Robert Grumet, M.D., an orthopedic surgeon for Hoag Orthopedic Institute in Los Angeles, California, talks about a new investigational surgery that will help patients suffering from damage in the articular cartilage.
Interview conducted by Ivanhoe Broadcast News in November 2016.
Tell us a little bit about the pothole surgery, the procedure.
Dr. Grumet: NeoCart is an investigational procedure that we’re doing for patients with isolated injuries to their articular cartilage. We are harvesting their cartilage and growing it in a lab and then re-implanting that cartilage in a patient where they are missing a piece of cartilage.
What is it that you are taking out of the knee and how are you growing it?
Dr. Grumet: NeoCart is a two stage procedure where arthroscopically we’ll harvest a piece of cartilage from the patient they don’t need. Later, we will grow that in the lab on to what’s called a scaffold where that cartilage will grow on to that membrane. Then, we can go back in a second procedure and re-implant that in to the hole where that patient was missing cartilage.
We’re not talking about stem cells we’re talking about something different.
Dr. Grumet: That’s correct.
How does it differ from stem cells?
Dr. Grumet: This is actually taking the patient’s native cartilage, which is a cell that is already produced, that is already a cartilage cell as opposed to stem cells which are cells that have not been predetermined right. They can potentially grow in to any type of cell. These cells are predestined to become cartilage cells. They are already going to become articular cartilage.
When you say articular cartilage it’s the stuff that moves your knee?
Dr. Grumet: Articular cartilage is the nice smooth covering that covers the end of the joints, in this case on the end of your femur bone and the top of your shin bone. It’s the nice glistening surface that allows your knee to bend friction free.
What’s the advantage of that?
Dr. Grumet: The advantage is that this cartilage that we’re implanting in patient’s knees is just very similar to their own cartilage; it’s the most similar that we know we can create for a patient. As opposed to other procedures or the gold standard procedure which is called the micro fracture, in which case we’re poking holes in to the patients femur bone or in this case the femur bone to create a bleeding surface and allow new cartilage to grow. But in that case it’s what’s called fibro cartilage which is basically a hybrid type cartilage. The NeoCart procedure is articular or hilanlite cartilage which is just like the patient’s own cartilage.
So function is better, longevity is better?
Dr. Grumet: Yeah, the idea is if we can recreate the normal anatomy that the function will improve, the patient’s long term outcomes could improve, it could delay the onset of arthritis in that knee long term.
How long has the trial been going on, have you been involved in it?
Dr. Grumet: I don’t have any idea.
How long have you been involved in the trial?
Dr. Grumet: A year now.
What have you seen so far?
Dr. Grumet: So far the results have been great. This is the Phase III of this clinical trial. Phase II of the clinical trial we were not involved with but showed very good promising results for the cartilage. For this procedure I should say over the micro fracture technique.
Who is a good candidate?
Dr. Grumet: Patients that are enrolled in this are between eighteen and fifty nine years of age. They have knee pain or mechanical type symptoms or swelling in their knee that we can attribute to articular cartilage damage. Those patients would have to have a focal defect which means one lesion or one area of cartilage missing in their knee. Patients who have defused arthritis or global loss of that articular cartilage are not great candidates for this.
Anybody else who is not a great candidate?
Dr. Grumet: People who are smokers, someone who smokes more than a pack a week and people who have had previous procedures are screened very heavily for this procedure.
What’s the advantage from the micro fracture from other procedures that you might use to fix a knee from the start because they said that you take the tissue and then it’s another six weeks or ten weeks?
Dr. Grumet: The total timeframe is actually very similar. For a micro fracture technique, you’re asking patients to stay off their leg for about six weeks. You’re gradually progressing their activities over the course of about four to six months. The only difference between micro fracture and the NeoCart procedure is that obviously there are two steps. Those two stages are about six weeks apart. But in total, the total recovery is still very similar.
What’s your thinking about the future of this? Is this going to be something that’s going to become standard?
Dr. Grumet: I’m very optimistic. I’ve seen great results in my patients. I’m very hopeful that this will be sort of a new frontier that patients will really benefit from.
Is this something that you would do in every case once it’s approved for someone who is a candidate?
Dr. Grumet: For those select cartilage defects I think I would, absolutely.
What’s the time frame?
Dr. Grumet: For that to be released?
Yes.
Dr. Grumet: They have to have all the patients enrolled, two hundred and forty something, I don’t know what NeoCart or Histogenics is up to, but I don’t know how far along they are with that number.
Just because people will hear it and they’ll think it’s really cool and they’ll be like calling their doctors when can I have that?
Dr. Grumet: I would say the potential advantage of this technique over micro fracture is the longevity of the procedure. Micro fracture tends to need another surgery in the future. There’s a high what they call revision rate for micro fractures. The hope is that is that a newer procedure would prevent the need for additional surgeries.
The trial is still open?
Dr. Grumet: The trial is still open.
If someone was interested in getting in the trial just contact NeoCart?
Dr. Grumet: Absolutely.
What about Oran was he a pretty typical case?
Dr. Grumet: He was. He had a traumatic injury and had an isolated defect in his knee that we felt was an appropriate candidate. He’s now six months from his surgery and doing very well.
Can you expand a little bit about how well he is doing?
Dr. Grumet: He’s doing well. He has no pain; he’s not having any swelling, he’s returning to his activities. He still has a little bit of work to do with his physical therapy but he’s progressing really well and he’s really happy with the outcome.
END OF INTERVIEW
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