Repair not Replace: Biologic Joint Preservation

Abstract

The work presented in this thesis has directly influenced patient care. Hip and knee osteoarthritis remain central themes and challenges in orthopedics, given their profound impacts on patient quality of life, health, and wellbeing. While the rise and evolution of arthroplasty has substantially contributed to patient care, especially in elderly populations, arthroplasty remains limited by activity restrictions, wear, the potential for catastrophic periprosthetic joint infection, and an inability to restore native biomechanics and function.

In this thesis, we presented a four-tiered approach in improving biologic hip and knee preservation. In Part I, we demonstrated the value of hip and knee preservation on a societal level, showing that restoration of function benefits both the individual patient and the broader group within which they live and interact. We then followed the natural progression of patient presentation in Part II wherein we developed preoperative prognostic tools for identifying and risk stratifying patients with hip and knee chondropathology. A central theme in joint preservation is that form begets function and therefore restoration of function often necessitates recreation of native joint anatomy and mechanophysiology. This principle is embodied in the clinical success of treating osteochondral lesions with osteochondral allograft by replacing like with like. In Part III, we explored in vitro methods with which osteochondral allografts can be optimized and be made more viable. Additionally, we have explored novel living donor methods with which this precious and otherwise non-scalable graft source can be expanded. Finally, in Part IV, we have presented technical advances, outcomes, and two prospective clinical trials which have resulted from direct efforts from the work embodied in this thesis.

In summary, the thesis presented demonstrates the process, outcomes, and successes of modern hip and knee preservation. When evaluating the patient with hip and knee cartilage defects, our goal is to restore rather than replace.