Treatment of arthrosis of the knee joint: Autologous chondrocyte transplantation

• Treatment of arthrosis of the knee joint: Goals of autologous chondrocyte transplantation
• Who is suitable for this type of treatment for knee arthrosis?
• Methods for restoring articular cartilage
• What type of doctor performs autologous cartilage cell transplantation?
• How successful will the treatment of arthrosis be with chondrocyte transplantation?
• What happens before surgery?
• How is arthroscopic chondrocyte transplantation performed?
• What type of anesthesia does the patient receive during surgical treatment of knee arthrosis?
• Will my knee hurt after surgery?
• Conditions of accommodation at the Gelenk Clinic
• What should you pay attention to after surgery?
• How much does it cost to treat knee arthrosis with autologous chondrocyte transplantation?
• Is this method right for me?
• How can a foreign patient make an appointment and the operation itself?

Painful wear and tear of the articular cartilage of the knee joint is explained by several factors: arthritis, arthrosis, injuries with deformations of bones or cartilaginous structures, metabolic disorders, as well as gout or hemochromatosis.
© bilderzwerg @ fotolia Arthrosis (wear and tear) of articular cartilage is the most well-known joint disease. One of the most common forms of the disease is arthrosis of the knee joint - a pathology that causes chronic pain, as well as limited movement of the patient. Over the course of several years, the sliding surface of the articular cartilage gradually wears out, and therefore slowly loses its original properties. Since cartilage tissue lacks nerve endings (nociceptors), knee injuries become noticeable only when the defect reaches the bone layer located under the articular cartilage. Autologous chondrocyte transplantation, or in other words cartilage cell transplantation, is an innovative surgical treatment for knee arthrosis that aims to correct cartilage deformities using the patient's own cartilage cells. Successful treatment of knee arthrosis using this technique is carried out by only a few knee specialists in Germany. Dr. Baum is the first surgeon in the world to perform arthroscopic articular cartilage transplantation. In addition, he is one of the developers of this method of treating knee arthrosis, who regularly trains new specialists.

Who is suitable for this type of treatment for knee arthrosis?

The method of cartilage tissue transplantation as a treatment for arthrosis of the knee joint is not suitable for every patient. At a progressive stage of the disease, this technique will no longer bring the desired result. In such cases, the surgeons at Gelenk Klinki in Freiburg will recommend the patient joint-preserving partial replacement or total knee replacement. Successful autologous chondrocyte transplantation depends on the following factors:

• knee stability, intact cruciate and collateral ligaments
• straight axis of the joint without deformities (e.g. hallux valgus or varus deformity of the legs)
• absence of articular mouse (tissue fragments formed due to defects in articular cartilage)
• at least partial preservation of the menisci
• cartilage damage on only one of the two articular surfaces

The usual indications for cartilage tissue (chondrocyte) transplantation are local injuries to the articular cartilage in the knee.

What are the ideal conditions to perform autologous chondrocyte transplantation?

• Patient age from 15 to 55 years
• Defect size up to 10 cm2 in the presence of healthy areas of cartilage
• Stability of the knee joint, undisturbed ligament structure
• No excessive stress on the knee, particularly due to excess weight

As a rule, this technique is suitable for people under the age of 55. However, the decisive factor in this case is not the biological, but the calendar age of the patient. Sometimes, if all the necessary indications are present, cartilage tissue transplantation is also performed for patients over 65. In order to accurately say whether this surgical intervention is right for you, the specialists of our orthopedic clinic need X-rays, as well as an MRI of the knee. Often, only during the operation the surgeon makes a decision regarding the final treatment method: sometimes partial endoprosthetics is enough for the patient, and sometimes, to restore mobility, it is necessary to perform a cartilage tissue transplant.

If doctors can determine that autologous chondrocyte transplantation does not make sense, you will be offered methods of treating arthrosis, such as partial prosthetics using the HEMICAP patellofemoral prosthesis, Repicci prosthetics or complete endoprosthetics.

Mosaic chondroplasty technique

The patient's position is on the back with the leg bent at 120°. An x-ray with a reference mark helps ensure that the knee is flexed enough to access the bone donor site.

Next, arthroscopic access is made to the femoral condyle with the damaged area of ​​cartilage. The area is cleaned with a curette and the edges are excised to obtain a smooth, healthy contour. Then a probe with marks is inserted - it is used to measure the exact size of the defect. If the defect is too large or located very far away, the operation is performed using arthrotomy (open approach).

The next step is to make a tissue incision and gain access to the area of ​​the bone from which the graft will be taken. The cross principle is used: if a defect is restored on the medial condyle, then the graft is taken from the lateral surface of the lateral one and vice versa. The tissue is taken with a tubular chisel. It is very important to maintain exact perpendicularity with respect to the surface of the cartilage at the moment of “driving in” the chisel.

The number of cylindrical osteochondral fragments harvested varies from three to five and depends on their size: the larger the graft, the fewer are required. Usually 3 grafts with a diameter of 10-11 mm or 5-6 with a diameter of 5-7 mm are taken.

After obtaining the required number of osteochondral fragments, the first “landing socket” is drilled on the defective area of ​​the cartilage. This is also done with a tubular chisel, but its diameter is 1 mm smaller than that used to extract grafts. The length of the landing hole is measured, the length of the graft is adjusted to it, which is carefully fixed to the place intended for it using the press-fit method. The procedure is repeated the required number of times. In this case, the holes are drilled in such a way that they are not parallel and fan out from the hypothetical center of curvature of the condyle, this allows the curvature of the articular surface to be restored as accurately as possible.

Methods for restoring articular cartilage

After extracting a small sample of autogenous cartilage tissue, the resulting chondrocytes are cultured in a special laboratory under sterile conditions. © Istockphoto.com

Step 1: Taking a sample of cartilage tissue (biopsy) from the knee joint

At the beginning of arthroscopic surgery (arthroscopy), Gelenk Clinic surgeons remove a small sample of autogenous cartilage tissue. In this case, a biopsy sample, the size of a grain of rice, is taken from a healthy, least loaded area of ​​the knee. Then the resulting chondrocytes (cartilage cells) are isolated in a special, highly specialized laboratory, after which they are cultured (grown) under sterile conditions.

The operation is performed on an outpatient basis and lasts approximately 30 minutes. The next day, the patient is sent for a blood test, during which 120 to 150 ml are removed from the vein. blood, from which serum (the liquid element of blood without formed parts) is obtained in the laboratory.

Step 2: Cell culture in the laboratory

The biopsy sample, about the size of a grain of rice, is delivered to the laboratory along with a blood test. The chondrocytes are then separated from the tissue sample and expanded under sterile conditions in the patient's own blood plasma. This method completely eliminates contact with foreign proteins or blood components.

At the end of the entire process, which usually lasts from 6 to 8 weeks, small spherical cell aggregates are formed containing hundreds of thousands of cartilaginous tissues capable of reproduction. In order to maintain quality, cells are delivered to the clinic within several hours in special refrigerated containers.

Restoration of bone and cartilage tissue in an experimental model of osteoporosis under the influence of a new economical phytotherapeutic composition (Phytocost New)

Volkov E.E.1, Korsun V.F. 4, Izvolskaya M.S.2 Vasilenko A.M.3

1LLC HuangDi Medical Center, Moscow, Russia; 2FGBUN Institute of Developmental Biology named after. N.K. Koltsov RAS, Moscow, Russia. 3FGBU "National Medical Research Center for Rehabilitation and Balneology of the Ministry of Health of the Russian Federation", 4FGAUHE "Peoples' Friendship University of Russia"

The recovery of bone and cartilage in an experimental model of osteoporosis under the action of a new cost-effective phytotherapeutic composition (Fitokost New)

Volkov EE, Korsun VF, Izvolskaia MS, Vasilenko AM

Summary.

The urgency of the problem is determined by the widespread prevalence of osteoporosis, the lack of effectiveness and iatrogenic effects of drug therapy. Against the backdrop of many different herbal medicine recipes from the field of traditional medicine, scientific data on its use in osteoporosis is scarce and is presented mainly by foreign researchers. Previously, we showed that the multicomponent domestic herbal medicine Fitokost corrects disorders in cartilage and bone tissues caused by prednisolone in an experimental model of osteoporosis.

Purpose of the study: to determine the effectiveness of the new, more economical phytocomposition “Phytocost New” on the course of experimental osteoporosis.

Materials and methods. Experiments were carried out on 3-month-old Balb/c mice as a model of osteoporosis. The animals were divided into 6 groups: 1 – control group – intact animals. Animals of groups 2-6 were intramuscularly injected with prednisolone (1.0 mg/mouse) daily for 14 days. Animals of group 2 were sacrificed at the end of the last injection of prednisolone. Animals of the 3rd group did not receive the herbal medicine for 30 days. Animals of the 4th group received the previously obtained phytopreparation Fitokost (50 mg/mouse) orally daily for 30 days. Animals of groups 5 and 6 received the new phytocomposition Phytocost New in doses of 50 and 5 mg/mouse, respectively, for 30 days.

Results. A dose-dependent reparative effect of Fitokost New was revealed in the form of a decrease in the number of chondroblasts and restoration of bone tissue, similar to the drug Fitokost.

Conclusion. The effectiveness of Fitokost New, which has a significantly smaller number of components compared to the previously obtained drug Fitokost, is not inferior to it in its activity in restoring cartilage and bone tissue in a model of osteoporosis.

Key words : osteoporosis, prednisolone, Phytocost New, cartilage and bone tissue.

Abstract

Background. The urgency of the problem is determined by the wide prevalence of osteoporosis, insufficient effectiveness and iatrogenic effects of drug therapy. Against the background of many different recipes of herbal medicine from the field of traditional medicine, scientific data on its use in osteoporosis are scarce and presented mainly by foreign researchers. Previously we have shown that multi-component domestic phytopreparation Fitokost corrigiruet disturbances in cartilage and bone tissues caused by prednisone in experimental models of osteoporosis. The purpose of the study was to determine the effectiveness of a new, more efficient creation of phyto compositions “Fitokost New” on the course of experimental osteoporosis. Materials and methods . The experiments were carried out on 3-month mice of Balb/c line on osteoporosis model. The animals were divided into 6 groups: 1 – control group – intact animals. Animals of groups 2-6 were administered daily intramuscular injection of prednisolone (1.0 mg/mouse) for 14 days. Animals of the 2nd group were slaughtered at the end of the last injection of prednisolone. Animals of the 3rd group did not receive phytopreparation within 30 days. Animals of the 4th group received daily oral previously obtained phytopreparation Fitokost (50 mg/mouse) for 30 days. Animals 5 and 6 groups received new fitokompozitsiya the New Fitokost in doses of 50 and 5 mg/mouse, respectively, for 30 days. Results. Revealed dose-dependent reparative effect Fitokost New reduction in the number of chondroblasts and bone regeneration like a drug Fitokost. Conclusion. The effectiveness of the New Fitokost, which have significantly fewer components, compared to previously obtained drug Fitokost, not inferior to it in their activity in the regeneration of cartilage and bone tissue in a model of osteoporosis.

Key words: osteoporosis, prednisone, Fitokost New, cartilage and bone tissue

Introduction. The growing prevalence, insufficiently effective treatment methods, and the personal and public socioeconomic burden of osteoporosis [1-3] necessitate the search for new and improvement of already known approaches to its prevention and treatment [4-6]. However, the optimistic expectations associated with the widespread introduction into practice of many modern pharmaceuticals for its treatment are not fully justified. This is due to the high level of drug iatrogenicity [5], the high price and insufficient effectiveness of drugs. Therefore, the search for complementary approaches to correcting disorders observed in osteoporosis, including in the arsenal of naturopathic remedies, remains relevant.

In connection with medicinal iatrogenies, interest in herbal medicine (PT) has begun to revive, which is recognized as one of the safest methods of treating acute and chronic diseases, provided that the treatment is carried out by a specialist and not by the patient himself. However, data on the scientific basis and practice of using PT for osteoporosis are currently most widely presented in foreign, and primarily Chinese, literature [7-15] and to a lesser extent by domestic researchers [16, 17]. Among several patented domestic PT compositions intended for the treatment and prevention of osteoporosis [18-19], their effectiveness has been assessed for only one composition [20], called “Fitokost”. This composition includes components from more than 60 medicinal plants that have the most pronounced effect on individual parts of the pathogenesis of osteoporosis.

Using a model of osteoporosis induced in mice by the administration of prednisolone, it was shown that the Phytocost composition causes restoration of bone and cartilage tissue in the hip joints of animals [21]. A more pronounced effect was observed under the influence of phytocost with cyclodextrin [22]. The studied domestic phytocompositions differ from a number of foreign analogues in a significantly larger number of components included in it. The multicomponent nature of Phytocost is due to a wide range of pathogenetic mechanisms of osteoporosis and the desire for their total overlap. This approach is appropriate for polyetiological osteoporosis, but can also be considered as polypharmacy in other situations. The goals for the development of any therapeutic agents, along with ensuring their effectiveness and safety, should also include affordability for the general public. Based on this, we have developed a new PT composition for the treatment of osteoporosis “Fitokost New”, containing 20 components.

Purpose of the work: to study the effect of the new phytocomposition Phytocost New on the restoration of cartilage and bone tissue in an experimental model of osteoporosis.

Materials and methods

The Phytocost New composition was obtained by extracting 20 phytocomponents using a previously described method [20]. It contains such substances as the fruits of Caucasian Sophora, the grass of Astragalus wooliflorum, the roots of cinquefoil, the roots of common dandelion, the roots of comfrey, the grass of knotweed, the grass of European sage, the rhizomes of bergenia, the bark of gray aspen, the thallus of Icelandic moss, the leaves of nettle. dioecious, meadowsweet herb, salvia officinalis leaves, calendula officinalis flowers, corn silk, chaga mushroom, lemon balm leaves, maclea cordate herb, licorice roots, dihydroquercetin with arabinogalactan (6-10%). Dihydroquercetin is a bioflavonoid obtained from the butt part of the Siberian larch, an active antioxidant with anti-inflammatory, analgesic and immunomodulatory effects. Arabinogalactan is a polysaccharide, also obtained from larch wood, used to increase the absorption of drugs characterized by low bioavailability. It has antioxidant and anti-inflammatory effects, helps restore the structure of connective tissue [23].

According to test report No. 19066.05.03 dated July 13, 2018, Phytocost New complies with the technical regulations of the Customs Union TR CU 022/2011; TR TS 029/2012; TRTS 021/2011. Registration number of the declaration of conformity: EAEU No. RU D-RU.NA30.V.03475. Date of registration of the declaration of conformity: 08/02/2018.

Experiments were carried out on Balb/c mice, females, 3 months old, weighing 20-23 g (Stolbovaya nursery, Russian Academy of Sciences). The mice were kept under standard conditions, 5 individuals per cage, with controlled temperature (24o C) and lighting (for 12 hours) and with free access to water and food. To model osteoporosis, mice were administered intramuscular (IM) daily prednisolone at a dose of 1.0 mg/mouse for 14 days. The dose of administered prednisolone was selected based on our previously obtained data [21].

All animals were divided into 6 groups of 10 animals each: 1 control group – intact animals. Animals of groups 2-6 were administered prednisolone daily for 14 days. Animals of the 2nd group were sacrificed on the 14th day after the last injection of prednisolone. Animals of the 3rd group did not receive the herbal medicine for 30 days. Animals of groups 2 and 3 served as comparison groups. Animals of the 4th group received the previously obtained phytopreparation Fitokost orally daily at an active dose of 50 mg/mouse for 30 days. Animals of groups 5 and 6 received Phytocost New in doses of 50 and 5 mg/mouse, respectively, for 30 days.

Mice were killed by cervical dislocation and femurs were removed. The bones were fixed in 10% formaldehyde prepared in phosphate-buffered saline (0.02 M, pH7.6) for 24 hours at room temperature. Decalcified in 5% trichloroacetic acid for 24-48 hours. They were washed in phosphate-buffered saline (0.02 M, pH 7.6) and frozen in isopentane at -400 C. Next, sections 10 µm thick were prepared on a Leyca cryostat (Germany). The sections were dried at room temperature for 1 hour and stained with hematoxylin and eosin. Hematoxylin - 5 sec, differentiated in running water for 10 min, eosin - 15 sec, washed in distilled water, dried, cleared in xylene and embedded with synthetic resin. Analysis of the preparations was carried out on an Olympus Vanox AH BT3 microscope (Germany) magnification (x 100) and (x 40). The images were photographed and morphological analysis of the cells in the field of view was performed. To determine the significance of differences between the experimental and control groups of animals, the nonparametric two-sided Mann-Whitney test (U-test) was used.

Results and discussion.

After a 14-day administration of prednisolone to mice, a significant increase in chondroblast proliferation was observed in the femoral head of mice (Fig. 1B), which persisted for 30 days (Fig. 1C), compared to the control group of animals that did not receive prednisolone injections (Fig. 1A) . After daily administration of the Phytocost New phytocomposition for 30 days at a dose of 50 mg/mouse, restoration of the cellular composition of hyaline cartilage to its previous state was observed, similar to the effect of the Phytocost composition administered at the same dose (Figure 1D, E). At the same time, the number of chondroblasts in the field of view decreased to the control level (group 1) and the number of chondrocytes began to increase (table). After taking Phytocost New at a dose of 5 mg/mouse, the number of chondroblasts also decreased significantly, but to a lesser extent than at a dose of 50 mg/mouse (Fig. 1 E).

In the group of animals that did not receive the phytocomposition (group 3), after 30 days, violations of its integrity and chaotic orientation of collagen fibers were revealed in the bone tissue (Fig. 2B), as well as changes in cellular composition compared to the 1st control group ( table). After taking herbal medicines at a dose of 50 mg/mouse (groups 4, 5), the structure of bone tissue was almost restored to the control level (Fig. 2A, D, E). In addition, in the bone tissue of animals taking herbal medicines, a decrease in the number of osteoblasts and an increase in the number of osteocytes was observed compared to comparison group 3 (table). After taking Fitokost New at a dose of 5 mg/mouse, bone tissue breaks also completely disappeared (Fig. 2E) and the cellular composition changed, similar to the effect of the drug at a high dose, although less pronounced (table). A decrease in the number of chondroblasts in cartilage tissue and an increase in osteocytes in bone tissue under the influence of Phytocost New at a dose of 5 mg/mouse indicate a positive effect of this dose, which will appear fully, apparently, at a later date. It should also be noted that the appearance and behavior of animals that received the herbal medicine differed favorably from those that did not take it.

Conclusion. The new economical phytocomposition Phytocost New provides high efficiency in the restoration of cartilage and bone tissue in an experimental model of osteoporosis. Reducing the number of components of the presented composition causes a reduction in the cost of its production.

Table. The influence of phytocompositions Fitokost and Fitokost New on the cellular composition of cartilage and bone tissue.

Note: significance of the difference between the experimental and control groups: M±SEM; * p < 0.05 compared with groups 2 and 3; ** p < 0.05 compared with group 2; n – number of animals in each group.

Rice. 1. Histological study of the effect of herbal preparations Fitokost and Fitokost New on the cartilage tissue of the head of the hip joint of mice in a model of osteoporosis induced by prednisolone. (A) – intact; (B) – after intramuscular administration of prednisolone at a dose of 1 mg/mouse after 14 and (C) 30 days; (D) – after daily oral administration of the Phytocost phytocomposition at a dose of 50.0 mg/mouse for 30 days; (D) - after daily oral administration for 30 days of the phytocomposition Fitokost New at a dose of 50.0 mg/mouse and (E) at a dose of 5.0 mg/mouse. Hemotoxylin-eosin staining. Analysis of the preparations was carried out on an Olympus Vanox AH BT3 microscope (Germany), magnification (x 100) and (x 40).

Rice. 2. Histological study of the effect of herbal preparations Fitokost and Fitokost New on the femoral bone tissue of mice in a model of osteoporosis induced by prednisolone.

(A) – intact; (B) – after intramuscular administration of prednisolone at a dose of 1 mg/mouse after 14 and (C) 30 days; (D) – after daily oral administration of the Phytocost phytocomposition at a dose of 50.0 mg/mouse for 30 days; (D) - after daily oral administration for 30 days of the phytocomposition Fitokost New at a dose of 50.0 mg/mouse and (E) at a dose of 5.0 mg/mouse. Hemotoxylin-eosin staining. Analysis of the preparations was carried out on an Olympus Vanox AH BT3 microscope (Germany), magnification (x 100) and (x 40).

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What type of doctor performs autologous cartilage cell transplantation?

A very important element for the employees of the orthopedic medical center Gelenk Klinik in Freiburg is the close connection between doctors and patients. This means that your attending physician will take care of you from the day you take your medical history until the operation itself. Your knee specialist will provide you with appropriate care during the postoperative period. This way, you will have a contact person who understands your situation and can answer all your questions at any time. Experts who treat knee arthrosis with autologous chondrocyte transplantation are Dr. Peter Baum, Prof. Dr. Sven Ostermaer and Privatdozent Dr. med. Dr. Bastian Markwas..

Why does the cartilage in the knee deteriorate?

Throughout life, a person bends and straightens the knee many times. If there is enough synovial fluid in the joint, this process is painless, since the lubricant softens friction. As soon as there is not enough lubricant, the joints begin to rub against each other. This leads to rapid wear and destruction of cartilage.

Cartilage cells (chondrocytes) feed through the synovial fluid, since there are no vessels directly in the joint that transport nutrients. That is why, to restore normal function of the knee, it is important to replenish the lack of lubrication, as well as perform a number of other procedures.

Without replenishing the deficiency of synovial fluid, any other manipulations become meaningless

How successful will the treatment of arthrosis be with chondrocyte transplantation?

The technique of autologous chondrocyte transplantation has been known for 25 years. Various scientific studies have shown that cell tissue transplantation leads to significant improvements in the cartilage surface of the knee joint. After surgery, the graft is difficult to distinguish from real articular cartilage. Such treatment of arthrosis helps reduce pain and also restores the patient’s previous mobility.

Dr. Baum is one of the world's top specialists in this field and performs autologous chondrocyte transplantation at the Gelenk Clinic at the highest level. Dr. Baum was the first orthopedic surgeon to perform this procedure arthroscopically, which means it is gentle and has almost no scars. Prof. Dr. Ostermaier and PD Dr. Markwas are leaders in the study of knee arthrosis treatments and have published numerous scientific publications on the topic.

Treatment

The goals and objectives of therapy are to reduce the frequency of inflammation, improve nutrition, eliminate provoking factors of injury, restore the integrity and smoothness of cartilage and the biomechanics of the joint. This is achieved by conservative and surgical methods. Taking anti-inflammatory drugs orally reduces inflammation. This therapy is complemented by oral administration of chondroprotectors and external use of ointments. If necessary, anti-inflammatory drugs are administered peri- and intra-articularly. Intra-articular injections of hyaluronic acid enriched with platelet-rich plasma restore the normal properties of synovial fluid, reduce the inflammatory response and promote cartilage regeneration. Surgical methods include arthroscopy, in which, after identifying the site of damage, removal of irregularities is performed, abrasive chondroplasty (restoring integrity by achieving the formation of a fibrous clot on its surface during microfracture of the subchondral bone), mosaic chondroplasty (introduction of osteochondral autografts). After surgery, a rehabilitation course helps to quickly restore joint function. All treatment together helps prevent the development of osteoarthritis and eliminate pain symptoms, improving the patient’s quality of life.

What happens before surgery?

First, a comprehensive clinical and imaging examination is carried out, which, in addition to a history and physical examination of the patient, includes x-rays under stress, as well as magnetic resonance imaging (MRI).

This will make it easier for the doctor to determine the extent of damage to the articular cartilage. If all the examinations completed show that the above treatment for arthrosis is suitable for the patient, the attending physician conducts an explanatory conversation with him, during which he explains the course of the operation, and also talks about possible complications after the intervention. After this, an anesthesiologist talks with the patient, who once again checks the patient’s health status. As a rule, the operation is performed the next day after the consent of the surgeon and anesthesiologist.

How is arthroscopic chondrocyte transplantation performed?

Transplantation of articular cartilage of the knee joint: after culturing the cells in a special laboratory, implantation of chondrocytes is carried out using a minimally invasive technique.
© dissoid, Fotolia Transplantation of cartilage cells obtained in the laboratory is always carried out arthroscopically, that is, in a minimally invasive manner. To insert the necessary instruments into the knee, the surgeon only needs minimal incisions.

At the beginning of the operation, the knee joint is cleaned of damaged cartilage tissue, after which grown cartilage balls (chondrospheres) are placed on the damaged area of ​​the knee. Thus, the chondrospheres immediately adhere to the bone and after a few weeks correct the defect by forming connective tissue of the cartilaginous type.

After contact of cartilage cells with the prepared site of the cartilage defect, connecting molecules (adhesive proteins) begin to firmly adhere to the bone within 10 minutes. In this way, the chondrocytes grow into the damaged part of the knee until it is completely filled. If there is no need for correction of the cruciate ligaments or meniscus, surgical treatment of arthrosis of the knee joint by autologous chondrocyte transplantation at the Gelenk Clinic lasts approximately 30-60 minutes.

In order for the surgical treatment of knee arthrosis using the above mentioned method to be successful, it is necessary to identify and, if necessary, treat the problems (for example, deformation pathologies, rupture of the cruciate ligament, meniscus injuries) that caused the injury to the articular cartilage. That is why the patient needs to take into account long-term postoperative treatment, as well as the need to take care of their health.

Mosaic chondroplasty of the patella and tibial articular surface

As we know, the knee joint has two more articular surfaces - the inner side of the patella and the articular surface of the tibia. They can also become damaged and require “repair”.

In the case of the patella, mosaic chondroplasty is not difficult. It is always performed in an open manner, as it requires dislocation of the patella. The source of grafts is usually the intercondylar groove, and the osteochondral fragments themselves are thinner - no more than 12 mm (for operations on the femoral epicondyles, their length is 15-18).

Carrying out mosaic chondroplasty of the articular surface of the tibia of the knee joint is technically quite difficult. This requires a guide ligamentoplasty of the anterior cruciate ligament - this provides access to the operation site. The sources of transplants are still the same.

What type of anesthesia does the patient receive during surgical treatment of knee arthrosis?

As a rule, the operation is performed under general anesthesia. Sometimes, in order to avoid the consequences of complete anesthesia, surgeons perform the intervention under spinal anesthesia, which is a type of local anesthesia. During this manipulation, an anesthetic is injected into the spinal canal of the lumbar spine, which allows the patient to remain fully conscious. The specialists at the orthopedic clinic Gelenk Klinik in Freiburg have many years of experience in both techniques. What type of anesthesia is most suitable in your individual case is discussed before the operation itself, taking into account all the tests and your state of health.

Will my knee hurt after surgery?

Surgical treatment of arthrosis of the knee joint, like other interventions, is associated with some pain. The high professionalism of our surgeons allows us to reduce the risk of pain to a minimum. As a rule, before surgery, a drug blockade of the damaged knee joint is performed, which relieves pain in the knee for about 30 hours. After this, the worst wave of pain is over and treatment can be carried out using conventional medications. Our goal is maximum pain relief for the patient.

Conditions of accommodation at the Gelenk Clinic

Private room at the Gelenk Clinic in Gundelfingen in Germany
As a rule, during an inpatient stay at the clinic you are in a separate room with a shower and toilet. In addition, we provide you with towels, a robe and slippers. You can also use the minibar and safe. Each room has a window.

You only need to bring your own medications, comfortable clothes and nightwear. After surgical treatment of arthrosis of the knee joint, we guarantee 24-hour care by qualified staff and experienced physiotherapists. Generally, the length of hospital stay after surgery is three days. Your family members can stay in a hotel, which is located a few steps from the clinic. We will be happy to take care of your hotel room reservation.

What should you pay attention to after surgery?

Immediately after surgery, the knee should be cooled and kept elevated. After approximately 12 days, the stitches are removed. After this you can take a shower again.

In order to avoid complications after surgical treatment of arthrosis of the knee joint, we recommend not placing special stress on the knee. During this time, you will be given sick leave and crutches with elbow support. Prevention of thrombosis during periods of inability to perform full exercise is mandatory. At this stage, physiotherapeutic treatment is a very important element in order to counteract the loss of muscle mass and preserve the function of the knee joint.

The return flight can be planned no less than 10 days later. However, we recommend flying home only after two weeks.

Physiotherapy is carried out to preserve the functions of the knee joint and strengthen the knee muscles.. © Elnur, Fotolia

Recommendations after arthroscopy (1st operation)

• Inpatient treatment: 2 days
• Recommended time of stay in the clinic: 7 days
• When is a return flight possible: 10 days after surgery
• When can you shower: after 5 days
• Recommended duration of sick leave: 2 weeks
• When the stitches are removed: after 5 days
• When can you drive again: after 2 weeks

Recommendations for autologous chondrocyte transplantation or elimination of the cause of articular cartilage damage (2nd operation)

• Inpatient treatment: 3 days
• When to stop using elbow crutches: after 6 weeks
• Gradual restoration of normal physical activity on the operated leg: after 6-8 weeks
• Recommended time of stay in the clinic: 10 days
• When is a return flight possible: 10 days after surgery
• Recommended return flight: after 2 weeks
• When can you shower: after 7 days
• Recommended duration of sick leave: 6 weeks
• When the stitches are removed: after 7-12 days
• When is it safe to drive again: 6-12 weeks

Main components of cartilage

Cartilage consists of two types of fibers:

1. Collagen - large molecules intertwined in triple helices. They occupy about half of the intercellular space and, thanks to this structure, successfully resist deformation. Collagen makes cartilage elastic.
2. Elastin - allows the cartilage to return to its original position, making it elastic.

Most of the intercellular space is occupied by water. The more it is, the better the functioning of the synovial fluid, which supplies the cartilage with nutrients from meat, fish, vegetables and other foods indicated for arthrosis. If there is not enough water, the joint fluid loses its viscosity, becomes less fluid, and the cartilage tissue does not receive everything it needs for normal functioning.

If there is a lack of water in the body, cartilage suffers

How much water should you drink per day to keep your joints healthy? Recommendations from a famous doctor:

How much does it cost to treat knee arthrosis with autologous chondrocyte transplantation?

In addition to the cost of the surgical treatment itself, treatment of knee arthrosis with autologous chondrocyte transplantation also involves diagnostics, doctor appointments, and additional resources such as elbow-supported crutches. Thus, the amount can range from 1,500 to 2,000 euros. If you require physiotherapeutic treatment after your stay at the Gelenk Clinic, we will be happy to help you and provide you with a preliminary cost estimate.

Information regarding the cost of hotel accommodation, as well as subsequent treatment at the rehabilitation clinic, can be found on the website of the clinic itself.

How can a foreign patient make an appointment and the operation itself?

In order to assess the condition of the knee joint, it is necessary to provide the results of imaging diagnostics - X-rays, as well as MRI. After viewing the sent images on our website, within 1-2 business days you will receive all the necessary information, a treatment proposal, as well as a cost estimate for surgical treatment of arthrosis of the knee joint.

Foreign patients can make an appointment with a Gelenk Clinic specialist in a short time frame that suits their plans. We will be happy to assist you with obtaining a visa after the advance payment indicated in the cost estimate has been received into our account. If your visa application is refused, we will refund your advance payment in full.

For foreign patients, we try to reduce the time interval between the preliminary examination and surgical treatment of arthrosis of the knee joint to a minimum.
This way you will not need to come to the clinic several times. During your outpatient and inpatient stay at the Gelenk Clinic in Freiburg, our multilingual patient management staff (English, Russian, Spanish, Portuguese) will answer all your questions. In addition, we provide a translator (for example, into Arabic), which is paid for by the patient himself. Also, we will be happy to help you organize a transfer, find a hotel and tell you how to spend your free time in Germany for you and your relatives. Send request