Rare treatment for arthritis wins approval for use on NHS

Release Date: 20/10/2017

Rare treatment for arthritis wins approval for use on NHS

A rare treatment for a type of arthritis in the knee – currently only offered at The Robert Jones and Agnes Hunt Orthopaedic Hospital (RJAH) in Shropshire – has won official approval to be funded by the NHS.

Autologous Chondrocyte Implantation (ACI) is a technique used to help patients with an articular cartilage defect, something that can impact younger people in their 20s and 30s – sometimes as a result of a sporting injury.

The procedure sees a sample of cartilage removed from the patient’s knee from which their own cells are then grown in a laboratory, a process which takes around three weeks. These cells, known as chondrocytes, are returned into the patient’s defect area in a second surgical procedure.
 


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ACI clinical trials have been running in several locations over a period of years, but it was only this month that, following extensive appraisal, the National Institute for Health and Care Excellence (NICE) concluded the volume of evidence to be enough to approve the technique for wider use on the NHS.

RJAH is the only site in the UK currently able to offer ACI. The specialist orthopaedic hospital has been working in partnership with Keele University and the Oswestry-based Orthopaedic Institute; the trio setting up the Oscell Cell Manufacturing Facility to produce the chondrocytes.

ACI procedures are performed at RJAH by Professor James Richardson and Mr Pete Gallacher, both experienced Consultant Orthopaedic Surgeons.

Professor Richardson said: “This facility has provided treatment to over 400 patients from across the UK in the last 20 years, along with many published studies of the outcome of ACI in the knee and ankle.

“ACI can help patients who have a particular defect or early arthritis, one which starts with what appears as a small pothole on the surface of the knee. When the normal, smooth surface is broken in this fashion it may not heal naturally.

“We take a small sample of cartilage out and grow cells up in the lab. These cells are then put back into the patient’s knee in what is a second, bigger operation.

“The patients are usually only in hospital for two days post-operatively, 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.”

The announcement that ACI would now be made available on the NHS was made at the 11th annual Oswestry Cartilage Symposium, hosted by RJAH earlier this month, at which 80 specialists from the Arthritis Research UK Tissue Engineering Centre and others from around the world were gathered.

ACI can only be offered to patients who meet a number of defined criteria as set out by NICE in their guidance note TA477, which can be read here.

These criteria include that the patient must not have had previous surgery to repair articular cartilage defects, as evidence from previous trials has shown ACI to be much less effective in these cases.

There should also be minimal osteoarthritic damage to the knee and the defect should be over two square centimetres.

Prof Richardson added: “The typical patient would be under the age of 40 and would be someone who might have picked up an injury playing football which has led to a chondral defect in their knee that causes pain and is tender on examination.

“This patient would otherwise be healthy, with intact ligaments and a straight leg.”

RJAH accepts patients from across the UK. It is important they have the support of their orthopaedic surgeon and an MRI which confirms the diagnosis and satisfies the criteria. Referrals can be made to either Mr Pete Gallacher or Prof James Richardson. 



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