A Biologic Joint Replacement Strategy to Treat Patients Post-Traumatic Osteoarthritis
Abstract
Damage to the knee from athletic activities, military training, blunt trauma, or penetrating trauma is very common in the line of duty. This damage degrades the natural biological and biomechanical environment of the joint, resulting in significant debilitation, pain, post-traumatic osteoarthritis (PTOA) and related healthcare costs for hundreds of thousands of orthopaedic patients each year, including military personnel. PTOA is a common cause of impairment in military personnel and may lead to departure from military Service for medical reasons. Damaged knees and ankles rarely demonstrate substantive functional healing. Current practices in orthopaedic surgery attempt to limit the incidence and severity of joint deterioration, but despite recent advances and state-of-the-art treatment protocols, trauma to the joints can be associated with as high as a 65% incidence of debilitating PTOA. The fundamental problem driving this high rate of PTOA is the relative inability of articular cartilage to functionally heal. Risk factors that significantly influence the incidence and severity of PTOA after joint injury include the patient’s age, extent of injury, and type and timing of treatments. Ideally, biologic “regenerative” treatments performed prior to the onset of debilitating PTOA would be used in these patients to prevent, or at least minimize, joint deterioration and dysfunction. However, regenerative strategies in orthopaedic trauma are not well developed; therefore, salvage procedures such as total joint replacement are often necessary. While joint replacement with metallic and plastic implants generally succeeds in decreasing joint pain and improving limb function, the limited life span of implants, associated morbidity, and complications are significant concerns. Perhaps more importantly, patients with total knee or ankle replacements cannot return to athletic activities, high-demand physical labor, or active military duty. Buckwalter and Lohmander have stated that, "No currently available synthetic material or combination of materials duplicates the ability of articular cartilage to provide a painless, low-friction gliding surface and to distribute loads across a synovial joint." Therefore, our solution is to utilize novel biologic joint restoration strategies using osteochondral allograft (OCA) transplantation to functionally rebuild damaged joints, thus avoiding the limitations and complications of total joint replacements while restoring high-level function. Specifically, our previous research and ongoing Department of Defense (DOD) study have validated our capabilities for preserving organ-donor OCAs at the highest quality levels for more than twice as long as current standards, replacing entire joint surfaces with viable tissues that integrate and function at high levels, and allowing patients to return to athletic activities, high-demand physical labor, or active military duty. This proposal for a DOD Congressionally Directed Medical Research Programs project expansion aims to further attack the critical unmet need for more optimal treatment options for millions of active patients with damaged knees and ankles. Our research strategy for accomplishing this objective is to use our proven translational approach to complete basic science, preclinical, and clinical projects that will (1) delineate the biologic and biomechanical roles of meniscus in the success of biologic restoration surgery of the knee; (2) comprehensively assess and compare outcomes in unicompartmental versus more extensive biologic knee joint restoration surgeries in PTOA patients; and (3) extend the indications for osteochondral allograft transplantation by evaluating the safety and efficacy of total biologic restoration surgery for treatment of ankle PTOA in a limited clinical trial. Completion of these three aims will further optimize and expand biologic joint restoration surgery for successful treatment of PTOA. Theref
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810430
Entities
People
- James P. Stannard
Organizations
- United States Army
- University of Missouri