Banner - Hide this banner





Author Topic: Microfracture and paste graft in Uk?  (Read 4361 times)

0 Members and 1 Guest are viewing this topic.

Offline midfield general

  • MINIgeek (20-50 posts)
  • **
  • Posts: 30
  • Liked: 0
Microfracture and paste graft in Uk?
« on: July 20, 2010, 01:13:03 PM »
Hi,
 I have been diagnosed with Grade II and III OA in my right knee, basically on all parts of the knee including patella but not covering the whole knee. As I am only 39, the prospect of living on painkillers for the next 20yrs fill me with dread. I have had a ACLrec on the same knee in May 2009 and 2 arthroscopies April 2009 and may 2010.
 So would microfracture and/or paste graft be something that would help give me a bit of pain relief, and if so how long are the positive effects of these procedures and most importantly are these offered on the NHS in the uk?
 I have been told by my Consultant that has been managing the Acl that there's very little he can do to improve my situation. I was a "sporty kind a guy", and I work(ed) as a Self Employed Landscape Gardener though since jan 2009 this has been VERY limited. My consultant says that its time to "Find a less active job, something you can do sitting down", but I would hate to give up something I love to do, not to mention worked hard over many years to achieve.
  What other procedures could you recommend that would at least allow me to return to work, even if at a slower pace?

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: Microfracture and paste graft in Uk?
« Reply #1 on: July 20, 2010, 02:16:38 PM »
Hi there

I also have early stage OA in my knees, mainly in the patella region but some isolated lesions on the medial condyle in the left knee. Microfracture traditionally doesn't have a great result for wider spread lesions especially on the patella. Any form of repair will depend on how large the lesions you have are and what the surrounding cartilage is like. You may want to check out new research using methods such as AMIC, and Cartifill which are both microfracture based with a membrane or collagen paste placed on top to stimulate stem cell development. As far as I know, the NHS is not funding them directly but there may be ways of exploring this via the relevant hospitals ( I think someone I know has recently had Cartifill done via the NHS in Kent on the patella).

Larger defects can be repaired using ACI - but this is a two stage operation and not usually recommended for wider spread arthritic damage.

There is injection therapy using lubricating fluids such as Euflexxa or Synvisc but they have about a 50% improvement rate and many people don't find them beneficial. Alongside this you could do worse than start to up your intake of supplements such as glucosamine and chondroitin. I have just started a new supplement called Regenovexx, time will tell if that helps.

There are currently trials and research going on for people in their 30s and 40s with OA that will involve harvesting stem cells, growing them and injecting them back into the joint. A recent news release talks about an Arthritis UK funded trial at the Oswestry hospital starting later in the year. You could ask your consultant if he has heard of this, and see if he will recommend you. Google Robert Jones and Agnes Hunt hospital and stem cell trial.

Don't forget good old fashioned PT and leg exercises, that you have no doubt been through with your ACLr. Keep the leg strong and the knee has a better natural brace.

Personally I'd be seeking a different opinion from an OS who tells me to sit down and lead a sedentary lifestyle at 39..... :-X :'(

It isn't all hopeless with early OA, and things are developing. I guess the longer term option is replacement parts.....people on here have had them at your age but of course it is a major operation. But if the restrictions are so great that the only option is replacement of some or all of the knee, then people have bypassed the usual "age" concerns and had great results. Check out Julie42 and UK_Girl on here.

Good luck

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Online Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4831
  • Liked: 402
  • Neelie knee!
Re: Microfracture and paste graft in Uk?
« Reply #2 on: July 20, 2010, 07:55:55 PM »
As Lottie says, you may get cover on the NHS.  However, I am scheduled to have AMIC (mfx + membrane) in September, but from my dealings with my private insurance company, it has been made clear to me that NICE has not approved any osteochondral grafting due to a lack of long-term outcomes data (and the insurers have as a result so far not agreed to cover).  With the current austerity drive in the public sector, although the NHS is ring-fenced, if NICE hadn't approved the procedures under the last Government, I think it is unlikely it will now (even though the objection is around data not cost...errr yeah).  AMIC is expensive, the membrane alone costs several thousands!  :o

My OS said that AMIC doesn't work for the patella due to the shearing forces, but is ok for condyle lesions etc as long as they are away from the tracking of the patella.

Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline midfield general

  • MINIgeek (20-50 posts)
  • **
  • Posts: 30
  • Liked: 0
Re: Microfracture and paste graft in Uk?
« Reply #3 on: July 21, 2010, 04:27:30 PM »
hi,
 Thanks lottiefox and vickster, sounds to me that the microfracture and/or paste graft is not really an option here.
  The thing is if its so successful in the states and the technique obviously works and they have been doing it for so long then why does the NHS continue to ignore what could well be a way of reducing the need for multiple operations and other procedures that ultimately will cost so much mire, crazy!. In a situation like mine where there's an opportunity for me to return to work therefore contributing via national insurance and tax rather than taking money out of the system via sick benefit and costly hospital time then you would think that they would be bending over backwards to get people back to work, as it is they want me to "do what you can, keep taking paracetamol and see how it goes for the next 6-8 months on a physio regimen." There seems t be no joined up thinking between Dpts so they fight there corner and if your treatment doesn't fit in their "box" then tuff!, wait another 12-16 weeks to see some-one else who cant do anything for you and round and round the system you go costing more and more money, its pathetic aaaaaghh! >:(
 Rant over sorry folks....for now till the next Jerk Doc says sorry pal come back in 20yrs then when youve got loads of other things wrong with you and couldnt move around too much caused by the fact that your overweight, watch too much tv and depressed( probably hooked on prozack and painkillers), then we will give you some treatment that will "improve your Quality of Life" " pah, yeah thats it right there!!!
SORRY... I did it again didnt I, soz   :-X

 So what can anyone recomend as regards treatments for the Knee (not the anger management, my friend stella helps, shes expensive but worth it ;) ;) )

 All feedback most welcome, thank you!
:-*

Offline midfield general

  • MINIgeek (20-50 posts)
  • **
  • Posts: 30
  • Liked: 0
Re: Microfracture and paste graft in Uk?
« Reply #4 on: July 21, 2010, 04:38:49 PM »
I would like to apologise for the last post Sorry its just not on is it?     

TOO many typo's,  I guess that what happens when you try and type shouting!! he he

 if you need cheering up heres something to put a smile on your faces.
    OOOHHH how I would love for this guy to get a job in the NHS

http://www.youtube.com/watch?v=RzToNo7A-94

 Terry I feel your pain    WAAAWW BABY!

Online Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4831
  • Liked: 402
  • Neelie knee!
Re: Microfracture and paste graft in Uk?
« Reply #5 on: July 21, 2010, 05:41:26 PM »
Microfracture is definitely available on the NHS, just depends if that is a route the surgeon advocates and whether the lesions are deep enough and indeed small enough (<2cm2). 

In my case, I already have crappy tender fibrocartilage filling my defect which is causing all my swelling and soreness (caused by a somewhat dramatic tumble from a bicycle last September when the hole would have been through to bone) - thus, little point in clearing out the defect, microfracturing in the hope that it fills with less crappy FC.  There are plenty of folks who benefit from mfx, just my knee seems to be offended by scar tissue, hence the attempt to get something more painless and durable  :D

I feel the same way about funding, I pay plenty of tax and NI too, am fortunate to have private HC but never dreamt that I may be refused private surgery on the basis of a NICE ruling  >:( My OS's secretary says that often NICE need 10 years of data (and presumably not only from the US) - dk how long cartifill has been around for but AMIC has only been in existence for 5 years or so globally.  As far as I can gather, AMIC is only really suitable for lateral condyle lesions that are grade III-IV in youngish patients (under 50ish) who do not have extensive OA.  It doesn't work on the patella according to my OS due to the shearing forces at work. 
Patellas seem to be a bit of a nightmare to fix - presumably the issues with yours are caused by maltracking?  The back of mine is manky too, will just have another short, back and sides when I have the lesion sorted!

As much as the NHS has its faults, all HC systems are under huge cost pressures now and priorities have to be drawn up - only finite funds are available as we live longer and populations grow  :(

Maybe look at self funding a private consultation with a knee specialist (perhaps Mr 'Cartifill' Shetty in Kent), or as Lottie says, perhaps there is a trial out there?
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline midfield general

  • MINIgeek (20-50 posts)
  • **
  • Posts: 30
  • Liked: 0
Re: Microfracture and paste graft in Uk?
« Reply #6 on: September 08, 2010, 11:36:27 AM »
Hi Vickster,
 thanks for the info.  Sorry for the delay in  reply but to be honest I was a bit fed up with talking about it and having nothing new to say. I'm sure you feel the same way too at times.
 But now there is at least some good news on my part, I have an appointment to see MR Briggs at Stanmore, from all that I have been able to find out about him from the Interweb and this site to he  seems to be the "go to man" for all things Knee. He is also involved with trials and new procedures and has a very approachable manner, so I'm told. I see him on the 29th sept so will be updating here after I see him and see what he can do for me.
 I hope things are improving for you, each step forwards is a move in the right direction. Chin up!  ;D















support