May 2, 1999

Note:  Below this article is an email sent to me by Susan L who relates what she believes was a much earlier knee transplant.    Doctor Glosser

KNEE

Measuring Success Against a Failure

By LAWRENCE K. ALTMAN

ere it not for the novel work of a German surgeon, it is unlikely that Mr. Hallam and Mr. Scott would have new hands.

In April 1996, the surgeon, Dr. Gunther O. Hofmann, transplanted a knee to an accident victim who otherwise would have undergone amputations or walked with a rigid leg.

That patient, and three other men after him, sought knee transplants and accepted the risks of immunosuppression drugs because they wanted to continue to be athletic.

Now the men, aged 17 to 47, have resumed working, surfboarding and participating in other sports, Dr. Hofmann said in an interview from his clinic in Murnau, near Munich.

Like hand transplants, the knee operations involve transplanting several types of tissue at the same time -- arteries, veins, bone, bone marrow, cartilage, ligaments and muscle. Unlike the hand, they do not involve skin and nerves.

The success of Dr. Hofmann, who said his clinic is the largest trauma center in southern Germany, was a critical factor in the decision to proceed with the hand transplants.

Dr. Hofmann's team, which has also performed three experimental femur transplants, has established strict medical criteria for selecting patients for knee transplants "because we are aware of the problems with a non-vital transplant," he said.

Only people who have destroyed their knee joint and knee cap and lost the ability to straighten a leg are eligible. The injury must have occurred within the last six months. And the team will not operate on any candidate for an artificial knee joint or other procedure to repair or reconstruct the joint.

Still, Dr. Hofmann estimated that he would have performed 50 knee transplants by now, except for difficulties in finding enough donors.

The four men who received new knees have varying limitations in movement, but all are vastly better off than without a transplant, Dr. Hofmann said.

One, a German dentist, has resumed full-time practice in Spain. A second, Elmar Deugebauer, works for U.P.S. in Germany and does heavy lifting. "He should not, but he does," Dr. Hofmann said. The two other men, who had to change careers because of their injuries, are in business school. One had had 30 operations before the knee transplant.

Dr. Llull, the plastic and transplant surgeon at the University of Pittsburgh who went to Murnau to examine the knee patients, said he was "astonished" when he visited Dr. Hofmann's clinic. "They had fabulous results," Dr. Llull said.

The U.P.S. worker was so enthusiastic about the surgery that he drove 700 miles to show off his knee to Dr. Llull, who had the patient walk up and down stairs. The only abnormality he detected was slight swelling, Dr. Llull said.

Dr. Hofmann said he was not aware of any other group that has attempted knee transplants, in part because few orthopedic surgeons have had experience with transplant surgery. "Everyone is waiting for the first five-year results of our program," he said, because "we have had problems."

Dr. Hofmann was referring to a fifth transplant patient, a 32-year-old woman who had undergone two major operations that failed to reconstruct her damaged knee. She suffered two severe leg infections, which Dr. Hofmann's team thought it had controlled before performing the knee transplant. But three weeks after she began taking the anti-rejection drugs, the infection recurred. To beat the infection, she had to stop taking the immunosuppressant drugs, but her body then rejected the new knee. With no working knee joint, she will walk with a rigid leg.