'What's hottest in medicine is technology and progress': Dr. Kevin Stone on key trends in knee surgery

Written by Shayna Korol | February 11, 2019 | Print  |

Kevin R. Stone, MD, is an orthopedic surgeon at The Stone Clinic in San Francisco as well as chairman and founder of the Stone Research Foundation.

In a San Francisco Examiner column, Dr. Stone highlighted trends in knee surgery.

Here are six key trends, according to Dr. Stone:

1. Platelet-rich plasma and growth factors: "[PRP] formulations with and without white cells may have different effects on the tissues," Dr. Stone wrote in the San Francisco Examiner. "Growth factors from fat cells, bone marrow concentrates and amniotic fluid are all potent. There's no clear superiority of one over the other at this time." While none have definitively helped regenerate tissue, they optimize healing after an injury or surgical repair.

2. Meniscectomies: More than 90 percent of meniscus treatments are meniscectomies.

The collagen meniscus implant is the only scaffold that can regrow the meniscus, but it is not being widely marketed or adopted, according to Dr. Stone. While meniscus transplantation has been shown to reduce pain and improve function in several studies, few surgery centers perform them, as the technique is difficult and time-consuming.

3. Autografts for anterior cruciate ligament repair: Nearly 300,000 ACL tears occur annually, and most are reconstructed with autografts, although allografts are becoming more widely available.

"It remains shocking to me that in the 21st century we are still robbing one part of the body to rebuild another," Dr. Stone wrote. "No new artificial ligaments have come on the market, though there are several supporting scaffolds or bands being used (despite a lack of outcome data)."

4. Articular cartilage repair with microfracture has fallen out of favor, Dr. Stone claims.

5. The advent of robotic-assisted surgery has enabled more accurate outpatient partial and total knee replacements, which younger patients tend to opt for. A shift to cementless knee replacement devices is occurring because not using cement reduces the chance of loosening.

6. "Real-time outcomes data is rapidly entering the field, thanks to the advent of personal fitness devices, ubiquitous electronic medical records and artificial intelligence-driven data mining programs," according to Dr. Stone in the San Francisco Examiner. Most patients have smartphones and can install apps that collect outcome data.

"What's hottest in medicine is technology and progress. What is not is a head-in-the-sand approach, repeating the same procedures with average or unknown outcomes," Dr. Stone concluded.

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