Focal metallic inlay resurfacing prosthesis in articular cartilage defects: short-term results of 118 patients and 2 different implants

  • Şahin ÇepniEmail author
  • Enejd Veizi
  • Mesut Tahta
  • Enes Uluyardımcı
  • Mohammed J. T. Abughalwa
  • Çetin Işık
Arthroscopy and Sports Medicine



The goal of this study was to share our experience with two different inlay metallic implants in the treatment of knee cartilage defects and to analyze their effects on functional scores.


This retrospective study included 118 patients operated on for focal full-thickness knee cartilage lesions, who were treated with a focal metallic inlay resurfacing prosthesis. A cobalt–chromium (Co–Cr) resurfacing implant was applied to 73 patients with a knee chondral lesion, and a biosynthetic implant was applied to 45. All patients were evaluated preoperatively and postoperatively using the KOOS, VAS, and Tegner activity scores.


The group with the Co–Cr-resurfacing implant showed a significantly greater improvement (p < 0.001) in the Tegner and VAS scores at the 2-year follow-up examination. The KOOS scores were similar in both groups. Median patient age was similar in both groups. All patients had a follow-up of at least 2 years. The preoperative and postoperative scores were compared and significant improvements (p < 0.001) were observed. The biosynthetic implant had a higher revision rate. In the univariate analysis, age and type of implant were significantly associated with revision surgery. In the multivariate Cox-regression analysis model, the type of implant was significantly associated with revision surgery.


All the patients operated with the above-mentioned implants showed significant improvements in pain and activity scores. Despite the overall good clinical results, 17% of patients with a biosynthetic implant and > 6% of patients with Co–Cr-resurfacing implant required revision surgery. Age and implant type were the main risk factors associated with revision.


Cartilage Inlay-resurfacing prosthesis Focal osteochondral defects Osteoarthritis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests and no funding was received from any source.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Davis JT, Jones DG (2004) Treatment of knee articular cartilage injuries. Curr Opin Orthop 15:92–99CrossRefGoogle Scholar
  2. 2.
    Ozturk A, Ozdemir MR, Ozkan Y (2006) Osteochondral autografting (mosaicplasty) in grade IV cartilage defects in the knee joint: 2- to 7-year results. Int Orthop 30:200–204CrossRefGoogle Scholar
  3. 3.
    Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13(4):456–460CrossRefGoogle Scholar
  4. 4.
    Shapiro F, Koide S, Glimcher MJ (1993) Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Jt Surg Am 75:532–553CrossRefGoogle Scholar
  5. 5.
    Widuchowski W, Widuchowski J, Trzaska T (2007) Articular cartilage defects: study of 25,124 knee arthroscopies. Knee 14(3):177–182CrossRefGoogle Scholar
  6. 6.
    Heir S, Nerhus TK, Røtterud JH, Løken S, Ekeland A, Engebretsen L, Arøen A (2010) Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. Am J Sports Med 38(2):231–237CrossRefGoogle Scholar
  7. 7.
    Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, Ghanem N, Uhl M, Südkamp N (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22(11):1180–1186CrossRefGoogle Scholar
  8. 8.
    Knutsen G, Drogset JO, Engebretsen L, Grøntvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture, findings at five years. J Bone Jt Surg Am 89(10):2105–2112CrossRefGoogle Scholar
  9. 9.
    Hunziker EB, Lippuner K, Keel MJ, Shintani N (2015) An educational review of cartilage repair: precepts and practice e myths and misconceptions e progress and prospects. Osteoarthr Cartil 23(3):334–350CrossRefGoogle Scholar
  10. 10.
    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96CrossRefGoogle Scholar
  11. 11.
    McCormack H, Horne DL, Sheather S (1988) Clinical applications of visual analogue scales: a critical review. Psychol Med 18(4):1007–1019CrossRefGoogle Scholar
  12. 12.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthrop Relat Res 198:43–49Google Scholar
  13. 13.
    Becher C, Huber R, Thermann H et al (2011) Effects of a surface matching articular resurfacing device on tibiofemoral contact pressure: results from continuous dynamic flexion–extension cycles. Arch Orthop Trauma Surg 131:413–419CrossRefGoogle Scholar
  14. 14.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502CrossRefGoogle Scholar
  15. 15.
    Becher C, Huber R, Thermann H, Tibesku CO, von Skrbensky G (2009) Tibiofemoral contact mechanics with a femoral resurfacing prosthesis and a non-functional meniscus. Clin Biomech (Bristol, Avon) 24:648–654CrossRefGoogle Scholar
  16. 16.
    Li CS, Karlsson J, Winemaker M, Sancheti P, Bhandari M (2014) Orthopedic surgeons feel that there is a treatment gap in management of early OA: international survey. Knee Surg Sports Traumatol Arthrosc 22(2):363–378CrossRefGoogle Scholar
  17. 17.
    Pascual-Garrido C, Daley E, Verma NN, Cole BJ (2016) A Comparison of the outcomes for cartilage defects of the knee treated with biologic resurfacing versus focal metallic implants. Arthroscopy 33(2):364–373CrossRefGoogle Scholar
  18. 18.
    Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC et al (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Jt Surg Am 89:2105–2112CrossRefGoogle Scholar
  19. 19.
    de Windt TS, Bekkers JE, Creemers LB, Dhert WJ, Saris DB (2009) Patient profiling in cartilage regeneration: prognostic factors determining success of treatment for cartilage defects. Am J Sports Med 37(Suppl. 1):58s–62sCrossRefGoogle Scholar
  20. 20.
    Levy YD, Gortz S, Pulido PA, McCauley JC, Bugbee WD (2013) Do fresh osteochondral allografts successfully treat femoral condyle lesions? Clin Orthop Relat Res 471:231–237CrossRefGoogle Scholar
  21. 21.
    Kirker-Head CA, Van Sickle DC, Ek SW, McCool JC (2006) Safety of, and biological and functional response to, a novel metallic implant for the management of focal full-thickness cartilage defects: preliminary assessment in an animal model out to 1 year. J Orthop Res 24:1095–1108CrossRefGoogle Scholar
  22. 22.
    Markarian GG, Kambour MT, Uribe JT (2016) Review of arthroscopic and histological findings following knee inlay arthroplasty. J Surg Orthop Adv 25:18–26PubMedGoogle Scholar
  23. 23.
    Beyzadeoglu T, Pehlivanoglu T (2018) Cartilage. 9(2):156–160Google Scholar
  24. 24.
    Laursen JO, Lind M (2017) Treatment of full-thickness femoral cartilage lesions using condyle resurfacing prosthesis. Knee Surg Sports Traumatol Arthrosc 25(3):746–751CrossRefGoogle Scholar
  25. 25.
    Bollars P, Bousquet M, Vandekerckhove B, Hardeman F, Bellemans J (2012) Prosthetic inlay resurfacing for the treatment of focal, full thickness cartilage defects of the femoral condyle: a bridge between biologics and conventional arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(9):1753–1759CrossRefGoogle Scholar
  26. 26.
    Becher C, Kalbe C, Thermann H, Paessler HH, Laprell H, Kaiser T, Fechner A, Bartsch S, Windhagen H, Ostermeier S (2011) Minimum 5-year results of focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee. Arch Orthop Trauma Surg 131(8):1135–1143CrossRefGoogle Scholar
  27. 27.
    Chahal J, Thiel GV, Hussey K, Cole BJ (2013) Managing the patient with failed cartilage restoration. Sports Med Arthrosc 21(2):62–68CrossRefGoogle Scholar
  28. 28.
    Dhollander AA, Almqvist KF, Moens K et al (2015) The use of a prosthetic inlay resurfacing as a salvage procedure for a failed cartilage repair. Knee Surg Sports Traumatol Arthrosc 23(8):2208–2212CrossRefGoogle Scholar
  29. 29.
    Hobbs H, Ketse-Matiwane N, van der Merwe W, Posthumus M (2013) Focal full thickness articular cartilage lesions treated with an articular resurfacing prosthesis in the middle-aged. SA Orthop J 12(4): 41–46. Accessed 28 Oct 2019
  30. 30.
    Becher C, Cantiller EB (2017) Arch Orthop Trauma Surg 137:1307. CrossRefPubMedGoogle Scholar
  31. 31.
    Goebel L, Kohn D, Madry H (2016) Biological reconstruction of the osteochondral unit after failed focal resurfacing of a chondral defect in the knee. Am J Sports Med 44(11):2911–2916CrossRefGoogle Scholar
  32. 32.
    Laursen JO (2016) Treatment of full-thickness cartilage lesions and early OA using large condyle resurfacing prosthesis: UniCAP®. Knee Surg Sports Traumatol Arthrosc 24(5):1695–1701CrossRefGoogle Scholar
  33. 33.
    Jasper LL, Jones CA, Mollins J, Pohar SL, Beaupre LA (2016) Risk factors for revision of total knee arthroplasty: a scoping review. BMC Musculoskelet Disord 17:182CrossRefGoogle Scholar
  34. 34.
    Kuipers BM, Kollen BJ, Bots PC, Burger BJ, van Raay JJ, Tulp NJ, Verheyen CC (2010) Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 17(1):48–52CrossRefGoogle Scholar
  35. 35.
    van der List JP, Chawla H, Zuiderbaan HA, Pearle AD (2016) The role of preoperative patient characteristics on outcomes of unicompartmental knee arthroplasty: a meta-analysis critique. J Arthroplasty 31(11):2617–2627CrossRefGoogle Scholar
  36. 36.
    Fuchs A, Eberbach H, Izadpanah K et al (2018) Knee Surg Sports Traumatol Arthrosc 26:2722. CrossRefPubMedGoogle Scholar
  37. 37.
    Nathwani D, McNicholas M, Hart A, Miles J, Bobić V (2017) Partial resurfacing of the knee with the biopoly implant: interim report at 2 years. JB JS Open Access 2(2):e0011. doi:10.2106/JBJS.OA.16.00011. Accessed 6 Apr 2017CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedics and TraumatologyAnkara City HospitalAnkaraTurkey
  2. 2.Department of Orthopedics and Traumatologyİzmir Atatürk Research and Training HospitalIzmirTurkey
  3. 3.Department of Orthopedics and TraumatologyDeveli HospitalKayseriTurkey
  4. 4.Department of Orthopedics and TraumatologyEmsey HospitalIstanbulTurkey

Personalised recommendations