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Chester Knee Clinic News 2011

CKC Research News

Updated on 15 October 2011

BioPoly™ RS Partial Resurfacing Knee Implant

Femoral condyle partial resurfacing device made from microcomposite of Hyaluronic Acid and UHMWPE. This product is not yet available for use in the UK or internationally.

BioPoly™ is a next generation orthopaedic biomaterial, combining Hyaluronic Acid (Bio) and ultra high molecular weight polyethylene (Poly). This proprietary material interacts favorably with native tissues and supports anatomical loads.

We have received a favourable ethical opinion from the NHS NRES Cambridge Central on 14 September 2011 for the multi-center, open label, prospective, consecutive series registry database of BioPoly™ RS partial resurfacing knee implant clinical trial. This trial will be based in Chester and several other centres in the UK (Warrington and two centres in London), over a period of five years. We plan to start this clinical trial towards the end of the year.

The data registry will increase the knowledge of outcomes for treatment of focal defects of the femoral condyles treated with BioPoly knee implant. The primary objectives of this study are to compare clinical outcomes between treatment with BioPoly-RS knee implant and microfracture (based on historical literature) and to compare preoperative and postoperative clinical status. Clinical outcomes will be determined using the KOOS, SF-36, VAS pain, and Tegner scores. Patient safety will be monitored continuously by evaluation of adverse events.

Further information:


CKC Conference News

Updated on 15 October 2011

On 17th March 2011 we held a seminar and an update on ACI/MACI/CCI Articular Cartilage Rehabilitation at Physiotherapy Department, Nuffield Health, The Grosvenor Hospital Chester. The lecture was given by Karen Hambly, Senior Lecturer in Sports Therapy, Director of Learning and Teaching, University of Kent, The Centre for Sports Studies at Medway Park. The seminar was attended by 12 local physiotherapists who are directly involved with postoperative rehabilitation of ACI/MACI articular cartilage repair procedures.

We are also participating in the following conferences:

  • Midlands Knee Controversies, Worcester, UK, 20 May 2011. Invited lecture: ACI Surgery. Presented by Vladimir Bobic
  • London Knee Meeting, London, 13 October 2011. Invited lecture: Articular Cartilage Repair: one step forwards, two steps back. Presented by Vladimir Bobic

Chester Knee Clinic will be holding a specialised seminar focused on Articular Cartilage Repair and Rehabilitation, with emphasis on evolving understanding of subchondral activity in May 2012. This exclusive seminar is designed as an update on biology of osteochondral unit and subchondral bone, with emphasis on practical aspects of postoperative rehabilitation and physiotherapy. Please check back here for programme and speaker updates, and information on how to register to attend.


CKC Clinical News

Updated on 12 February 2011

Prineo® and Dermabond®

The next generation skin closure system and High viscosity topical skin adhesive

We are planning to start using Prineo®, the next generation of skin closure, for all knee replacements instead of skin staples, from February this year. This technology offers a fast, secure, minimally invasive way to close long incisions by combining mesh technology with liquid adhesive for skin closure. This system also provides a microbial barrier to bacteria that can lead to infection, which is potentially significant considering last year's BMJ publication of controversial paper about the use of skin staples in orthopaedics (see BMJ 2010;340:c1199, 16 March 2010 and published response to the article). We have not seen any particular problems with using skin staples after a knee replacement surgery in our practice, but the use of Prineo® skin closure system definitely offers one clear advantage - no need for removal of metal staples.

We will also start using Dermabond® ( for smaller skin incisions, instead of subcuticular stitching. Since there are no stitches, there are none of the discolorations or "track marks" that stitches can leave around wounds and incisions. The other advantage is a strong, fast hold, and a layer of protection from the bacteria that may lead to infection. Dermabond® is waterproof, so patients can shower immediately.

Further information: Ethicon Topical Skin


Recent Orthopaedic and Sport Injury News

Updated on 16 October 2011

Wearing helmet 'beneficial' for skiers and snowboarders

BBC News Health, 11 February 2011

Helmets should be included in ski hire packages to protect against head injuries, say researchers in the British Medical Journal. University of Innsbruck sports scientists say research has shown ski helmets reduce head injuries by 35% in adults and 59% in children under 13. Awareness of brain injuries from accidents could also increase helmet use, they argue. But some instructors think they are unnecessary ...

Update on Local Anaesthetics in Orthopaedic Surgery

From: Inside AANA, Arthroscopy Association of North America Newsletter

Intra-articular use of local anesthetics has received a great deal of attention recently in the orthopaedic literature and in the lay press due to concerns for chondrotoxicity and for being a contributing factor to shoulder chondrolysis associated with the use of continuous infusion pain pumps. Local anesthetics have been an integral part of routine intraarticular injections following arthroscopy, for diagnostic tests, and as a component of therapeutic intra-articular injections ranging from cortisone to hyaluronic acid to biologics such as platelet rich plasma (PRP). Consequently, an awareness and understanding of the potential risks and alternatives to intraarticular local anesthetics is important.

The potential risks for chondrotoxicity can be reduced by minimizing the use of local anesthetics. It is important and prudent for every physician to be aware of these potential risks and consider whether the local anesthetic component of an intra-articular injection is necessary and whether similar effects can be achieved with a lower dose of local anesthetic. Multiple intra-articular injections over a short time period and continuous intra-articular administration of local anesthetics carry the highest potential risks for chondrotoxicity.

Source: Constance R Chu and Michael J O'Malley. Update on Local Anesthetics in Orthopaedics. AANA Newsletter, November 2010.

For results of AANA's membership survey on use of local anaesthetics for intra-articular injections see the attached pdf article. Source: AANA Newsletter August 2011, Local Anesthetics Survey.

Effects of Local Anaesthetics on Articular Cartilage

AJSM PreView, published on 22 April 2011.

Background: Recent basic science studies have demonstrated local anesthetic chondrotoxicity in vivo and in vitro in both human and animal cartilage. Clinically, chondrolysis associated with the use of intra-articular local anesthetic pain pumps has been described by several groups. This has raised concern regarding the clinical use of intra-articular local anesthetics.

Methods: The authors undertook a review of the current orthopaedic literature on local anesthetic chondrotoxicity and its potential relationship to clinical chondrolysis.

Results: Local anesthetics such as bupivacaine, lidocaine, and ropivacaine are chondotroxic to human articular cartilage in vitro, although ropivacaine is less so. The evidence suggests that there is a greater risk for chondrolysis with a longer exposure to a higher concentration of local anesthetic, such as with a pain pump, than with a single injection. However, late cellular and metabolic changes are seen after even a single injection of bupivacaine in animal models, and the loss of an intact cartilage matrix also leads to more extensive chondrocyte death. Some studies suggest that additives and the pH of the local anesthetic solution may also play a role in chondrotoxicity.

Conclusion: Intra-articular local anesthetics should be used with caution, especially continuous infusions of bupivacaine and lidocaine at high concentrations in joints with compromised cartilage. The consequences of a single intra-articular injection of local anesthetic remains unclear and requires further investigation.

Clinical Relevance: Intra-articular use of local anesthetics may have lasting detrimental effects on human articular cartilage and chondrocytes, although the clinical relationship between local anesthetic exposure and chondrolysis requires further study.

Abstract: Samantha L. Piper, Jonathan D. Kramer, Hubert T. Kim, Brian T. Feeley. Effects of Local Anesthetics on Articular Cartilage Am J Sports Med published online before print April 22, 2011.


Other CKC News

Updated on 20 March 2011

In March 2011, Chester Knee Clinic went on a week-long ski trip to Kaunertal, Tyrol, Austria. While many resorts in the Alps have been suffering from insufficient snow, Kaunertal's high altitude glacier location provided ideal conditions and fantastic skiing. Undeterred by the 40-minute drive along the narrow Glacier Road (with its 29 hairpin bends), reaching an elevation of 2,750 metres, we enjoyed skiing under clear blue skies every day and we had a great time all round. We even had a chance to visit the nearby resort of Pitztal, another glacier resort with good selection of excellent slopes. We all skied well, and we are pleased to report no injuries beside a few torn trouser legs, bent ski poles and minor sunburns.


This page was launched on 01 February 2011. Last update: 16 October 2011.

Site last updated on: 28 March 2014

Disclaimer: This website is a source of information and education resource for health professionals and individuals with knee problems. Neither Chester Knee Clinic nor Vladimir Bobic make any warranties or guarantees that the information contained herein is accurate or complete, and are not responsible for any errors or omissions therein, or for the results obtained from the use of such information. Users of this information are encouraged to confirm the accuracy and applicability thereof with other sources. Not all knee conditions and treatment modalities are described on this website. The opinions and methods of diagnosis and treatment change inevitably and rapidly as new information becomes available, and therefore the information in this website does not necessarily represent the most current thoughts or methods. The content of this website is provided for information only and is not intended to be used for diagnosis or treatment or as a substitute for consultation with your own doctor or a specialist. Email addresses supplied are provided for basic enquiries and should not be used for urgent or emergency requests, treatment of any knee injuries or conditions or to transmit confidential or medical information. If you have sustained a knee injury or have a medical condition, you should promptly seek appropriate medical advice from your local doctor. Any opinions or information, unless otherwise stated, are those of Vladimir Bobic, and in no way claim to represent the views of any other medical professionals or institutions, including Nuffield Health and Spire Hospitals. Chester Knee Clinic will not be liable for any direct, indirect, consequential, special, exemplary, or other damages, loss or injury to persons which may occur by the user's reliance on any statements, information or advice contained in this website. Chester Knee Clinic is not responsible for the content of external websites.

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