5 to 8 years follow-up of knee chondral defects treated by PVA-H hydrogel implants

F.V. Sciarretta

Clinica Nostra Signora della Mercede, Rome, Italy. fabio.sciarretta@tin.it

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• Orthopedics

AIM: Despite the various treatment options available, symptomatic articular cartilage defects continue to represent a therapeutic challenge for knee surgeons. This study has been developed in order to retrospectively evaluate and present long term results, from 5 to 8 years, of PVA-H hydrogel impants (“Cartiva”) in the treatment of knee chondral focal defects.

PATIENTS AND METHODS: Presented are the clinical and MRI evaluation of 18 patients with III and IV degree knee chondral or osteochodral defects treated by PVA-H hydrogel implants. Defects were no larger than 20 mm in diameter. Average age at time of surgery was 54 years. There were 11 male and 7 female patients. A total of 20 implants were implanted, 16 with 10 mm and 4 with 15 mm Cartiva implants. One patient was treated bilaterally. The majority (80%) of surgeries were performed arthroscopically. Patients have been assessed by IKDC, SF36 scores and by MRI imaging.

RESULTS: All patients have shown improvement of knee function and knee scores, in many cases over 50 points of IKDC, except three. Of these, the first mantained a rather good quality of life for over 5 years with approximately the same level of functionality she enjoys now, after implant removal and knee replacement during 2008. The second case was a 43 year old female with a post-traumatic chondral defect in a valgus knee. The patient experienced post-op pain: the implant was removed among another institution at 6 months post-op and was converted to OATS. The third case was a 49 year old male with a severe arthritic pre-op knee and may not have been ideal candidate for Cartiva, but was too young for a total knee replacement at the time of operation and, despite a severe knee worsening during the last year that will need in the short future a knee replacement, has, at over 6 years follow-up, an IKDC score of 33.33 from a pre-op of 37.93.

CONCLUSIONS: 5 to 8 yy follow-ups enable us to conclude that the use of PVA-H synthetic implants in knee chondral defects in middle aged patients can guarantee critical knee function improvement and severe pain reduction. Even the patients, that have needed a knee replacement, have well done for the first four-five years. Therefore, this mean that this type of treatment with the correct indications and future implant and instrumentation improvements, already in course, may guarantee a several year period of knee health and active life style.

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