Dr.Jitendra Chowdhary
D.Ortho,DNB (Ortho),MNAMS. Fellow in Joint Replacement USA
+91 99740 87245
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Joint Replacement
 Total Knee Replacement
 Total Hip Replacement
 Total Shoulder Replacement
 Total Elbow Replacement
 Uni Compartmental Replacement
 Knee Arthroscopy
 Autologus Carilage Cell Implantation
 Stem Cell Therapy for Joint Cartilage
 
Autologus Carilage Cell Implantation...
 
 
 
Overview
  Autologous Chondrocyte Implantation (ACI) is a technique that aims to repair damaged cartilage in a joint. The knee joint is most commonly treated with this technique. Cartilage Cells (chondrocytes) are taken from the knee and multiplied in culture to increase the number of cells. When there are enough cells available, these cells are implanted back into the knee to repair the area of cartilage damage.
Stage I (Cell Harvest)
  The first procedure is usually an arthroscopy, (key-hole surgery) to collect cartilage, which is then sent to the laboratory for the cartilage cells (chondrocytes) to be prepared. (see cell culture ) Some blood is taken from you, and from this sample serum is prepared. The serum contains nutrients and growth factors, which helps the cells to grow.
Stage II (Cell implantation)
  Stage II involves a more major operation. Knee - defects of cartilage only The joint is opened through an incision at the front of the knee. The cartilage defect is debrided (tidied up) and all loose bits of tissue are removed. A patch of periosteum is usually taken through a separate incision on the shin. The periosteum is the outer lining of the bone and is used to make a patch that is fixed to the defect. Very fine stitches are used to hold the periosteum to the defect and tissue "glue" may be used to make the patch watertight. The cells are then injected under the patch. An alternative to periosteum is to use chondrgide or a similar collagen membrane - this has some advantages in the short term but these have yet to be proved in the long term.
 
  Knee - defects of cartilage and bone - osteochondral or OCD or osteochondritis dissecans Again the knee is approached through an open incision as the bone defect is a large part of the pain source and needs to be drilled out. THis can be as large as 25mm in diameter. A new technique developed at Oswestry is the OsPlug operation. The defect is filled with a plug of bone the same size taken from the side of the knee. This is a secure and stable graft of your own bone. Care is take to contour this o the right shape and then a patch of collagen membrane sutured over the surface using a 'top down' method. Water tightness is tested using some spare serum (saline is harmful to cells) and then your cultured cells inserted over the bone plug.
Patella and trochlea
  The knee cap has a joint that forms part of the knee and has to be carefully assessed for alignment. If condrocyte implantation is undertaken with bad alignment then the new cartilage will wear as fast as the old. Various techniques are used depending on what is needed. The patellar tendon may need to be moved, or the medial patello-femoral ligament reconstructed. A new method of reconstructing the medial ligament developed at Oswestry appears to be very effective.
Ankle
  Good exposure is key to success in the ankle and either the bone on the inside or the outside of the ankle is divided to allow access. Bone loss is common and is debrided and plugged with a piece of your own bone. A layer of periosteum or chondrogide is then used to repair the defect. Another option preferred by some surgeons at Oswestry is to treat the defect by keyhole surgery. After careful debridemet of cartilage and bone as necessary, air is put in the joint. Chondrocytes are added to a collagen membrane and inserted with a fibrin sealant.
Hip
  An anterior approach to the hip allows the femoral head to be dislocated carefully. Similar steps to the knee then are used either to remove unstable cartilage and debride the base of the cartilage base. If there is an area of avascular necrosis or dead bone then this is best drilled out and plugged in the OsPlug procedure. Again a membrane is stitched over, tested for cell leakage and cells inserted. The hip is reduced into the socket and the muscle sutured back in place.
 
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