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Focal metallic inlay resurfacing prosthesis for the treatment of localized cartilage defects of the femoral condyles: a systematic review of clinical studies

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To systematically review the results of focal metallic inlay resurfacing prosthesis for the treatment of isolated cartilage defects of the femoral condyles.

Methods

A systematic electronic search of the PubMed database and the Cochrane Library was performed in April 2017 to identify studies that reported clinical or radiographic outcome of focal metallic inlay resurfacing prosthesis for the treatment of isolated cartilage defects of the femoral condyles. Included studies were abstracted regarding study characteristics, patient demographics, prosthetic device and location, indications and contraindications, and outcome measures. Outcome of interest included functional outcome scores, radiographic measures, complications, re-operations, and conversion to arthroplasty. The methodologic quality of the included studies was assessed with the Coleman Methodology Score.

Results

Six studies with a total of 186 patients met the inclusion criteria. Five studies were level IV evidence, and one was level III. The methodologic quality of the included studies was good, with a mean Coleman Methodology Score of 78. Two different implants were used: the HemiCAP® (five studies; 66% of study group) and UniCAP® (one study; 34%) implant. The mean age was 46–54 years, and the mean follow-up was 24 months to 7 years. Pre- and post-operative outcome scores were compared in all six studies, and five studies reported significant improvements at the final follow-up for all scores (objective und functional KSS, KOOS, WOMAC, Tegner, HSS Knee and Function score, SF-36 and SF-12 physical component score) except for the SF-36 and SF-12 mental component score. Progression of osteoarthritis was analysed using the Kellgren–Lawrence grading in three studies (30% of study group), with two studies reporting significant progression. The OARSI grading system was analysed in one study with no significant progression. The overall conversion rate to arthroplasty was 22% with considerable differences between the two implants: 9% for HemiCAP® and 47% for UniCAP®.

Conclusions

Focal metallic inlay resurfacing prosthesis seems to be a viable option for a carefully selected group of patients. Significant improvement in knee function and pain was observed in most patients. Uncertainty remains with regard to progression of osteoarthritis because of conflicting results and inconsistent reporting. One out of five patients has to be converted to arthroplasty after an average of 4 years. However, compared to the UniCAP® implant, considerable lower conversion rates were reported for the smaller HemiCAP® implant.

Level of evidence

Systematic review of level III and IV studies, Level IV.

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Reprinted with permission from Arthrosurface, Inc., Franklin, MA

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Authors and Affiliations

  1. Department of Orthopedics and Trauma Surgery, Medical Center – Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79016, Freiburg, Germany

    Andreas Fuchs, Helge Eberbach, Kaywan Izadpanah, Gerrit Bode, Norbert P. Südkamp & Matthias J. Feucht

  2. Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany

    Andreas Fuchs, Helge Eberbach, Kaywan Izadpanah, Gerrit Bode, Norbert P. Südkamp & Matthias J. Feucht

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  1. Andreas Fuchs
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  2. Helge Eberbach
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  6. Matthias J. Feucht
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Correspondence to Matthias J. Feucht.

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The authors declare that they have no conflict of interest with regard to the present study.

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There is no funding source.

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This was a systematic review of published literature, and IRB approval was not required.

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Informed consent was not applicable to this study.

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Fuchs, A., Eberbach, H., Izadpanah, K. et al. Focal metallic inlay resurfacing prosthesis for the treatment of localized cartilage defects of the femoral condyles: a systematic review of clinical studies. Knee Surg Sports Traumatol Arthrosc 26, 2722–2732 (2018). https://doi.org/10.1007/s00167-017-4714-4

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