Next Generation Cartilage Repair and the Pre-arthroplasty Patient. Pre-arthroplasty artificial Implants Part B: Metallic

Mini-metal implants are indicated for the treatment of symptomatic focal chondral or osteochondral defects in patients considered too old for biological reconstruction or too young with limited cartilage defects for knee arthroplasty. Precise surgical techniques are required to ensure optimal positioning with recession below the articular cartilage surface. Partial resurfacing for femoral or trochlea surfaces using the HemiCAP and UniCAP implants or the Episealer system has shown good short-term outcomes for middle-aged patients. In some series, however, quantification of tibial articular surface wear was not reported making interpretation of the clinical benefit difficult. When successful, clinical function is high and results appear durable. Favorable outcomes are seen with well-defined indications of: isolated defect, healthy opposing articular cartilage, and >50% volume meniscus. Indications also include patients with failed previous cartilage repair and those facing revision articular cartilage repair. Extended indications may include multiple lesions and the requirement for concomitant osteotomy or ligament reconstruction.