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Cartilage Replacement Surgery
Dr. Peter Howard, an orthopedic sports medicine surgeon with BayCare discusses the benefits and qualifications for a cartilage replacement surgery.
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Originally from Petoskey, Michigan, Dr. Howard has undergone extensive training in shoulder surgery, sports medicine, minimally invasive arthroscopy, and orthopedics at several prestigious universities and medical centers. Dr. Howard obtained his undergraduate degree with Honors from Michigan State University in East Lansing, Michigan. After his undergraduate education, Dr. Howard completed his medical degree at Wayne State University in Detroit, Michigan in 2008. He then trained in orthopedics at the Western Michigan University Homer Stryker School of Medicine. During his final year, he served as chief resident at Bronson Methodist Hospital and Borgess Medical Center. Seeking additional sub-specialization, he trained in shoulder surgery, sports medicine, and minimally invasive arthroscopy at the Houston Methodist Hospital. During his time there he worked with and cared for the Houston Astros, Texans, Dynamo, Rockets, the Rice University Owls, and many high school teams. Currently Dr. Howard is a team physician for the Toronto Blue Jays during Spring Training, Dunedin Blue Jays, and River Ridge High School.
In his time off Dr. Howard enjoys fishing, boating, going to the beach, cooking, and spending time with his wife and children.
Learn more about Dr. Peter Howard
Peter J. Howard, MD
Dr. Peter Howard is an orthopedic surgeon who specializes in shoulder surgery, sports medicine, and arthroscopy. Dr. Howard’s expertise includes rotator cuff repairs, cartilage transplants, meniscus injuries, ACL injuries, shoulder dislocations, hip impingement, fractures, joint replacement, and arthritis care. Dr. Howard’s areas of interest include the shoulder, elbow, hip, knee, and biologic therapies. Dr. Howard focuses on helping athletes and weekend warriors get back to full activity. Dr. Howard’s offices are in the Palm Harbor and in New Port Richey.Originally from Petoskey, Michigan, Dr. Howard has undergone extensive training in shoulder surgery, sports medicine, minimally invasive arthroscopy, and orthopedics at several prestigious universities and medical centers. Dr. Howard obtained his undergraduate degree with Honors from Michigan State University in East Lansing, Michigan. After his undergraduate education, Dr. Howard completed his medical degree at Wayne State University in Detroit, Michigan in 2008. He then trained in orthopedics at the Western Michigan University Homer Stryker School of Medicine. During his final year, he served as chief resident at Bronson Methodist Hospital and Borgess Medical Center. Seeking additional sub-specialization, he trained in shoulder surgery, sports medicine, and minimally invasive arthroscopy at the Houston Methodist Hospital. During his time there he worked with and cared for the Houston Astros, Texans, Dynamo, Rockets, the Rice University Owls, and many high school teams. Currently Dr. Howard is a team physician for the Toronto Blue Jays during Spring Training, Dunedin Blue Jays, and River Ridge High School.
In his time off Dr. Howard enjoys fishing, boating, going to the beach, cooking, and spending time with his wife and children.
Learn more about Dr. Peter Howard
Transcription:
Cartilage Replacement Surgery
Amanda Wilde (Host): This is BayCare HealthChat. I'm Amanda Wilde. Healthy cartilage helps cushion your joints and bones. So when cartilage wears away, your body can't move well. And if left untreated, your problems will worsen. Today, we'll look at cartilage transplant with fellowship-trained orthopedic sports medicine surgeon, Dr. Peter J. Howard. Dr. Howard, great to have you here.
Dr. Peter Howard: Well, thanks so much, Amanda. I really appreciate the opportunity to talk to your listeners.
Amanda Wilde (Host): Well, what is cartilage made of and what happens when it wears out?
Dr. Peter Howard: Cartilage is a substance that exists in all of our joints. It is a very hard but smooth surface that provides gliding of our joints back and forth so that we can move freely. So, cartilage is very important for the normal function of our bodies. Without that normal function, if it starts to break down due to injury or age, then our body starts to get pain in the joints.
Amanda Wilde (Host): Is it inevitable that it will break down at some point in our lives?
Dr. Peter Howard: Not necessarily. Breakdown of cartilage can be from a variety of different causes. Sometimes it's due to old injuries. Sometimes it's due to age-related process that deteriorates the cartilage. Sometimes it's genetic and it just unfortunately happens. And some people get cartilage destruction or wear from weight, which can play a factor in cartilage damage as well.
Amanda Wilde (Host): So when the cartilage wears down, there are replacement procedures. What are they? How is this transplant performed?
Dr. Peter Howard: Sure. There are many different ways to treat cartilage problems. The most common one that you may be aware of is knee replacement surgery. And this is a procedure that only specific people qualify for, and there's a lot of people who are not interested in having their joints replaced. Cartilage transplant surgery or cartilage replacement surgery, there are several different ways of either restoring function to the cartilage or moving cartilage from one area of the joint to another or even regrowing cartilage that can be placed back into the knee with the patient's own cells that are taken from the body joint at an earlier procedure.
Amanda Wilde (Host): So, regeneration of the cartilage?
Dr. Peter Howard: Correct. Cartilage regeneration works by initially taking a sample of the patient’s cartilage. At the time of that procedure, the cartilage damage is assessed. It is smoothed out and a tiny portion of cartilage in an area of the knee, for example, is taken where it won’t cause problems if it is removed. After that, it’s sent to a lab where it can be analyzed and regrown onto a sheath of tissue. If the patient qualifies and still has disabling knee pain, then I can go back and, with surgery, we can put that cartilage back into the knee, restoring the cartilage to the knee, using the patient’s own cells. Then once implanted, those cells can regrow into normal cartilage, thus setting the joint right again by putting the original cartilage back in where the defect or hole or wear of cartilage was before.
Amanda Wilde (Host): Is this regeneration we’re talking about also what cartilage transplant is?
Dr. Peter Howard: Yes. There are other procedures such as an osteochondral, so that means cartilage and bone transplant, and that can be moved from one portion of the knee to another portion of the knee or even knee to elbow, that can be done in the shoulder or hip. And this is a good solution for smaller-sized cartilage defects, that the large defect is usually much better treated with regeneration. But smaller ones can be done in a single-stage procedure by simply moving the cartilage from one portion of the body to another portion of the body, and then it grows back into that area where the cartilage has been worn.
Amanda Wilde (Host): This is an amazing procedure. Is it relatively new or has cartilage transplant been around a while?
Dr. Peter Howard: Cartilage transplant has actually been around for a long time, approximately 20 to 30 years. The technology to be able to transplant or regenerate cartilage has significantly advanced over the past 10 years, making it much easier for the surgeon to perform the technique and much easier for the patient to recover from the surgeries. That's one of the reasons why it's becoming more mainstream and able to be accessed by patients, is that the technology to be able to do these procedures has significantly improved compared to when they first started.
Amanda Wilde (Host): Well, who is a suitable candidate for this procedure?
Dr. Peter Howard: A suitable candidate for a cartilage regeneration or cartilage transplant procedure would be a patient who has a cartilage defect that is identified with an MRI. This person is otherwise healthy and active and not overweight. This person is anywhere from teenage years to the middle-aged years in the 50s or so. And this person wants to have a restoration of function to correct their cartilage problem without needing a knee replacement.
Amanda Wilde (Host): So, can this be used in place of a knee replacement?
Dr. Peter Howard: Think of this procedure and this technology as a way of avoiding a knee replacement. Some patients come to the doctor to come see me and, unfortunately, they ask about these procedures, but they already have changes to their bones or their bones are even becoming crooked due to arthritis. Cartilage procedures are unfortunately not going to work well in that particular person as the problem has progressed too far. This is used to avoid a knee replacement down the road, so this would treat someone perhaps 10, 15 years before they would need a knee replacement.
Amanda Wilde (Host): How long does a cartilage transplant last?
Dr. Peter Howard: Cartilage transplants are living cells. So the cartilage transplant, if successful, then it would last the person the rest of their life. The cartilage can be continually replenished by the joint fluid and the bone from underneath, and it becomes part of the person unless there's arthritis that develops elsewhere, or an injury or something like that. The cartilage transplant or regeneration procedure should be durable for the rest of that person's life.
Amanda Wilde (Host): That's amazing. What do you see after surgery that tells you the procedure was successful?
Dr. Peter Howard: So after the procedure, patients are in some discomfort due to the surgery, and they perform physical therapy to restore range of motion and to reduce swelling. After we get through that phase, which can be a month or two, then we get to the phase where we start strengthening the muscles, for example, around the knee. As we strengthen those muscles, it can be, say, three, four, five, six months after surgery, some patients really start to notice that, as they're doing these strengthening exercises to recover from surgery, the pain that they had that brought them in to see the physician isn't there anymore. And the only pain that they're experiencing or discomfort is, say, sore muscles from doing the exercises to recover from surgery. And that's when we really know that the surgery has been successful and the cartilage transplant or regeneration procedure is really doing what we want it to do.
Amanda Wilde (Host): And how often do you find this procedure does hold and is successful? What's the success rate?
Dr. Peter Howard: The success rates for the cartilage regeneration procedure are around 90%. About nine out of 10 patients will have excellent relief. The other 10% usually have good relief and only a small single-digit percentage of patients has relief that says this wasn't very good of a procedure. That also applies to the transplant procedure. The transplant procedure has a little lower success rates in the high 80%. And then, the remainder of people, a good percentage of them have good relief, but may still have a little bit of pain. And a small single-digit percentage of people may not necessarily get the pain relief that they were looking for.
Amanda Wilde (Host): Well, that's a really high percentage success rate, and because success can last a lifetime, is this your first go-to for patients who qualify?
Dr. Peter Howard: Well, as a physician, I always try to choose the conservative treatment first. I will recommend physical therapy, anti-inflammatories if the patient can tolerate them, potentially a cortisone injection. And if that does not work, then we do start to consider the cartilage transplant or regeneration procedures.
The MRI is essential to evaluate the cartilage in the knee. These procedures are used to only treat focal or solitary or single-cartilage defects in one small area of the knee. If the MRI shows that there’s diffuse or widespread cartilage damage, then I usually discuss with the patient that they’re not a candidate for this procedure. So usually, after developing a relationship with the patient and trying other non-surgical treatments, if it’s a single problem of cartilage defect or problem with that cartilage, then usually the patient can be a good candidate. Oftentimes, there are other problems in the knee, perhaps an ACL tear or a meniscus tear or some other problem that can be addressed at the same time. So if there’s a second problem that takes priority, say an ACL tear, often we’ll treat this cartilage problem at the same time as that other surgery.
Amanda Wilde (Host): What a relief for the patient.
Dr. Peter Howard: Yes, indeed. I try to really minimize how many surgeries patients have to go through.
Amanda Wilde (Host): Well, cartilage transplant sounds like a fantastic way to alleviate pain and restore mobility for the long-term, if you're at that point where you need it.
Dr. Peter Howard: Correct. It's an excellent technology and procedure that's been around for decades. And nowadays, it is a procedure that has a well-defined recovery period, well-defined rehabilitation and, according to the studies, has excellent results for most patients.
Amanda Wilde (Host): Well, doctor, thank you so much for this insight into cartilage transplant, a way to advance comfortably as we age.
Dr. Peter Howard: You're welcome, Amanda. Thanks so much for letting me talk to your listeners today.
Amanda Wilde (Host): That wraps up this episode of BayCare HealthChat. Head over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other BayCare podcasts.
For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. I'm Amanda Wilde, and we'll talk again next time.
Cartilage Replacement Surgery
Amanda Wilde (Host): This is BayCare HealthChat. I'm Amanda Wilde. Healthy cartilage helps cushion your joints and bones. So when cartilage wears away, your body can't move well. And if left untreated, your problems will worsen. Today, we'll look at cartilage transplant with fellowship-trained orthopedic sports medicine surgeon, Dr. Peter J. Howard. Dr. Howard, great to have you here.
Dr. Peter Howard: Well, thanks so much, Amanda. I really appreciate the opportunity to talk to your listeners.
Amanda Wilde (Host): Well, what is cartilage made of and what happens when it wears out?
Dr. Peter Howard: Cartilage is a substance that exists in all of our joints. It is a very hard but smooth surface that provides gliding of our joints back and forth so that we can move freely. So, cartilage is very important for the normal function of our bodies. Without that normal function, if it starts to break down due to injury or age, then our body starts to get pain in the joints.
Amanda Wilde (Host): Is it inevitable that it will break down at some point in our lives?
Dr. Peter Howard: Not necessarily. Breakdown of cartilage can be from a variety of different causes. Sometimes it's due to old injuries. Sometimes it's due to age-related process that deteriorates the cartilage. Sometimes it's genetic and it just unfortunately happens. And some people get cartilage destruction or wear from weight, which can play a factor in cartilage damage as well.
Amanda Wilde (Host): So when the cartilage wears down, there are replacement procedures. What are they? How is this transplant performed?
Dr. Peter Howard: Sure. There are many different ways to treat cartilage problems. The most common one that you may be aware of is knee replacement surgery. And this is a procedure that only specific people qualify for, and there's a lot of people who are not interested in having their joints replaced. Cartilage transplant surgery or cartilage replacement surgery, there are several different ways of either restoring function to the cartilage or moving cartilage from one area of the joint to another or even regrowing cartilage that can be placed back into the knee with the patient's own cells that are taken from the body joint at an earlier procedure.
Amanda Wilde (Host): So, regeneration of the cartilage?
Dr. Peter Howard: Correct. Cartilage regeneration works by initially taking a sample of the patient’s cartilage. At the time of that procedure, the cartilage damage is assessed. It is smoothed out and a tiny portion of cartilage in an area of the knee, for example, is taken where it won’t cause problems if it is removed. After that, it’s sent to a lab where it can be analyzed and regrown onto a sheath of tissue. If the patient qualifies and still has disabling knee pain, then I can go back and, with surgery, we can put that cartilage back into the knee, restoring the cartilage to the knee, using the patient’s own cells. Then once implanted, those cells can regrow into normal cartilage, thus setting the joint right again by putting the original cartilage back in where the defect or hole or wear of cartilage was before.
Amanda Wilde (Host): Is this regeneration we’re talking about also what cartilage transplant is?
Dr. Peter Howard: Yes. There are other procedures such as an osteochondral, so that means cartilage and bone transplant, and that can be moved from one portion of the knee to another portion of the knee or even knee to elbow, that can be done in the shoulder or hip. And this is a good solution for smaller-sized cartilage defects, that the large defect is usually much better treated with regeneration. But smaller ones can be done in a single-stage procedure by simply moving the cartilage from one portion of the body to another portion of the body, and then it grows back into that area where the cartilage has been worn.
Amanda Wilde (Host): This is an amazing procedure. Is it relatively new or has cartilage transplant been around a while?
Dr. Peter Howard: Cartilage transplant has actually been around for a long time, approximately 20 to 30 years. The technology to be able to transplant or regenerate cartilage has significantly advanced over the past 10 years, making it much easier for the surgeon to perform the technique and much easier for the patient to recover from the surgeries. That's one of the reasons why it's becoming more mainstream and able to be accessed by patients, is that the technology to be able to do these procedures has significantly improved compared to when they first started.
Amanda Wilde (Host): Well, who is a suitable candidate for this procedure?
Dr. Peter Howard: A suitable candidate for a cartilage regeneration or cartilage transplant procedure would be a patient who has a cartilage defect that is identified with an MRI. This person is otherwise healthy and active and not overweight. This person is anywhere from teenage years to the middle-aged years in the 50s or so. And this person wants to have a restoration of function to correct their cartilage problem without needing a knee replacement.
Amanda Wilde (Host): So, can this be used in place of a knee replacement?
Dr. Peter Howard: Think of this procedure and this technology as a way of avoiding a knee replacement. Some patients come to the doctor to come see me and, unfortunately, they ask about these procedures, but they already have changes to their bones or their bones are even becoming crooked due to arthritis. Cartilage procedures are unfortunately not going to work well in that particular person as the problem has progressed too far. This is used to avoid a knee replacement down the road, so this would treat someone perhaps 10, 15 years before they would need a knee replacement.
Amanda Wilde (Host): How long does a cartilage transplant last?
Dr. Peter Howard: Cartilage transplants are living cells. So the cartilage transplant, if successful, then it would last the person the rest of their life. The cartilage can be continually replenished by the joint fluid and the bone from underneath, and it becomes part of the person unless there's arthritis that develops elsewhere, or an injury or something like that. The cartilage transplant or regeneration procedure should be durable for the rest of that person's life.
Amanda Wilde (Host): That's amazing. What do you see after surgery that tells you the procedure was successful?
Dr. Peter Howard: So after the procedure, patients are in some discomfort due to the surgery, and they perform physical therapy to restore range of motion and to reduce swelling. After we get through that phase, which can be a month or two, then we get to the phase where we start strengthening the muscles, for example, around the knee. As we strengthen those muscles, it can be, say, three, four, five, six months after surgery, some patients really start to notice that, as they're doing these strengthening exercises to recover from surgery, the pain that they had that brought them in to see the physician isn't there anymore. And the only pain that they're experiencing or discomfort is, say, sore muscles from doing the exercises to recover from surgery. And that's when we really know that the surgery has been successful and the cartilage transplant or regeneration procedure is really doing what we want it to do.
Amanda Wilde (Host): And how often do you find this procedure does hold and is successful? What's the success rate?
Dr. Peter Howard: The success rates for the cartilage regeneration procedure are around 90%. About nine out of 10 patients will have excellent relief. The other 10% usually have good relief and only a small single-digit percentage of patients has relief that says this wasn't very good of a procedure. That also applies to the transplant procedure. The transplant procedure has a little lower success rates in the high 80%. And then, the remainder of people, a good percentage of them have good relief, but may still have a little bit of pain. And a small single-digit percentage of people may not necessarily get the pain relief that they were looking for.
Amanda Wilde (Host): Well, that's a really high percentage success rate, and because success can last a lifetime, is this your first go-to for patients who qualify?
Dr. Peter Howard: Well, as a physician, I always try to choose the conservative treatment first. I will recommend physical therapy, anti-inflammatories if the patient can tolerate them, potentially a cortisone injection. And if that does not work, then we do start to consider the cartilage transplant or regeneration procedures.
The MRI is essential to evaluate the cartilage in the knee. These procedures are used to only treat focal or solitary or single-cartilage defects in one small area of the knee. If the MRI shows that there’s diffuse or widespread cartilage damage, then I usually discuss with the patient that they’re not a candidate for this procedure. So usually, after developing a relationship with the patient and trying other non-surgical treatments, if it’s a single problem of cartilage defect or problem with that cartilage, then usually the patient can be a good candidate. Oftentimes, there are other problems in the knee, perhaps an ACL tear or a meniscus tear or some other problem that can be addressed at the same time. So if there’s a second problem that takes priority, say an ACL tear, often we’ll treat this cartilage problem at the same time as that other surgery.
Amanda Wilde (Host): What a relief for the patient.
Dr. Peter Howard: Yes, indeed. I try to really minimize how many surgeries patients have to go through.
Amanda Wilde (Host): Well, cartilage transplant sounds like a fantastic way to alleviate pain and restore mobility for the long-term, if you're at that point where you need it.
Dr. Peter Howard: Correct. It's an excellent technology and procedure that's been around for decades. And nowadays, it is a procedure that has a well-defined recovery period, well-defined rehabilitation and, according to the studies, has excellent results for most patients.
Amanda Wilde (Host): Well, doctor, thank you so much for this insight into cartilage transplant, a way to advance comfortably as we age.
Dr. Peter Howard: You're welcome, Amanda. Thanks so much for letting me talk to your listeners today.
Amanda Wilde (Host): That wraps up this episode of BayCare HealthChat. Head over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other BayCare podcasts.
For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. I'm Amanda Wilde, and we'll talk again next time.