Knee and hip transplants, rather than artificial joints, can be the best treatment for young, active people who need replacement joints, says Dr. Allan Gross, a University of Toronto orthopedic surgeon and pioneer in the field.
One of Gross' next patients will be a 15-year-old Baltimore County youth who fractured his hip in 1989 in a water skiing accident.
For 18 years, Gross has used cartilage and the underlying bone of knee joints from healthy donors under 30 who die in car crashes to help others whose joints have been destroyed by similar violence. The recipients will be able to walk and even engage in some sports again.
Cartilage, situated on the surface of a joint, is a dense connective tissue that can withstand pressure.
More recently, Gross has branched out into hip transplants, applying the same technique developed originally for knee transplants by the University of Toronto's division of orthopedics, which he heads.
"We perform between 10 and 20 transplants a year on patients with post-traumatic defects caused by injuries due primarily to high impact motor vehicle accidents, leading to the loss of one-quarter to one-third of the joint," Gross said in a telephone interview.
"Because this surgery is so unique, we get patients from all over the world including Australia, Israel, South America and Germany, in addition to the United States."
Within the next few months -- or as soon as a donor can be found -- Gross is scheduled to do his fourth experimental hip transplant. His patient will be 15-year-old Jonathan Kehl of Bowley's Quarters.
Kehl has been diagnosed as having avascular osteo necrosis, or bone death, caused by a lack of blood flowing into the hip. He has spent most of the past two years on crutches.
"If Jonathan's transplant is successful, he will be able to return to leisure sports -- sports that do not involve competition," Gross said.
Football and baseball star Bo Jackson, who was released in mid-March by the Kansas City Royals after a fracture dislocation reportedly caused some joint deterioration of his left hip, is not a candidate for the Canadian program, the specialist said.
"Bo Jackson is far, far too active," said Gross, who does the transplants at the University-affiliated Mount Sinai Hospital. "He could not be transplanted and return to that level." According to some orthopedic experts, the best treatment for Jackson might be "non-surgical -- just waiting and letting the hip heal."
Increasing attention is being paid to the emerging field of transplantation now "because of the need to replace large and small defects due to tumors, trauma and congenital problems," said Dr. John Garrett, who heads a group practice of orthopedists in Atlanta.
Garrett is one of a handful of orthopedists in this country who, since the early 1980s, have been doing the same kind of transplants as Gross. While Garrett concentrates on the knees only, he and Gross both use "fresh grafts" as opposed to "frozen grafts."
"The advantage of using fresh grafts is that the cartilage is still alive," said Gross. "And, if it's in a good situation and everything goes well, it's accepted by the host and it remains alive."
Other programs are under way at Harvard University, the University of California at San Diego and the University of Miami in Florida. Similar work is being done in Hanover, Germany.
"I've studied with Dr. Henry Mankin at Harvard and Dr. Gross and we've learned from each other," Garrett said. "Gross is the best man for the Baltimore area teen-ager. When a person has avascular osteo necrosis, the transplant does not do as well in the knee as it does in the hip."
A long-term study by Gross of 51 patients who received knee joint transplants within 24 hours of the donor's death showed success in 76 percent after an average follow-up time of 4.3 years. The patients returned to normal activities without pain and the graft was accepted, Gross explained.
ZTC The study also found that after an average of 14 years, 72 percent of the transplants were still in place or functioning without need for additional surgery. The study concluded that the transplants work best in people under 50.
Gross' findings were reported April 21 in Washington during an international symposium sponsored by the Musculoskeletal Transplantation Foundation, a non-profit consortium of 13 medical schools, affiliated hospitals and organ procurement organizations.
So far, Gross has done 189 fresh grafts -- 178 on the knee, three on the hip, four on the elbow and four on the ankle. "We have the biggest series with the longest follow-up," he said.
Donors are located by the Multiple Organ Retrieval and Exchange Programme of Toronto and must meet the criteria outlined by the American Association of Tissue Banks.