Dr. Hangody is the Senior Consultant Orthopaedic and Trauma Surgeon at Uzsoki Hospital in Budapest, Hungary. He also lectures and presents his research findings through Europe and the United States and sees patients at his private practice – Sanitas Private Clinic – in Budapest. This year, Dr. Hangody was elected President of the Hungarian Orthopaedic Society. The main focus of his current research is cartilage repair and revision surgery of Anterior Cruciate Ligament (ACL) injuries. He pioneered the mosaicplasty procedure as a way to repair damaged knee cartilage.
Knee1: You are noted as being the first orthopedic surgeon to perform a Mosaicplasty – Osteochondral (Bone/Cartilage) Transfer Procedure – in a knee. How did you develop this procedure?
Dr. Hangody: During my daily work, I was really interested to find a better solution for full-thickness cartilage defects (injuries) than the traditional techniques. One of the biggest problems was to solve the congruency problem of the resurfaced area. There are only limited areas in the knee that could serve as donor sites for an osteochondral transplantation. Usually there is not enough field for graft harvest, and the shape of this area is different from the recipient site. The mosaicplasty concept involves a harvest of several small grafts instead of one big block. A mosaic like implantation technique can result in a good congruency.
Knee1: What types of injuries/conditions would require someone to have mosaicplasty?
Dr. Hangody: Focal chondral or osteochondral defects of the weight bearing surfaces between 1-4 cm²: are the best indications. This technique can be used mainly in the knee, ankle and sometimes in the hip, elbow and shoulder.
Ed. Note: Doctors use mosaicplasty most commonly to treat Osteochondritis Dissecans (OCD), a condition in which cartilage and bone partially or completely tear away from where they belong.
Knee1: How long did it take for you to perfect this procedure?
Dr. Hangody: I had the idea in 1991. After pre-clinical experimental studies and cadaver works (to develop an appropriate instrumentation) we introduced the mosaicplasty into the clinical practice at 6th February 1992. The initial work to perfect the procedure took about one-and-a-half years, but we continued our development work to create an arthroscopic solution and this did take about additional two-and-a-half years.
Knee1: Do you see mosaicplasty as your greatest contribution thus far to orthopedic medicine?
Dr. Hangody: Yes, I think, that this is now the most popular modern cartilage repair technique all over the world, so I’m really to proud to provide a new idea for the daily orthopaedic practice. I am really proud to know that the initial phase of the mosaicplasty development was carried out by Hungarian participants: orthopaedic surgeons, histologic experts, medical engineers etc. Hungary is a small country with limited financial capacity for basic science, so I think that the mosaicplasty project was a valuable contribution for the whole world.
Knee1: You work in both a public hospital in Hungary as well as in your own private practice. In what areas of orthopedic medicine are you currently focusing your efforts?
Dr. Hangody: My main field is sports medicine and spine surgery. My special focus in the experimental work is cartilage repair and ACL-PCL surgery … because of the frequency of severe cartilage (injuries) in my daily work. This is one of our most frequent problems.
I do about 500 arthroscopies per year, and cartilage problems are very common during my daily work. During my clinical practice I use mosaicplasty, microfracture, periosteal transplantation and, in rare situations, chondrocyte transplantation to treat focal chondral defects. Beside my clinical experiences, I (have done) experimental work in this field in the last twelve years. I tried to find something new and useful for the daily orthopaedic practice. I think that the mosaicplasty is something that fulfills these expectations.
Knee1: Where do you see cartilage repair research heading in the next few years?
Dr. Hangody: I think that the cartilage repair is a revolutionary area of the orthopaedics. In the recent ten years we have already achieved a reasonable advance comparing to the former period, but we are looking forward to see further successes in this field. I’m sure that in the future the new developments of this area will significantly decrease the number of knee prostheses (knee replacement) candidates. Mosaicplasty and other new forms of hyaline or hyaline-like resurfacements represent an ideal preventative and post-injury treatment option.
Knee1: In 2000, you received the title of "Doctor of the Hungarian Scientific Academy." How did you achieve this honor?
Dr. Hangody: I have been working in the basic science of the cartilage repair field since 1989. I have done a lot of clinical and experimental work to check the clinical outcome of the present therapeutic options and develop new alternatives. In 1994 I collected the results of the first 5 years and achieved the Ph.D. title. After that I continued my work on the same field and a summary of the forthcoming 6 years resulted in the D.Sc. title (Doctor of the Hungarian Scientific Academy). I am really proud to have this title, as I achieved this honour from a public hospital instead of a university clinic.
Knee1: Can you talk about any of your work as a Consulting Physician with Smith & Nephew Endoscopy?
Dr. Hangody: After my initial Hungarian development of the mosaicplasty instrumentation, I have collaborated with the Smith and Nephew Endoscopy since 1996. We developed together the arthroscopic mosaicplasty instrumentation. One of the best engineer in the endoscopy field, Mike Ferragamo, provided me very valuable collaboration and perfect conditions for the development of this very precise and user-friendly instrumentation.
Knee1: What have been some of your greatest challenges practicing medicine? How have you overcome them?
Dr. Hangody: One of my greatest challenges in the practicing medicine is to find a good harmony between the trauma and orthopaedic field. My main satisfaction is to be a successful surgeon in my daily work. Scientific achievements also represent a proud to my experimental efforts. I hope, that in the future I will find a harmony between the daily practice and the research work. I am really happy with my actual focuses: cartilage repair, ligament surgery and spine surgery. I hope, that I can continue my experimental work in these fields.