Brian Hall, 56, of Valparaiso, Indiana, is no stranger to knee pain. As a high school athlete, he had his first arthroscopic knee surgery at 14. “In those days, I was just happy to get back to playing sports,” Hall explains.
As time went on, Hall’s activities increased as he enjoyed life as a husband and father. He took up running, long bike rides, walks with his dog, and extreme hiking, which included five trips up and down the Grand Canyon.
But his knee pain persisted.
“Basically, my knee has hurt me since I was 14 years old,” Hall says.
The knee pain eventually affected his work as an electrician, an occupation he has held for 30 years. It wasn’t unusual to find bottles of Advil in his lunchbox so that he could continue to climb ladders and work in small spaces. Over time, he gained unwanted weight as he backed off his activities.
“Pain just wears you out,” he explains. “It just makes everything more difficult.”
Seeking the right specialist
Worried that his livelihood could be at stake, he sought advice from Adam Yanke, MD, PhD, a complex knee condition and cartilage specialist at Midwest Orthopaedics at Rush. Hall was convinced a total knee replacement was going to be the solution to his chronic pain.
After a careful exam and study of Hall’s images, Dr. Yanke surprised Hall by recommending a cartilage transplant to the patella and an osteotomy. He explained that the knee is composed of three compartments: 1) the patellofemoral (kneecap); 2) medial (inner) and 3) lateral (outer) compartment. Of the three components of Hall’s knee, just the patellofemoral compartment was affected by cartilage damage and the remaining two compartments were perfectly healthy. Furthermore, only one side of his patellofemoral joint was damaged. As opposed to a partial knee replacement, Dr. Yanke recommended a cartilage transplant that would retain more of Mr. Hall’s native knee tissue and would result in a more normal feeling knee.
What is a cartilage transplant?
A cartilage transplant procedure is most commonly performed on younger patients with cartilage damage, as they are more likely to have more localized disease. For some patients, this procedure could be the only knee procedure they need to remain pain-free for a lifetime. This procedure also does not preclude patients from having knee replacement procedures in the future if needed.
Hall gave the green light to the cartilage transplant and underwent the surgery very successfully.
During the osteotomy phase of the procedure, a portion of Hall’s tibia (shin bone) was cut to change the alignment and decrease pressure on the patella. During the cartilage transplant phase, new cartilage and bone were transplanted into the patella (called an osteochondral allograft) to perform a biologic resurfacing. This graft naturally integrates with the patient’s own bone to eventually form a new cartilage surface to decrease pain and swelling.
Freedom from pain
Within two weeks of surgery, Hall was out of pain for the first time since he could remember. As part of his prescribed rehabilitation, he went home with a piece of equipment that automatically bends and straightens a patient’s knee (called a continuous passive motion—or CPM—machine). Within a couple of days, he was bending his knee on his own and no longer needed the machine.
“I was thrilled but not surprised that Mr. Hall did so well,” explains Dr. Yanke. “He was the perfect candidate for this procedure and I knew he was very motivated. Understanding a lot about cartilage disease allowed me to help him choose the best treatment for him.”
Today, Hall walks his four dogs an hour each day. He has been enjoying completing projects on his home and is planning to book his sixth hiking trip in the Grand Canyon.