Treatment of Unicompartmental Cartilage Defects of the Knee with Unicompartmental Knee Arthroplasty, Patellofemoral Partial Knee Arthroplasty or Focal Resurfacing

Focal chondral defects are common lesions of the articular cartilage. They are predominantly found on the medial femoral condyle and often progress to osteoarthritis of the knee. Various conservative treatment options are available. The conservative treatment might reduce pain and delay the progress of degenerative processes. However, restoration of the articular cartilage cannot be accomplished. If the conservative treatment fails unicompartmental arthroplasty, patellofemoral joint replacement or focal resurfacing are reasonable options to postpone total knee arthroplasty. A careful patient selection before surgery is crucial for all three treatment options. The following overview reports indications and outcomes of medial partial knee replacement, patellofemoral partial knee replacement, and focal resurfacing treatment options for focal chondral defects.

Ten-Year Average Full Follow-up and Evaluation of a Contoured Focal Resurface Prosthesis (HemiCAP) in Patients in the United Kingdom

A significant number of patients are affected by localized articular damage that is appropriate neither for traditional arthroplasty nor for biological repair. A focal resurfacing system using a matched contoured articular prosthetic (HemiCAP) has been introduced for the treatment of such cases. Independent long-term results of these implants are limited. We retrospectively evaluated the use of this resurfacing system in 14 patients (13 males, 1 female), with a mean age of 40.3 years (range: 28–49), with focal femoral condyle defects. The same consultant orthopaedic surgeon performed all procedures. Our primary outcome measure was revision rate. Secondary outcome measures included radiographic evaluation (prosthesis migration signs, radiolucency), patient-reported functional evaluation (knee injury and osteoarthritis outcome scores), and complications. A total of 10 patients were treated on the medial femoral condyle, 2 were treated on the lateral condyle, and 2 received bicondylar implants (14 in total). Average follow-up was 107 months (range: 59–135). Three patients were lost to follow-up at the time of study. One patient was excluded from the study. Of the 10 left, 2 had to be revised, leading the survival rate to be 80% at 9.4 years. In four contactable patients, average Knee injury and Osteoarthritis Outcomes score at 121 months postsurgery (9.75 years) was 92.9 (as compared with 57.7 preoperatively). There were no complications. This series demonstrates that focal resurfacing is a safe, suitable, and useful temporizing step in knee arthroplasty surgery. The use of the focal resurfacing implant in this way allows the delay in transition to knee arthroplasty. This series shows an excellent functional outcome for remaining implants at average 10 years, with low complication rates.

Partial Hemiresurfacing of Osteochondral Defects of the Talus? Surgical Technique and Preliminary Report from Four Patients

Background: Osteochondral lesions of the medial talus (OLT) frequently lead to chronic ankle pain and osteoarthritis. Arthroscopic debridement, subchondral bone stimulation by drilling, and microfracturing are options for primary therapy in small lesions. In larger lesions, restoration of the talar dome contour seems to be a mandatory course of action. Methods: In a case series, we followed up four patients being treated with a focal resurfacing prosthetic due to large osteochondral talar lesions. In contrast to other studies, we can report on an off-label application to restore defects of the lateral talar dome with two patients for the first time. At follow-up, three patients reported a remarkable reduction in pain and were able to return to sports activities. One patient developed pseudarthrosis of the medial malleolar osteosynthesis. Conclusions: With selected patients, focal resurfacing appears to be an option for large osteochondral defects of the talus.