MU researchers develop technique to improve biologic joint replacements

Photo of James Stannard, MD, and James Cook, DVM, PhD
James Cook, DVM, PhD, left, and James Stannard, MD, have led the effort to improve biological joint replacements.

James Stannard, MD, and James Cook, DVM, PhD, have witnessed many advancements in orthopaedic surgery during the past 20 years. They cannot help but notice many remaining limitations for patients, too, which have inspired them to develop new technology for biologic joint replacements.

Metal and plastic joint replacements wear out over time. Patients with these replacements may be forced to give up activities they enjoy, like running or skiing.

Working together and leading a team of researchers at the University of Missouri’s Comparative Orthopaedic Laboratory and Missouri Orthopaedic Institute, Cook and Stannard have developed a bone-and-cartilage preservation system. It reduces the need for metal and plastic implants in treating many disorders of the knee, hip, ankle and shoulder.

“It’s a game-changer,” said Stannard, the J. Vernon Luck Sr. Distinguished Professor of Orthopaedic Surgery and chair of orthopaedic surgery at the MU School of Medicine. He specializes in orthopaedic trauma and knee surgery. “It means we are able to provide not only a more natural joint repair option, but we also can predict a better outcome.”

“A patient suffering from arthritis or other joint disorders could potentially be a candidate for metal and plastic joint replacements,” Cook said.

Cook leads MU’s Comparative Orthopaedic Laboratory and serves as the William and Kathryn Allen Distinguished Professor in Orthopaedic Surgery at the MU School of Medicine.

“While metal and plastic joint replacement is an effective surgery, it is a repair strategy,” Cook said. “We’re interested in regeneration. With our new preservation technique, we can actually put new cartilage in your joint that can respond to daily activities and renew itself like young, healthy cartilage does. The cool thing is that this strategy allows you to do the activities that you want to do. It’s like a fountain of youth for your joints.”

The technology, called the Missouri Osteochondral Allograft Preservation System, or MOPS, more than doubles the “storage life” of bone-and-cartilage grafts from organ donors compared to current methods. The preservation technique also allows surgeons to verify the quality of the grafts they will use for these biological joint replacement surgeries.

“Although I can reconstruct most of a knee joint, the biggest challenge is replacing the protective lining on the ends of the femur and tibia,” Stannard said. “This lining, called articular cartilage, is a thousand times slicker than wet ice, and it protects the joint during everyday activities.”

When articular cartilage is damaged from disease or injury, the bones it protects eventually become damaged. This condition, and the pain associated with it, is known as arthritis.

“We can use osteochondral allografts from a donor to fill in the damaged areas, rather than remove bone, and implant metal and plastic components,” Stannard said. “However, current preservation methods for the allografts themselves limit the number we have available to us.”

With the current preservation method, only 20 percent of donated allografts are used. To overcome this challenge, MU’s Orthopaedic Research Team developed their preservation technology. With the new system developed at MU, the grafts’ shelf life can be extended to at least 60 days, with 90 percent or more of cells remaining viable.

“So, by increasing quality of the grafts for a much longer period of time, we also increase the quantity of grafts that will be available to help patients,” Cook said.

He is hopeful that they will be able to begin using the technology for Missouri Orthopaedic Institute patients this year. Research studies about the preservation system have been published in academic journals, including the Journal of Knee Surgery in 2012 and Clinical Orthopaedics and Related Research, a publication of the Association of Bone and Joint Surgeons, in 2014. Cook said the technology is approved by the Food and Drug Administration and has provisional patents in the United States and several other countries. It is in the final stage of pre-clinical evaluation at the Comparative Orthopaedic Laboratory in preparation for clinical use at the Missouri Orthopaedic Institute.

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