Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2015; 6(9): 655-659
Published online Oct 18, 2015. doi: 10.5312/wjo.v6.i9.655
Recent advances and future directions in the management of knee osteoarthritis: Can biological joint reconstruction replace joint arthroplasty and when?
Nikolaos K Paschos
Nikolaos K Paschos, Department of Biomedical Engineering, University of California, Davis, CA 95616, United States
Author contributions: Paschos NK developed the idea and wrote the manuscript.
Conflict-of-interest statement: The author does not have any conflict of interest related to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nikolaos K Paschos, MD, PhD, Department of Biomedical Engineering, University of California, One shields ave, Davis, CA 95616, United States. npaschos@ucdavis.edu
Telephone: +1-215-8824440 Fax:+1-530-7545739
Received: May 30, 2015
Peer-review started: June 1, 2015
First decision: July 7, 2015
Revised: July 12, 2015
Accepted: August 20, 2015
Article in press: August 21, 2015
Published online: October 18, 2015
Processing time: 144 Days and 4.2 Hours
Abstract

In this article, a concise description of the recent advances in the field of osteoarthritis management is presented. The main focus is to highlight the most promising techniques that emerge in both biological joint replacement and artificial joint arthroplasty. A critical view of high quality evidence regarding outcome and safety profile of these techniques is presented. The potential role of kinematically aligned total knee replacement, navigation, and robotic-assisted surgery is outlined. A critical description of both primary and stem cell-based therapies, the cell homing theory, the use of biologic factors and recent advancements in tissue engineering and regenerative medicine is provided. Based on the current evidence, some thoughts on a realistic approach towards answering these questions are attempted.

Keywords: Osteoarthritis; Biological joint reconstruction; Total joint arthroplasty; Cartilage; Evidence-based

Core tip: In the quest for answers for the future of joint reconstruction, this article explores how feasible is to claim today that biological joint reconstruction will soon replace artificial joint arthroplasty. Will stem cell-based therapies, biologic factors, tissue engineering and regenerative medicine be able to change orthopedic practice in the near future? What is the current evidence? On the other hand, are kinematically aligned total knee replacement, and robotic-assisted surgery able to further advance joint replacement? Based on the current evidence, some thoughts on a realistic approach for the future of joint reconstruction, biological or not, are discussed.