Decision Making - AAOS Instructional Course

76 Pages·2011·2.4 MB·English

Knee Osteoarthritis: Viscosupplementation to Cartilage
Transplantation and Resurfacing Procedures
Resurfacing Procedures and the Degenerative Knee
“Joint Resurfacing”
AAOS Annual Meeting – ICL February 18, 2011
Phil Davidson, MD
Heiden Davidson Orthopedics
Park City, UT USA
Disclosure
Arthrosurface – consultant, stock options
29 y.o. mother of 3
Defining the Issue:
Why discuss or consider Joint Resurfacing for the
Degenerative Knee
• 2 main scenarios where
this is relevant
1. Younger patients in
whom traditional TKA
is not an attractive
option
2. “Middle Age” or
“Boomer” patients
wanting to maintain
high levels of function
Intro to Joint Resurfacing
• Variety of Lesions
• Variety of Etiologies
• Variety of Options
• Focus of this ICL is on
degenerative lesions
• Degenerative lesions MUCH more
common than focal defects
• Goal is to make sense of
evaluating and treating an array of
degenerative pathology while
incorporating some new treatment
paradigms
Joint Resurfacing
A wide realm between…..
Arthroscopic debridement
Traditional TKA
Goals of
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
Joint Resurfacing Treatments:
…an evolving continuum of options, biological thru prosthetic
• Debridement
• Marrow stimulation
• Biological restoration
– Biologic grafts
– Biosynthetics
– Scaffolds
– Cellular therapy
• Prosthetic Resurfacing
– Bio-Prosthetic mix
– Inlay Arthroplasty
– Onlay Arthroplasty
– Total Joint
Spectrum of Pathology
Spectrum of Treatments
….solution lies in
understanding
comprehensive
pathology and having
available a wide realm of
treatments to customize
treatment for each
patient
How do we systematically, scientifically and
effectively get a handle on these challenging cases?
31 year old UPS worker 39 year old female ski guide
Comprehensive Knee Treatment
• Biological and
Prosthetic Joint
Resurfacing not in
isolation
• Stability
• Alignment
• Meniscal status
• Other compartments