ME AND MY OPERATION: Op to ease creaky knee using a slice of someone else's hip!

By Adrian Monti for the Daily Mail

Published: 16:30 EST, 6 July 2015 | Updated: 17:23 EST, 6 July 2015

Donor bone is now being used to treat knee arthritis. Peter Childs, 62, a company director, from Iver, Buckinghamshire, tells ADRIAN MONTI how the procedure has given him a new lease of life.

THE PATIENT

Tennis has been one of my passions since I was eight years old. But at the end of 2013 I was worried that I might have to give it up as my right knee, especially on the inside, was very painful when I played.

Peter Childs, 62, suffered painful knees as cartilage tissue had worn away

Even at home my knee felt stiff, and if I sat for long periods it ached when I moved. It twinged when I ran for the Tube or stood up from bending or kneeling.

The same thing had happened 14 years earlier with my left knee, so in January 2014 I booked privately to see the same consultant orthopaedic surgeon. It was the same problem: the cartilage tissue had worn away.

With my left knee the surgeon had performed an operation called an osteotomy, which involved cutting a horizontal slice into the top of the shin bone and putting a piece of artificial bone into the gap. This realigned my leg by taking the weight off the damaged area of my knee. The recovery took nine months.

The surgeon said an osteotomy was my best option again. But he suggested I saw a leading specialist, Adrian Wilson, who would be better informed of any surgical advances. I got an appointment with him that July and had full-body X-rays and a knee scan so Mr Wilson could work out how big the wedge should be.

He tried the new procedure using donor bone

Then he told me he was pioneering a new method, using a piece of donor bone from a bone bank. He said this would plug the gap better than artificial bone and mean a less painful recovery. They would also insert metal plates so I could put my weight on the bone during the healing period.

Mr Wilson said one day I might need a full or partial knee replacement, but this would stop the pain and stiffness for now.

The idea of having a stranger's bone in my body didn't bother me; it seemed more natural than having artificial bone.

For the operation I was given a general anaesthetic and woke with my leg wrapped in a cooling compression blanket. I couldn't see or feel the plates unless I pressed hard on my knee. The next day I was able to walk down the corridor on crutches.

I went home after four days and had physio and did walking exercises in the pool at my gym to strengthen my muscles. After six weeks I discarded the crutches and was using the stairs. It was a much faster recovery than before.

After four months I was playing tennis again and I'm still playing nearly a year later. In January I will have the metal plates removed. My knee is 90 per cent better - more than I could have hoped for.

THE SURGEON

Adrian Wilson is a consultant orthopaedic knee surgeon at the North Hampshire Hospital in Basingstoke and the BMI Hampshire Clinic.

Most people have evidence of wear-and-tear osteoarthritis by the age of 50, and more than 70,000 knee replacements are carried out every year.

Osteoarthritis occurs when the shock-absorbing cartilage lining our joints gets worn away, and eventually bone rubs on bone. Often it causes minor symptoms for years before disturbing sleep or making walking or climbing stairs difficult and painful.

Because we usually put more weight through the inner side of the joint, this is where the trouble tends to start. Until recently treatment options have been limited. One is an arthroscopy, where we look inside the knee with a camera and remove loose cartilage via keyhole surgery.

This can settle down an acute episode but the benefits are often short-lived. Alternatives have been to do nothing, offer temporary relief with injections, or do a partial or full knee replacement. But if you are active, knee replacements may last only ten years. In Europe young, active people are offered an alternative - knee osteotomy. In Germany 20,000 patients undergo this every year, compared with 1,000 here.

The procedure takes the pressure off the worn part of the knee joint, straightening a bowed leg and shifting the patient's weight to an area where the cartilage is not so worn away. This reduces pain and improves mobility.

It involves making a cut in the bone a few centimetres below or above the knee joint. The cut only goes 90 per cent across the bone at an oblique angle, so the uncut 10 per cent acts like a hinge. Then we slowly widen the gap by pulling the bone apart until we have created an opening of the appropriate size, typically just a few millimetres but it can be up to 20mm.

The bone is then fixed internally on either side of the knee joint with titanium plates, screwed into place under the skin. They allow full movement, and the patient can immediately put their full weight on their legs. Surgeons either leave the gap empty or fill it, often by taking bone from the patient's pelvis. This can be painful and carries risks of bleeding, swelling and infection in the site the bone is taken from. The pelvis would take six months to heal, too.

Other techniques have included using coral and chalk. However, these remain a foreign material in the body, never being replaced by the body's own bone. Patients also have discomfort in the weeks after surgery because artificial options are never as good a fit as real bone; this means more pain, swelling and a longer recovery.

The procedure takes the pressure off the worn part of the knee joint

But 14 months ago I started filling the wedge with donated human bone, which means less pain. The bone acts like a cork in a bottle and stops the blood flowing out of the cut bone. I use wedges cut to size from donated femoral heads, the ball at the top of the thigh bone that makes up the hip joint.

The North Hampshire Hospital holds a human tissue licence, so we can harvest and store bone removed during hip replacement surgery when patients have agreed to this. At other centres, donated bone may also come from deceased patients.

The donor bone acts as scaffold to hold the leg in its new position. If you were to test the grafted tissue six months later, it would have been totally replaced by new bone created from the patient's cells, while the donor bone is slowly reabsorbed into the body.

There's no risk of rejection because bone is dead and has no blood supply. All donors are screened, so there is virtually no risk of disease transmission.

I've set up the London Osteotomy Centre with other surgeons, which will specialise in treating the young with arthritic knees.

This surgery effectively buys time - if you need your knee looked at again years later, you can have a replacement.

ANY DRAWBACKS?

'There's still a potential risk of infection,' says Paul Trikha, a consultant knee surgeon at the Surrey Orthopaedic Clinic. 'But by using fresh frozen bone, figures I've seen suggest this is less than 0.5 per cent.

'There's also a slight risk that the graft may fail to incorporate properly, for instance, if the patient's blood supply isn't very good.'

Privately, the operation costs about £9,500 and on the NHS it costs about £6,000.

For more information, visit londonosteotomycentre.com 

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