Knee Osteoarthritis: Viscosupplementation to Cartilage Transplantation and Resurfacing Procedures Resurfacing Procedures and the Degenerative Knee “Joint Resurfacing” AAOS Annual Meeting – ICL February 18, 2011 Phil Davidson, MD Heiden Davidson Orthopedics Park City, UT USA Disclosure Arthrosurface – consultant, stock options 29 y.o. mother of 3 Defining the Issue: Why discuss or consider Joint Resurfacing for the Degenerative Knee • 2 main scenarios where this is relevant 1. Younger patients in whom traditional TKA is not an attractive option 2. “Middle Age” or “Boomer” patients wanting to maintain high levels of function Intro to Joint Resurfacing • Variety of Lesions • Variety of Etiologies • Variety of Options • Focus of this ICL is on degenerative lesions • Degenerative lesions MUCH more common than focal defects • Goal is to make sense of evaluating and treating an array of degenerative pathology while incorporating some new treatment paradigms Joint Resurfacing A wide realm between….. Arthroscopic debridement Traditional TKA Goals of Joint Resurfacing – Relieve pain – Optimize function, sport and activities – Improve mechanics – Long lasting – Prevent or limit future degenerative dhanges – Retain future options surgically – Principles extend to many joints Joint Resurfacing Treatments: …an evolving continuum of options, biological thru prosthetic • Debridement • Marrow stimulation • Biological restoration – Biologic grafts – Biosynthetics – Scaffolds – Cellular therapy • Prosthetic Resurfacing – Bio-Prosthetic mix – Inlay Arthroplasty – Onlay Arthroplasty – Total Joint Spectrum of Pathology Spectrum of Treatments ….solution lies in understanding comprehensive pathology and having available a wide realm of treatments to customize treatment for each patient How do we systematically, scientifically and effectively get a handle on these challenging cases? 31 year old UPS worker 39 year old female ski guide Comprehensive Knee Treatment • Biological and Prosthetic Joint Resurfacing not in isolation • Stability • Alignment • Meniscal status • Other compartments