At 19, Kent Klawer had the arthritic left shoulder of an 80-year-old man.
The damage almost forced the Riverside college student to forsake competitive swimming.
Now 23, he’s the beneficiary of a promising surgical procedure called the Graftjacket that saved his shoulder, salvaged his swimming stroke and eased his pain.
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Through tiny incisions into the bone, an orthopedic surgeon covered Klawer’s shoulder socket with transplanted cadaver tissue, its cells removed to prevent rejection. The goal was to allow Klawer’s bone marrow to seep into the graft and eventually regenerate cartilage through his own stem cells.
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That’s exactly what happened, said Klawer’s doctor, Joseph Burns. In fact, he said it was the best outcome he’d ever seen in such a severe case of arthritis. Anecdotal testimonials from Klawer and two biopsies have revealed almost-normal cartilage, Burns said.
“My shoulder is so much better,” said Klawer. He got married, enrolled in a master’s program in counseling at California Baptist University and works as a barista at Starbucks.
“I couldn’t hold my arm up at all,” he said. “We’d go out to eat, the waiter would hand me water, and I’d drop the glass on the table.”
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PIONEERING EFFORT
A swimmer since youth, Klawer’s troubles flared up four years ago when he was an undergraduate at Cal Baptist. “The burning and throbbing in my left shoulder was chronic,” he said.
His pain worsened after traditional arthroscopic surgery in March 2006. That summer he returned home to Santa Clarita and consulted Burns at the Southern California Orthopedic Institute in Van Nuys. A shoulder specialist, he’s considered a pioneer in the use of potentially regenerative material instead of the standard plastic or metal.
After Klawer weighed his options, he agreed that August to the surgery, which his insurance covered.
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Burns vetoed the usual shoulder replacement for Klawer — a metal ball and a thick plastic socket– as a poor option for a young person with advanced arthritis. The inserts work well for people in their 70s and 80s, but eventually wear out, Burns said.
Instead, he turned to the burgeoning field of biologics, using materials that come back to life and is especially widespread in hernia repair, wound healing, foot and ankle surgeries.
Burns noted that surgeons have grafted tissues from cadavers in patients’ shoulders to repair torn rotator cuffs with “very good success” in the past eight years. But using grafts to reconstruct an arthritic shoulder socket is fairly rare, said Burns.
“When you put the graft in, you’re asking the body to grow into the new matrix, make it come alive,” Burns said. He compared the cadaver tissue to an empty building, populated by the body’s own regenerated cells.
The doctor placed a 4.5-by-3.5 centimeter of skin patch from a cadaver’s low back onto Klawer’s shoulder. With the graft’s cells removed, the patient’s body recognizes the tissue as its own rather than as foreign material to cast off. “The patient’s own stem cells inside the shoulder joint from the bone marrow will differentiate into cartilage cells,” Burns said
Klawer began to feel better in three months when the cells started to regenerate. Unlike a shoulder replacement with a plastic insert, the two-hour Graftjacket procedure can be repeated, Burns said.
Klawer needed 1 ½ years to rehabilitate his shoulder.
“The recovery was long and hard,” Klawer said. He still exercises his rotator cuff and is delighted that the shoulder doesn’t hurt when he swims or lifts his left arm.
Burns predicted that Klawer’s graft should last only three or four years. But of the 15 patients with arthritic shoulders on whom he’s performed the surgery, the doctor said that Klawer has shown the most improvement.
“This surgery is the last resort,” Burns said. “I don’t have other good options.”
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