Monday, April 20, 2009

STI: More cartilage transplants for bad knees

April 21, 2009

More cartilage transplants for bad knees

Younger patients turn to treatment to fill 'potholes' in damaged tissues

By Salma Khalik 


ACTIVE people in their 40s are no longer putting up with the pain and immobility caused by damaged cartilage in their knees.


They are instead checking into hospitals to get their problem surgically fixed.


The operation, an autologous cartilage transplant, involves harvesting a small amount of their cartilage or connective tissue, growing this in a laboratory till there are millions of cells, and then implanting this in their bad knees.


The National University Hospital (NUH) has done more than 100 such transplants since 2000.


Demand for this treatment is growing, with two or three operations done every month here.


The surgery is like having an infusion of fresh cartilage to patch up 'potholes' in the tissue, which could have come from contact sports or other injuries.


The patient's pain from this problem comes from the holes leaving nerve ends in the bone exposed.


Patients are always given painkillers as the first line of treatment. But if these do not work, and the person wishes to continue playing sports, an autologous transplant of cartilage is now a viable option.Since the cartilage is harvested from the patient himself, the risk of rejection is zero.


However, this is not a treatment surgeons offer older people, who are mostly given total knee replacements.


But as Dr M. Yegappan, an orthopaedic doctor in private practice, pointed out, knee replacements are not the best solution for patients in their 40s or 50s as artificial knees last only a decade or two.


A 40-year-old getting his first replacement will need two or more in his lifetime.


The downside of an autologous cartilage transplant is its cost, although subsidised treatment is available in public hospitals.


NUH - still the only place here with laboratory facilities to grow cartilage cells - charges $9,000 for this service alone; a subsidised patient pays $2,500 for this.


The surgeon's fee for the two operations - the first to harvest the cartilage and the second, to implant - is extra.


A surgeon in private practice, like Dr Yegappan, charges about $35,000 in all, which includes the $15,500 cost of growing his patient's harvested cartilage in an Austrian laboratory. The bulk of this bill is covered by insurance, he said.


The total of $6,000 Mr Hui Kong Meng, a 42-year-old wafer engineer, paid last year for subsidised treatment in a B2 ward at NUH is typical. His medical insurance picked up most of the tab.


He is back to his golf, swimming and weight training, but has stopped doing long-distance runs to preserve his repaired knees.


He opted for surgery because each time his knees became inflamed, they hurt for a week or two and it was taking longer for the pain and swelling to go down.


Associate Professor James Hui, the director of NUH's Cartilage Repair Programme, said the hospital also grows cartilage stem cells for orthopaedic surgeons in other hospitals and has helped hospitals in Thailand, Indonesia, Malaysia and Saudi Arabia set up cartilage transplant programmes.


Tan Tock Seng Hospital, which has done this surgery for several soldiers, uses cartilage from NUH.

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