New knee cartilage created from stem cells in hip – pioneering approach

A new knee operation that could prevent the development of arthritis is being trialled at Southampton General Hospital in the UK. The procedure involves coating damaged cartilage with stem cells taken from a patient’s own hip, and surgical glue. If successful, the technique regenerates the remaining tissue and creates a permanent “like-for-like” replacement for the first time.
Cartilage is a tough, flexible tissue that covers the surface of joints and enables bones to slide over one another while reducing friction and acting as a shock absorber.
Damage to the tissue in the knee is common and occurs over time through gradual wear and tear, and following sudden twists or direct blows, such as falls or heavy tackles playing sports. If left untreated, it can progress to arthritis and severely impair leg movement.

The most commonly used procedure to repair the injury is currently microfracture, which involves trimming any remaining damaged tissue and drilling holes in the bone under the defect via keyhole surgery to promote bleeding and scar tissue to work as a substitute.
But this technique has variable results, with some studies suggesting the procedure offers only a short-term benefit (the first 24 months after surgery), and does not lead to the formation of new cartilage.
People who have the new operation have the cartilage cut and tidied and undergo microfracture, but their cartilage tissue is then coated with a substance made up of bone marrow cells, platelet gel and hyaluronic acid.
During the 30-minute procedure, the bone marrow sample is spun in a centrifuge in the operating theatre to give a concentrated amount of the patient’s own stem cells. These cells are then mixed with the gel and acid to create a ‘glue’ substance which is placed over the cartilage defect and allowed to set.
“The development of this technique and the study we are conducting could revolutionise the treatment of common cartilage injury by creating a like-for-like, identical cartilage replacement for the first time,” explains lead investigator, Gorav Datta. “So far, treatments developed to combat the long-term problems associated with cartilage damage have had varied outcomes, resulting in knee pain for many people in older age and shortened careers for many amateur and professional sports players.
“At present, although the removal of damaged cartilage and microfracture surgery can provide a short-term solution, the chances, particularly for sports players, of developing arthritis in later life or requiring ongoing treatment remain high.”