Another way to knee recovery that doesn't involve replacement surgery | The Excerpt
On a special episode (first released on December 12, 2024) of The Excerpt podcast: Approximately 800,000 knee replacement surgeries are performed each year in the U.S. People living with chronic pain or in need of a better solution are taking the chance to go under the knife for a better quality of life. But it's an invasive procedure, often involving a several-days-long stay in the hospital followed by 6 months to a year of physical therapy. But what if there is another road to knee recovery, a less invasive one with a faster route to getting back to doing the things you love? CartiHeal implants, made from coral exoskeletons may just be the magic bullet for thousands whose knees are only partially damaged. Dr. Cassandra Lee, an orthopedic surgeon and sports medicine specialist at UC Davis, joins The Excerpt to discuss new treatment options.
Hit play on the player below to hear the podcast and follow along with the transcript beneath it. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.
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Dana Taylor:
Hello and welcome to The Excerpt. I'm Dana Taylor. Today is Wednesday, December 11th, 2024, and this is a special episode of The Excerpt.
Approximately 800,000 knee replacement surgeries are performed each year in the US, first pioneered back in 1968. It was a medical breakthrough for patients who were living with chronic pain and were unable to do their normal activities. But having a total knee replacement is also an invasive procedure, often involving a several days long stay in the hospital, followed by six months to a year of physical therapy. But what if there's another road to knee recovery, a less invasive one with a faster route to getting back to doing the things you love? CartiHeal implants made from coral exoskeletons may just be the magic bullet for thousands whose knees are only partially damaged. Joining us now to discuss these new treatment options is Dr. Cassandra Lee, an orthopedic surgeon and sports medicine specialist at UC Davis. Thanks for joining me, Dr. Lee.
Dr. Cassandra Lee:
Thank you for having me.
Dana Taylor:
Tell me about this CartiHeal or coral implant. What is it really, and how does it work?
Dr. Cassandra Lee:
I think for you to really understand how the CartiHeal implant works is, let's go back to what arthritis and cartilage is. So articular cartilage is that white pearly stuff that covers the end of your bones. It's what allows our joints to move very smoothly and allows us to jump, run, do anything active that we want to do. What can happen over time is that we can start getting little cracks and little fissures and then little potholes within that cartilage, and then it starts wearing down and eventually as you wear down, it can then become bone on bone arthritis, what you alluded to with knee replacements. Cartilage is an interesting tissue in that it cannot heal itself. It cannot regrow itself. So all the technologies we're trying to work with are trying to signal the body to see how well can we take the cells that we have in our bodies and try to regrow cartilage. Not perfect cartilage, but some kind of scar cartilage so that we can get back to being active for longer.
So what the CartiHeal implant does is that it is a piece of coral, it's made out of calcium aragonite. That's the technical stuff that's in there. And what it can do is we put it into the bone within the knee joint and it can heal the bone, which is part of your knee joint. There's little holes on top that all those healing cells that are in your bone marrow can trickle up into that CartiHeal implant and then come up and then turn into a more cartilage type tissue. So it can heal that bone and cartilage and help regrow something that allows you to stay active for longer.
Dana Taylor:
Is this new coral treatment option expensive to produce? What does accessibility look like for patients from a cost perspective?
Dr. Cassandra Lee:
So this is something that is covered by your insurance. So like any type of surgical procedure when we take someone to surgery, we do work with insurance to get authorization, and then I think out-of-pocket expenses depended upon your insurance policy. It is available in the U.S. The clinical trial was several years ago. So I think over time... It's been FDA approved for a few years now. So it is something that is readily accessible and available throughout the United States.
Dana Taylor:
Dr. Lee, why not skip the cartilage replacement and just use the coral implants? Wouldn't that be an even faster road to recovery
Dr. Cassandra Lee:
If it were that easy, right? So cartilage replacement is not as easy as it sounds on paper. We have a lot of different technologies that we try to regrow cartilage and keep our patients active for longer. So if you think of a road, so if you have a small crack or a small pothole, those are something that we can kind of manage with just like a little spackling if you will. There isn't a version of that with cartilage replacement or regeneration, but then now imagine that pothole gets deeper and deeper so you get past the asphalt down into the dirt. And so there's a whole spectrum of how we look at cartilage defects into arthritis. And CartiHeal is just one of those many tricks or tools in our bag that we can help treat our patients. We have anything from cell-based therapies where we can actually take cartilage from you, your own tissue, we can grow it in a lab and then we can implant that into your joint and then help you grow new cartilage.
So that's something like for smaller pothole, if you will. And then now imagine the pothole gets a little bit bigger and a little bit deeper and the road's a little bit more cracked up. So that's where you have a little more arthritis, and that's where something like CartiHeal implant would be more effective in that it has a little bit more area to heal. And then finally when you get to the point where you're just down to the dirt road, that's when you're on bone-on-bone arthritis and unfortunately we just don't have anything to fix that outside of a knee replacement.
Dana Taylor:
So we've focused on knee replacement specifically, but do the treatment options that you've described offer of new hope to those in need of something like a hip replacement as well, how else might this CartiHeal material or the others be used?
Dr. Cassandra Lee:
I think that's what the exciting thing is. I think knee arthritis is so common, but arthritis is everywhere in your body and millions of people around the world are affected by it. The knee is something that's the most studied, but certainly we're taking these technologies and apply it to the ankle, to the hip and even to the shoulder. But as of right now, at least in the United States, the FDA has approved a type of matrix like CartiHeal for the knee. We have also that cell-based therapy that is approved by our FDA for the knee. I know there's probably studies ongoing around the world looking at other parts. There are even mechanical implants, like metal implants that we can do that are like shock absorbers that is not quite a knee replacement, that is also FDA approved in this country.
Dana Taylor:
As a surgeon, can you tell us how cartilage replacement therapy with or without coral implants compare to a total knee replacement? Why would a doctor recommend one over the other?
Dr. Cassandra Lee:
So it depends on your philosophy of how to look at the knee joint. I think a lot of times we think about knee joint preservation, trying to keep the mechanics that are already there, how your knee feels to you, how your knee responds to you. When we do a total knee replacement, we are in effect resurfacing or cutting out the ends of those bones and recreating that shape with that end of the femur, end of the tibia, and then a plastic insert to be like the cartilage and meniscus. And it just doesn't act like your knee. It should take away pain. That is a great procedure for pain, but it doesn't quite perform the same way as your old knee.
So I think as long as the knee joint isn't too far gone, if we're not talking about bone-on-bone and you're young, you're active. And young, that number is... I'm not saying 30, 40, I'm saying 50, 60, maybe even the 70s. I have plenty of patients coming in who are more active than I am. So if you're a young active patient and your joint isn't what we call end stage bone-on-bone, I think it's not unreasonable to go ahead and try to do a joint preservation technique so that we can keep you active for longer with a knee that feels like yours.
Dana Taylor:
When we look at all types of synthetic cartilage, has there been research on the long-term effects on the body overall, the joint and its surrounding tissue?
Dr. Cassandra Lee:
When you're saying synthetic, I'd like to say your natural tissue versus there's actually things that are being developed that is artificial cartilage. So that's an exciting field. So many people around the world are working on this articular cartilage problem. And so we have different perspectives and different approaches, right? Anything from cell-based of your own cells to even donor cells, something we called an allograft or we're talking about matrices, which are kind of like scaffolds, like this CartiHeal that we're trying to put into the bone and utilize your own body's cells to come up, like the bone marrow cells to come up and make new cartilage. And then even the last part of it is a truly artificial man-made plastic or some kind of biomaterial. So there are so many different approaches to this, and I would say cell-based therapies. So using your own tissue has been in use since the late '90s. So there's a lot of data on that.
Scaffolds, depending on what you're looking at, there are some 10-year data outcomes depending on how old this technology is. We have good data for maybe 10 to 20 years, maybe up to 30. But some of the newer things that are being developed like that truly artificial plastic cartilage, it's just coming to first-in-human trials in the U.S. We're not quite there to give you more than two-year outcome right now. For things to become FDA-approved in this country, it has to go through first-in-human trials saying, is it safe? The second one is, does... The phase II trials or something where does your body reject it or you follow it for a certain amount of time?
And then phase III trials go towards comparing it against what's already in practice to say, does it work? There is a lot of legwork, if you will, to show that these technologies are safe. That being said, have there been things that we've taken off the market because even though it's gone through these trials, something happened as we put them in more patients? Yes, there have been small things here and there that have happened that way. But in general, I think this is why we have an FDA, to make sure that things are safe for our patients and everyone around us.
Dana Taylor:
So how far off are we from stem cell therapy negating the need for joint replacements? Is the research there that promising?
Dr. Cassandra Lee:
Everything is promising. We're just not there yet, right? We're not at that Star Trek, inject something or wave something over your leg and then all of a sudden you have a great knee. I think stem cells are tricky because we're not talking about the same cells. And I think that's a big argument between where we are in scientific world and in the lay public. I'd love to say that there's one cell in your body that I can be like, "Hey, turn into bone, turn into cartilage, do your job." But we're not there yet. We can do that in a Petri dish. There's certain cell types that we're going to call multi-potential or pluripotential, meaning it has the ability to turn into a lot of tissues, but we don't have that one magic cell that turns into everything. There's a lot of room to learn about this and we're just not quite there yet.
Dana Taylor:
Are high impact sports and activities the primary cause of damage or loss of cartilage? Are there preventative measures that pro athletes take to protect their cartilage that the rest of us can also do?
Dr. Cassandra Lee:
There is prevention, but part of how arthritis comes about is yes, past trauma. So if you do something high impact, or unfortunately if you hurt that knee in that high school football game, that does come back and kind of haunt you a little bit down the road. But there's also genetic component, right? So if you look at your family members, and a lot of them had knee replacements early on, unfortunately that is a cartilage you have. But that's not something you can change, right? So what can you change? Cartilage likes to be loaded, but the question is how much? So we do want people being active. We want them doing weight-bearing exercises. We do want them doing cardiovascular exercises because that's good for your heart and lungs too. And then we also want you to be strong, balanced, and flexible. So everything is, we want you to stay active, be strong that your muscles can support the knee joints, and then also be flexible enough that you're not loading your knee, maybe crooked or something like that. So everything is maintenance and balance.
Dana Taylor:
The loss of cartilage can make mobility challenging. A lack of mobility then can lead to a sedentary lifestyle, which also poses health risks. What can you share with us about the health challenges that may be exacerbated by a loss of cartilage?
Dr. Cassandra Lee:
Yeah, that is a difficult problem, right? So the idea is that if you have breakdown of your cartilage, that leads to arthritis. And then what patients feel is anything from stiffness to swelling, to pain, to loss of emotion, all these don't make you get off the couch and go run, right? It hurts. So my analogy that I think about when I talk to patients is that think about an older piece of machinery. I'm not calling this old, but think about something that's been worn, has a little bit of rust. The more you use it, the more you put maintenance into it, the better and longer it can run, right? So there comes an age when we do have to put maintenance in. We do have to do strengthening exercises, we do have to do motion, and it doesn't have to be a high impact. It just has to be moving.
So stationary bike, walking, elliptical, getting in the pool, taking away weight off of it. And then flexibility is going to be important because if it's too stiff, it's hard to move in that full range of motion, and then things get a little bit more stiff, if you will. And then balance. Balance is also an important part of it because you want to be able to load things evenly. So when we're talking about exercise, I'm not telling you to go run a marathon, I'm telling you to stay mobile. You can be on a stationary bike, do stretching and strengthening. So something like yoga, Pilates, anything where you're working on your flexibility and balance is all important in maintaining the joint and maintaining your overall health when you have osteoarthritis.
Dana Taylor:
Are there any ethical considerations here for pro athletes? I'd love to see Michael Jordan come out of retirement who we all feel good is new with this new therapy or others such as stem cell therapy.
Dr. Cassandra Lee:
Wow, that's a really tough question. So I want to caution against some of these technologies that we do have. We can try to slow the progression of arthritis, but we're not stopping the natural [inaudible 00:13:47]. We can't put something in there right now and regrow brand new articular cartilage that you had when you were two years old, we're just not there yet. Certainly that that is the holy grail, and that's what we want to strive for when we regenerate cartilage. But for now, a lot of this is maintenance on the patient's part in terms of what you can do from a nutrition and exercise standpoint. But also if this is hindering you and you have these isolated cartilage defects, but not severe bone-on-bone arthritis, we can try to intervene to try to slow down the progression. But the progression is inevitable. Right now with where our technologies are at, you will be looking at knee replacement. The hope is that we can slow that down and push that down the road.
Dana Taylor:
Dr. Lee, thank you so much for being on The Excerpt.
Dr. Cassandra Lee:
Thank you so much for having me.
Dana Taylor:
Thanks to our senior producers, Shannon Rae Green and Kaely Monahan for their production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to podcasts@usatoday.com. Thanks for listening. I'm Dana Taylor. Taylor Wilson will be back tomorrow morning with another episode of The Excerpt.
This article originally appeared on USA TODAY: Another way to knee recovery that doesn't involve replacement surgery
