Initial tissue repair predicts long-term clinical success of knee joint distraction as treatment for knee osteoarthritis

Objective In end-stage knee osteoarthritis, total knee arthroplasty (TKA) may finally become inevitable. At a relatively young age, this comes with the risk of future revision surgery. Therefore, in these cases, joint preserving surgery such as knee joint distraction (KJD) is preferred. Here we present 5-year follow-up data of KJD. Design Patients ( n = 20; age <60 years) with conservative therapy resistant tibiofemoral osteoarthritis considered for TKA were treated. Clinical evaluation was performed by questionnaires. Change in cartilage thickness was quantified on radiographs and magnetic resonance images (MRI). The 5-year changes after KJD were evaluated and compared with the natural progression of osteoarthritis using Osteoarthritis Initiative data. Results Five-years posttreatment, patients still reported clinical improvement from baseline: ΔWOMAC (Western Ontario and McMaster Universities Arthritis Index) +21.1 points (95% CI +8.9 to +33.3; P = 0.002), ΔVAS (visual analogue scale score) pain −27.6 mm (95%CI −13.3 to −42.0; P < 0.001), and minimum radiographic joint space width (JSW) of the most affected compartment (MAC) remained increased as well: Δ +0.43 mm (95% CI +0.02 to +0.84; P = 0.040). Improvement of mean JSW (x-ray) and mean cartilage thickness (MRI) of the MAC, were not statistically different from baseline anymore (Δ +0.26 mm; P = 0.370, and Δ +0.23 mm; P = 0.177). Multivariable linear regression analysis indicated that KJD treatment was associated with significantly less progression in mean and min JSW (x-ray) and mean cartilage thickness (MRI) compared with natural progression (all Ps <0.001). Conclusions KJD treatment results in prolonged clinical benefit, potentially explained by an initial boost of cartilaginous tissue repair that provides a long-term tissue structure benefit as compared to natural progression. Level of evidence, II.

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Knee joint distraction in regular care for treatment of knee osteoarthritis: A comparison with clinical trial data

PLoS ONE ◽

10.1371/journal.pone.0227975 ◽

2020 ◽

Vol 15 (1) ◽

pp. e0227975 ◽

Cited By ~ 5

Author(s):

Mylène P. Jansen ◽

Simon C. Mastbergen ◽

Ronald J. van Heerwaarden ◽

Sander Spruijt ◽

Michelle D. van Empelen ◽

...

Keyword(s):

Clinical Trial ◽

Knee Joint ◽

Knee Osteoarthritis ◽

Clinical Trial Data ◽

Trial Data ◽

Regular Care ◽

Joint Distraction

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Knee Joint Distraction as Treatment for Osteoarthritis Results in Clinical and Structural Benefit: A Systematic Review and Meta-Analysis of the Limited Number of Studies and Patients Available

Cartilage ◽

10.1177/1947603520942945 ◽

2020 ◽

pp. 194760352094294

Author(s):

Mylène P. Jansen ◽

Tim A.E.J. Boymans ◽

Roel J.H. Custers ◽

Rutger C.I. Van Geenen ◽

Ronald J. Van Heerwaarden ◽

...

Keyword(s):

Systematic Review ◽

Knee Joint ◽

Structural Parameters ◽

Meta Analysis ◽

Tibial Osteotomy ◽

Control Groups ◽

Joint Distraction ◽

Short And Long Term

Objective Knee joint distraction (KJD) is a joint-preserving osteoarthritis treatment that may postpone a total knee arthroplasty (TKA) in younger patients. This systematic review and meta-analysis evaluates short- and long-term clinical benefit and tissue structure changes after KJD. Design MEDLINE, EMBASE, and Web of Science were searched for eligible clinical studies evaluating at least one of the primary parameters: WOMAC, VAS-pain, KOOS, EQ5D, radiographic joint space width or MRI cartilage thickness after KJD. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies. Results Eleven articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups with multiple follow-up moments were included, of which 2 were randomized controlled trials. Significant improvements in all primary parameters were found and benefit lasted up to at least 9 years. Overall, outcomes were comparable with control groups, including high tibial osteotomy, although TKA showed better clinical response. Conclusions Current, still limited, evidence shows KJD causes clear benefit in clinical and structural parameters, both short- and long-term. Longer follow-up with more patients is necessary, to validate outcome and to potentially improve patient selection for this intensive treatment. Thus far, for younger knee osteoarthritis patients, KJD may be an option to consider.

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Knee joint distraction as standard of care treatment for knee osteoarthritis: a comparison with clinical trial patients

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2019.02.589 ◽

2019 ◽

Vol 27 ◽

pp. S515-S516 ◽

Cited By ~ 1

Author(s):

M. Jansen ◽

S.C. Mastbergen ◽

M.D. Van Empelen ◽

E.C. Kester ◽

F.P. Lafeber ◽

...

Keyword(s):

Clinical Trial ◽

Knee Joint ◽

Knee Osteoarthritis ◽

Standard Of Care ◽

Care Treatment ◽

Joint Distraction ◽

Standard Of Care Treatment

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Clinical outcomes of knee joint distraction combined with marrow stimulation procedures for patients with advanced knee osteoarthritis

The Knee ◽

10.1016/j.knee.2021.10.007 ◽

2021 ◽

Vol 33 ◽

pp. 342-350

Author(s):

Nobuo Adachi ◽

Seiju Hayashi ◽

Atsuo Nakamae ◽

Masakazu Ishikawa ◽

Goki Kamei ◽

...

Keyword(s):

Knee Joint ◽

Knee Osteoarthritis ◽

Clinical Outcomes ◽

Marrow Stimulation ◽

Joint Distraction

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Six weeks of continuous joint distraction appears sufficient for clinical benefit and cartilaginous tissue repair in the treatment of knee osteoarthritis

The Knee ◽

10.1016/j.knee.2016.05.001 ◽

2016 ◽

Vol 23 (5) ◽

pp. 785-791 ◽

Cited By ~ 13

Author(s):

J.A.D. van der Woude ◽

R.J. van Heerwaarden ◽

S. Spruijt ◽

F. Eckstein ◽

S. Maschek ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Clinical Benefit ◽

Tissue Repair ◽

Cartilaginous Tissue ◽

Joint Distraction

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The temporal effect of intra-articular ozone injections on pain in knee osteoarthritis

British Medical Bulletin ◽

10.1093/bmb/ldz028 ◽

2019 ◽

Cited By ~ 1

Author(s):

Antonio Oliviero ◽

Lorenzo Giordano ◽

Nicola Maffulli

Keyword(s):

Quality Of Life ◽

Pain Relief ◽

Knee Joint ◽

Knee Osteoarthritis ◽

Joint Pain ◽

Therapeutic Modality ◽

Ozone Therapy ◽

Treatment Protocols

Abstract Background Osteoarthritis (OA) is a most common orthopaedic condition, often complicated by inflammatory features. Sources of data A systematic search in PubMed, Embase, Google Scholar and Scopus databases (to January 2019) was performed to define the effect obtained in patients with OA of the knee by injections of ozone, on pain and physical function. Six RCTs and 353 patients were included. Areas of agreement Recently, an increasing number of physicians have used ozone therapy to alleviate the symptoms of acute and chronic OA of the knee. Ozone can allow greater mobility of the knee joint, pain relief and decrease in effusion. Areas of controversy The volume and concentration of ozone injected are different in the various treatment protocols published. Growing points The action of ozone is unclear, but it is a promising therapeutic modality capable of impacting, favourably, function and quality of life. Areas timely for developing research The lack of a clear protocol of use is a major limitation, and to date there is no clear evidence of long-term efficacy.

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