Intraoperative surface mapping
Preserves anatomy, minimal bone resection
Ways to think about Inlay:
“filling a cavity”
“new tiles on the floor”
“patching a tire”

32. Inlay Resurfacing: Anatomical Reconstruction
Accommodate complicated curvatures
Minimally invasive procedure allows for other reconstructions at same time
Inlay Arthroplasty is stable
Accounts for different sizes and shapes of persons and joints

33. Inlay – Contoured Articular Prosthesis
Geometry based on patient’s native anatomy
Intraoperative joint mapping
Account for complex asymmetrical geometry
Extension of biological resurfacing

34. Inlay- Platform Technology
Multiple Joints
Multiple sizes and shapes
Metallic Inlay in conjunction with stud or set-screw
Poly (special plastic) Technology uses cement in socket

35. Patellofemoral (knee cap joint) Inlay Resurfacing
Trochlea alone or Bipolar
Traditional prostheses limited success and rarely used
Inlay device allows for realignment easily, as no overstuffing
Inlay device can handle very advanced PF DJD and morphologic variability
Traditional PFA
Inlay PFA

36. Case # 1 – 42 year old female

37. Case #1

38. Case #1

39. Inlay Unicompartmental resurfacing arthroplasty aka…
Inlay Unicompartmental resurfacing arthroplasty aka….UniCAP™scope assisted Uni, AKR , etc..

40. Cementation

41. UniCAP case example – medial knee resurfacing 46 year old cyclist

42. UniCAP – medial knee resurfacing

43. UniCAP – medial knee resurfacing

44. UniCAP – medial knee resurfacing

45. UniCAP – medial knee resurfacing

46. UniCAP – medial knee resurfacing

47. Minimum 5-year results of focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee. Becher, C. et.al. Arch Orthop Trauma Surg . DOI /s June, 2011.
21 patients, mean age 54 yrs, minimum f-u 5 yrs, small focal unipolar lesions
KOOS scores improved significantly (P < 0.005)
pain (51.1 to 77.6),
symptoms (57.9 to 79.5),
ADL (58.8 to 82.4),
Sports (26.3 to 57.8)
Tegner activity level
improved significantly (P< 0.02) from 2.9 to 4.
SF-36(physical) increased by 15.2 to 46.9 compared to the preoperative value
16/21 of the would have the operation again.
Radiographic results:
solid fixation, preservation of joint space and no change in the osteoarthritic stage.

48. Inlay Shoulder Resurfacing

49. ANATOMIC INLAY RESURFACING FOR GLENOHUMERAL OSTEOARTHRITIS Clinical Results in a Consecutive Case Series

50. Shoulder Resurfacing Study- Patient Population
Males – 29
Female – 19
Mean age at surgery
61 years
Follow-up
3 years

51. HemiCAP in OA Concurrent Procedures Rotator Cuff Repair12
Subacromial Decompression 25
Distal Clavicle Resection 23
Biceps Tenodesis 2
Biceps Tenotomy 21
Capsulolabral Repair 5
Hardware Removal 1
HemiCAP in OA

52. Simple Shoulder Test

53. VAS Pain

54. NO reported loosening of implant in the shoulder
No signs of
Device disengagement
Progressive periprosthetic radiolucency
Implant subsidence

55. Osteoarthritis treatment: Resurfacing!
Removal of bone spurs
Soft tissue releases
Treat ALL conditions of shoulder

56. CONCLUSIONS Shoulder Resurfacing with HemiCAP for Glenohumeral Osteoarthritis
Short term (3 year) results very encouraging
Restoration of native anatomy
Comprehensive pathology treatment is key
Excellent option for primary OA of Shoulder

57. Combining Inlay and Onlay Technologies

58. Combining Inlay and Onlay Technologies

59. Case #2 32 year old female rancher
Neutral alignment
Told she needed a TKA
Healthy, ideal body weight

60. PFJ

61. MFC

62. Radiographs

63. Resurfacing & Alignment
Must know alignment, potentially correct or accommodate with resurfacing
Must have long leg standing films available
Inlay does not restore joint height
Onlay can offer more joint height restoration

64. Onlay Resurfacing Arthroplasty A Uni or Partial by any other name???
Onlay optimizes fit of implant to bone
Onlay minimizes bone resection
Onlay accounts for alignment and patient specific anatomy using pre-op data acquisition

65. Onlay Resurfacing Very little bone cut off
Implants custom made from CT scan
More accurate fit may increase longevity
Accommodate morphologic variability, “odd sizes and shapes”

66. Case #4 Onlay

70. Biologic Treatment - Injured Worker

71. Prosthetic Resurfacing Procedures
4/22/2017
Outpatient or one night stay
Full WB immediately
Full ROM immediately
Appropriate for “younger” patients and high demand boomers

72. Updating Traditional TKA
Pre op limb imaging can yield data about bone shape , size and alignment
Alignment, sizing and intended corrections can be precisely calculated preoperatively
This digital information can be used to plan, create cutting guides and manufacture implants
Increases precision
Increases efficiency by: decreasing OR time, instruments, and inventory
May lessen or obviate the need for intraoperative navigation systems
Saves time and money while potentially making outcomes more predictable and ultimately better.

73. Updating Traditional TKA
Pre-op templated cutting guides/blocks
Avoid/minimize intraoperative intra and extra medullary alignment guides
These traditional guides can be used as “double-check”

74. Updating Traditional TKA
Bicruciate preserving resurfacing devices
Onlay 3 compartments
Pre-commercial prototype

75. Closing thoughts…..Joint Resurfacing
Excellent Option for many, but not all, patients
Retain future options – as much as possible
Resurfacing may be a bridging procedure
Maximize Outcomes
Equal, or better than traditional treatments
Offering additional options to patients that may have had few alternatives to Total Joint

76. Future Trends
“Geographic” , biologic , or large area contoured resurfacing for DJD
Combining biologics with prosthetics
Enhanced biomaterials for resurfacing implants, nanotechnology
Decreasing the time and costs associated with patient specific implants and instruments
Both patient demand and cost containment will drive the need for more precise, less invasive joint resurfacing

77. Thank You phildavidsonmd@gmail. com Office: 435-615-8822 www
Thank You Office: