David A. Kolin, Tracey L. Hunter, Joseph A. Ogyaadu, Henry O. Duah, Henry O. Tutu, Anthony Bandoh, Prudence Nutsuklo, Kwadwo Boachie-Adjei, Kaitlin M. Carroll, Vijay B. Vad
Effectiveness of Carboplasty for Severe Knee Osteoarthritis in Ghana
Introduction: Osteoarthritis is a debilitating joint disease affecting about 251 million people worldwide. The total knee arthroplasty (TKA) is one of the most effective treatments for severe osteoarthritis; however, this surgery has considerable costs, complication risks, and access limitations for marginalized populations. Alternative treatments are in demand to help combat the growing prevalence of osteoarthritis. In low-income countries such as Ghana, TKA surgeries are infrequent. This study investigates the efficacy of carboplasty in reducing osteoarthritis-induced disability in Ghana.
Design: Sixteen patients with severe knee osteoarthritis were prospectively recruited to undergo carboplasty at a hospital in Ghana. Carboplasty is a novel, inexpensive procedure that introduces autologous mesenchymal stem cells into the chondral-bone interface using PeCaboo, a percutaneous cartilage-bone optimization system. Age, sex, body-mass index (BMI), Veterans RAND 12-item health survey (VR-12), Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were measured at baseline and at three months, six months, and one year following carboplasty. One-way analysis of variance (ANOVA) was used to assess patient-reported outcome measures.
Results: Thirteen patients who completed follow-up had a mean age of 56.5 years (range, 39 to 80) and 11 (84.6%) were female. Three months after the procedure, VR-12, VAS, WOMAC, and KOOS were 1.87 (95% CI, 1.42-2.32), 29.46 (95% CI; 18.41-40.51), 0.14 (95% CI; 0.05-0.23), and 77.21 (95% CI, 69.04-85.38), respectively. After 3 months, all four patient reported outcome measures trended towards their baseline values.
Conclusions: In Ghana, carboplasty has benefits for patients with severe knee osteoarthritis. The procedure provides a 3-month relief of pain and dysfunction and can be re-administered repeatedly. Minimally invasive outpatient carboplasty can be a more cost-effective treatment option than TKA. Results from a large randomized-controlled trial could confirm the safety, efficacy, and cost-effectiveness of carboplasty.