Cartilage cell transplantation procedure for arthritis approved by NHS

A researcher in a lab using a pipette.

Patients with a certain form of arthritis have a new preventative treatment option available to them, following the recent NHS approval of a cutting-edge cartilage cell transplantation procedure.

Autologous chondrocyte implantation (ACI) has won approval to be funded across the NHS thanks to a growing body of clinical evidence – supported by Versus Arthritis and others – that has conclusively demonstrated the considerable benefits the technique offers.

How the procedure works

ACI is designed to help patients who have small areas of cartilage damage or early osteoarthritis of the knee. These conditions can often affect younger people in their 20s and 30s, sometimes as the result of a sporting injury.

The procedure sees a sample of cartilage removed from the knee, allowing doctors to grow a fresh supply of healthy cells that are native to the patient's body in a laboratory, a process that takes around three weeks. These chondrocyte cells can then be returned to the affected area in a second surgical procedure.

Following this process, the cells anchor themselves to the bone within 24 hours, resulting in fresh cartilage growth at the damaged site. Patients can expect to resume everyday use of the joint in three months and full activities including sports after 12 months, making this a much better option for younger patients than knee replacement, which was previously the only alternative treatment.

A growing body of supporting evidence

Before the recent decision to approve this treatment for full NHS funding, ACI was only available at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, Shropshire.

However, further studies of the procedure have been ongoing in numerous locations in recent years to prove the considerable benefits that ACI can offer. Research carried out by the Arthritis Research UK Tissue Engineering Centre and the ASCOT clinical trial, led by Professor Sally Roberts and also funded by Versus Arthritis, have contributed evidence that helped to secure the eventual approval.

Their research highlighted a number of factors – including age, gender, location and number of defects, and the number of previous operations – that can all affect the chances of ACI succeeding, giving doctors valuable guidance in determining which patients are most likely to benefit.

As such, ACI has now been approved for the treatment of patients who have not had previous surgery to repair articular cartilage defects, with minimal osteoarthritic damage to the knee, and defects that measure over two square cm.

The experts' view

Professor James Richardson, an experienced consultant orthopaedic surgeon performing this procedure at the Robert Jones and Agnes Hunt Orthopaedic Hospital, said: "The patients are usually only in hospital for two days postoperatively, though there is a lot of rehabilitation and physiotherapy to follow after that. The results we have seen have been positive, particularly if the patient has not had prior microfracture."

Dr Stephen Simpson, director of research at Versus Arthritis, said: "It is certainly positive news that, thanks to the valuable research in this area, ACI is being made available on the NHS. This means that more people with this type of cartilage damage or early osteoarthritis will be able to access and potentially benefit from this treatment.

"Osteoarthritis affects over eight million people in the UK and can have a devastating impact on daily life, making things like getting dressed or going to work difficult. We're determined to prevent people from experiencing these challenges and this development is a fantastic example of how our funded research can deliver clinical advances and help more people to live the pain-free life they deserve."