Interview with Dr. med. Michael Schramm, Erlangen, Germany
Dr Schramm, you performed your first Episealer surgery 24 months ago, what convinced you to start using Episealer?
I had discovered the option of the Episealer procedure at the German orthopaedic convention in Berlin in October 2015 and I was very interested in this kind of treatment. In the former years, I had performed a lot of studies in the laboratory for biomechanical research at the FAU-Erlangen University. This is why I am still fascinated by innovative and rationally new methods for biomechanical repair of cartilage defects. What attracted me the most was the individual design matching the anatomic surface. I do have a very good experience using such technologies with total knee procedures. I also believe in the function of the hydroxyapatite- covered surface bonding to the bone and the cementless press-fit application.
What made you decide to use Episealer for your first patients?
In June 2016 I got a special patient referred for arthroscopic treatment. A 66-year old woman with an isolated osteochondral lesion at the medial femoral condyle and the tibial surface was intact. I performed arthroscopy with microfracturing of the damaged area.
She was still in pain following the arthroscopy with microfracturing, she still suffered from effusions of the joint. She obviously needed treatment, but not yet a total knee or a hemiarthroplasty as the tibia was not affected by chondral lesions, also the lateral side and the ligaments were intact. In her case, the origin of the defect was most likely vascular, like an Ahlbäck disease, but not as big and spread as you would usually expect. There was a treatment gap.
I considered the case ideal for the Episealer procedure. So I started to get into close contact with the experts for it. I performed the requested special MRI and discussed the case with Prof Leif Ryd from Sweden. The MRI findings with an osteochondral defect, isolated at the distal medial femur, an Episealer could cover her cartilage defect well and it filled the treatment gap. Therefore it was my treatment of choice.
How is the patient doing today, 24 months after the surgery?
She reports nearly no pain at her operated knee, the VAS Score is rated 1- 2. She is not limited considering walking distance or walking time. She uses no crutches or braces and has a slim joint line without effusions. ADL activities are not compromised. The radiographs demonstrate a very good position of the twin implant, no loosening, no radiographic evidence of progression of the osteoarthrosis.
With the existing experience of 4 procedures, how does Episealer suit your practice?
The Episealer fits very well into my portfolio of surgeries. It is filling a treatment gap. Up to now four successful cases have convinced me a lot of the usefulness of this individually shaped device. All of those four patients stopped suffering from the typical pain originating from the osteochondral lesions immediately after surgery. I am looking forward to my next upcoming cases!