Abstract
Purpose
Osteochondral defects have a limited capacity to heal and can evolve to an early osteoarthritis. A surgical possibility is the replacement of the affected cartilaginous area with a resurfacing device BioPoly™ RS Partial Resurfacing Knee Implant. The aim of this study was to report the clinical and survival outcomes of the BioPoly™ after a minimum follow-up of 4 years.
Methods
This study included all patients who had a BioPoly™ for femoral osteochondral defects greater than 1 cm2 and at least ICRS grade 2. The main outcome was to observe the KOOS and the Tegner activity score were used to assess outcomes preoperatively and at the last follow-up. The secondary outcomes were the VAS for pain, the complications rate post-surgery and survival rate of BioPoly™ at the last FU.
Results
Eighteen patients with 44.4% (8/18) of women were included with a mean age of 46.6 years (11.4), a mean body mass index (BMI) of 21.5 (kg/m2) (2.3). The mean follow-up was 6.3 years (1.3). We found a significant difference comparing pre-operative KOOS score and at last follow-up [respectively, 66.56(14.37) vs 84.17(7.656), p < 0.01]. At last follow-up, the Tegner score was different [respectively, 3.05(1.3) vs 3.6(1.3), p < 0.01]. At 5 years, the survival rate was of 94.7%.
Conclusions
BioPoly™ is a real alternative for femoral osteochondral defects greater than 1 cm2 and at least ICRS grade 2. It will be interesting to compare this implant to mosaicplasty technic and/or microfracture at 5 years postoperatively regarding clinical outcomes and survival rate.
Level of evidence
Therapeutic level III. Prospective cohort study.
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P-AB contributed to article design, data analysis and article writing. VF contributed to data collection and article writing. EK contributed to data collection and article writing. FPE contributed to surgeon, article design and article writing.
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This study was approved by the research ethics committee of Maussins Clinics under the reference N° Maus-2020-11-01.
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A video of the surgical technique. After performing a medial parapatellar approach, a pilot pin is inserted at the centre of the osteochondral defect. The second stage is to determine the size of the implant. This is done by a size trial over the defect, ensuring complete coverage. The defect must be shouldered on all sides by normal cartilage. A reamer is then used to prepare the site of the implant. The shoulder is drilled until the reamer makes contact with the top of the cannula. The ideal placement is for the top of the trial to be 0.5 mm recessed below the articulating cartilage. The implant is then inserted carefully by aligning the stem with the previously created pilot hole (MP4 193050 kb)
Appendix 1
Appendix 1
N° | Side | IMC | Gender | Age | Sport level | Biopoly size (mm) | Defect localization | Bony allograft | Meniscal lesion | Prior surgery | Diagnosis |
|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Right | 18.0 | F | 65 | Sedentary | 15 | Lateral condyle | No | No | No | Osteonecrosis |
2 | Right | 19.0 | F | 52 | Occasional | 15 | Lateral condyle | No | No | No | Post-traumatic lesion |
3 | Right | 18.7 | F | 36 | Occasional | 15 | Medial condyle | No | No | No | Post-traumatic lesion |
4 | Left | 22.1 | M | 36 | Occasional | 15 × 25 | Medial condyle | Yes | No | No | Sequel of osteochondritis |
5 | Left | 20.5 | F | 34 | Occasional | 15 × 25 | Medial condyle | No | No | No | Sequel of osteochondritis |
6 | Left | 19.8 | M | 40 | Sedentary | 15 | Medial condyle | No | No | No | Osteonecrosis |
7 | Right | 23.0 | M | 61 | Sedentary | 15 | Medial condyle | Yes | No | No | Osteonecrosis |
8 | Right | 24.8 | M | 55 | Occasional | 15 | Medial condyle | No | No | No | Post-traumatic lesion |
9 | Left | 21.0 | M | 46 | Occasional | 15 | Medial condyle | No | No | No | Post-traumatic lesion |
10 | Left | 24.7 | M | 30 | Occasional | 15 × 25 | Medial condyle | No | No | No | Sequel of osteochondritis |
11 | Right | 24.7 | F | 56 | Sedentary | 15 | Lateral condyle | No | No | No | Post-traumatic lesion |
12 | Right | 19.6 | M | 34 | Occasional | 15 | Lateral condyle | No | No | No | Post-traumatic lesion |
13 | Right | 22.8 | F | 56 | Competition | 15 | Lateral condyle | No | No | No | Post-traumatic lesion |
14 | Right | 19.8 | F | 47 | Sedentary | 15 | Lateral condyle | No | No | No | Osteonecrosis |
15 | Left | 22.9 | M | 29 | Occasional | 15 | Lateral condyle | No | No | No | Osteonecrosis |
16 | Right | 25.0 | M | 56 | Occasional | 15 | Medial condyle | No | No | No | Osteonecrosis |
17 | Left | 19.0 | F | 58 | Sedentary | 15 | Lateral condyle | No | No | No | Osteonecrosis |
18 | Right | 20.7 | M | 47 | Sedentary | 15 | Medial condyle | No | No | No | Post-traumatic lesion |
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Bouché, PA., Fiodière, V., Kierszbaum, E. et al. Clinical evaluation of a resurfacing device implant for femoral osteochondral defects greater than 1 cm2 with a minimal follow-up of 4 years: a prospective cohort study. Eur J Orthop Surg Traumatol 33, 3693–3701 (2023). https://doi.org/10.1007/s00590-023-03613-y
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DOI: https://doi.org/10.1007/s00590-023-03613-y