Advanced Knee Osteoarthritis in an Active Male: Biologics or Total Knee Replacement

A healthy 54-year-old man presents to your office for your opinion regarding his progressively worsening right knee pain. At age 24, he underwent a primary anterior cruciate ligament reconstruction as a result of a skiing injury. He subsequently has had 2 arthroscopic surgeries, the first a partial resection undergone 15 years ago for a degenerative tear, followed 5 years later by a complete medial meniscus resection. His pain now interferes with his ability to complete a full round of golf, and he does not want to resort to using a cart. During the previous 2 years, he has tried a variety of treatments, including nonsteroidal anti-inflammatory medications, physical therapy with home exercises, unloader and patellar bracing, 2 corticosteroid injections, and 2 hyaluronic acid injections. He has experienced some temporary relief, but none of these treatments have allowed him to fully engage in golfing. Knee radiographs demonstrate Kellgren-Lawrence Grade 3 osteoarthritis, predominately affecting the medial compartment, but there is tricompartmental involvement. He consulted with an orthopedic surgeon, who recommended a total knee replacement (TKR). A second physician suggested he try stem cell therapy for osteoarthritis. He would like to re-engage in golfing and even skiing, and he seeks your advice regarding whether the total knee replacement (TKR) or stem cell treatment would provide the optimal treatment for his knee pain and function. Dr. Wayne Colizza will argue that a TKR will offer the best possible outcomes. Dr. Victor Ibrahim will argue that stem cell therapy is a viable treatment option for this patient.