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Giant step for surgery; A revolutionary operation to regrow knee cartilage from scratch is helping patients get back on their feet at a Birmingham hospital. Health Correspondent Alison Dayani goes into theatre to see the breakthrough first hand.

Byline: Alison Dayani

Cartilage. You wouldn't think twice about it until you lost it. Everyone has it, but once it's gone, that's your lot.

Or that's what everyone thought. Unassuming and unappreciated, this tough, shock-absorbing tissue forms even before the skeleton in the womb, but it often wears out around the knee, meaning a life of pain or a complex replacement operation for sports enthusiasts or arthritis sufferers.

Now, through revolutionary advances, cartilage cells that would never regenerate in the body are being re-grown in a petri dish pe·tri dish
n.
A shallow circular dish with a loose-fitting cover, used to culture bacteria or other microorganisms.



Petri dish

a shallow, circular, glass or disposable plastic dish used to grow bacteria on solid media such as agar.
.

Surgeon Ashvin Pimpalnerkar, a consultant in orthopaedics, carries out the rare operation on only ten patients a year at Good Hope Hospital, in Sutton Coldfield Sutton Coldfield, city (1991 pop. 102,572), Birmingham metropolitan district, central England. The city is a residential suburb of Birmingham with a metal products industry and a large television transmitting station. .

He first takes a precise scraping of healthy cells from a patient's knee, and sends them off to grow in a laboratory for eight to ten weeks in Germany before they are returned to be replaced as a full sheet of cartilage.

The procedure is revolutionising not just sports injuries but every-day wear and tear on young patients.

Patients like Helen James, from Rugeley, have been among the lucky few to reap its rewards.

Ms James was a nursery manager at Bushbabies in Sutton Coldfield when she fell badly while demolishing a garden wall around two years ago and damaged her knee to such an extent it locked up and left her in agony.

She was left with no cartilage inside the knee, with bone rubbing directly onto bone. Anxious that her only option was a knee replacement that would wear out in future decades, she was offered the pioneering option.

"Even simple things like sitting on the floor with children at the nursery became impossible and I was living in agony," said Ms James, aged 33.

"I was nervous, but I had no pain when I woke up from surgery and after a while I could start doing exercises again. It's mind-blowing to think that cartilage was taken out of my knee and re-grown.

"It's very odd but amazing a·maze  
v. a·mazed, a·maz·ing, a·maz·es

v.tr.
1. To affect with great wonder; astonish. See Synonyms at surprise.

2. Obsolete To bewilder; perplex.

v.intr.
 too. It's a shame that not many people get this operation."

Mr Pimpalnerkar is keen to do more such operations but said: "It is quite an expensive procedure, so this is aimed at younger patients or traumatic sports injuries at the moment.

Most tend to be under 40 and do things like skiing. Cells are impregnated im·preg·nate  
tr.v. im·preg·nat·ed, im·preg·nat·ing, im·preg·nates
1. To make pregnant; inseminate.

2. To fertilize (an ovum, for example).

3.
 on to a graft where they grow and the cartilage is replaced like for like when put back in.

"It is like a hole in an ice skating ice skating, gliding along an ice surface on keellike runners known as ice skates. Skating as a Sport


Skating, besides being an important form of winter recreation and the essential skill in the game of ice hockey (see hockey, ice) has developed
 rink - I am laying a new piece of ice."

The patch of cartilage that the surgeon has laid out in front of him has come directly from the Braun laboratory in Germany for this operation on his latest patient Gurvinder Sihota, a 39-year-old gas engineer from Perry Barr Perry Barr is an area in north Birmingham, England.

It is also a council constituency, managed by its own district committee. The constituency includes the smaller Perry Barr ward and the wards of Handsworth Wood, Lozells and East Handsworth, and Oscott.
.

It has spent weeks growing from Mr Sihota's original sample and now has 11 million cells within its fiveinch-squared area.

"Cartilage cells don't multiply, that is why they have to go to a lab where growth factors are added," said Mr Pimpalnerkar.

"You can't trip up with these cells or sneeze sneeze, involuntary violent expiration of air through the nose and mouth. It results from stimulation of the nervous system in the nose, causing sudden contraction of the muscles of expiration.  on them or its all over.

"It is an amazing breakthrough and something that may become the norm one day in the future."

It takes barely an hour to cut into the knee and lay down fresh cartilage, which is carefully attached to the knee with absorbable stitches.

For patient Mr Sihota it is a medical miracle that now means he can climb the stairs, go running and chase after the children pain-free.

He was lying on some grass when a friend jumped on top of him in a prank four years ago, but that joke caused irrepairable damage to ligaments in his knee.

"The surgery available now is so advanced," said Mr Sihota. "I thought that my injury would affect me for life, but that isn't the case any more.

"It's fantastic to think that part of me was grown in a lab and put back in my body.

"Who knows what the future holds?" FACTFILE Cartilage is a tissue containing very few cells and not supplied with blood vessels, which means its regeneration capabilities are limited Every step you take puts a load five-and-half times the body weight on to the knee and jumping increases it even more Patients are back up and walking six weeks after the operation More than 70,000 knee replacements are carried out in England and Wales England and Wales are both constituent countries of the United Kingdom, that together share a single legal system: English law. Legislatively, England and Wales are treated as a single unit (see State (law)) for the conflict of laws.  each year but that number is rising

CAPTION(S):

The operation has given Helen James a new lease of life The new piece of cartilage being prepared and then inserted into the knee of patient Gurvinder Sihota, pictured bottom Surgeon Ashvin Pimpalnerkar preparing for the revolutionary knee operation at Good Hope Hospital in Sutton Coldfield
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Publication:The Birmingham Post (England)
Date:Jun 3, 2010
Words:795
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