Knee joint distraction results in MRI cartilage thickness increase up to ten years after treatment

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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Changes in Cartilage Thickness and Denuded Bone Area after Knee Joint Distraction and High Tibial Osteotomy—Post-Hoc Analyses of Two Randomized Controlled Trials

Journal of Clinical Medicine ◽

10.3390/jcm10020368 ◽

2021 ◽

Vol 10 (2) ◽

pp. 368

Author(s):

Mylène P. Jansen ◽

Susanne Maschek ◽

Ronald J. van Heerwaarden ◽

Simon C. Mastbergen ◽

Wolfgang Wirth ◽

...

Keyword(s):

Knee Joint ◽

Knee Osteoarthritis ◽

High Tibial Osteotomy ◽

Cartilage Thickness ◽

Effect Sizes ◽

Tibial Osteotomy ◽

Bone Area ◽

Cartilage Restoration ◽

Joint Distraction ◽

Post Hoc

High tibial osteotomy (HTO) and knee joint distraction (KJD) are joint-preserving treatments that unload the more affected compartment (MAC) in knee osteoarthritis. This post-hoc study compares two-year cartilage-thickness changes after treatment with KJD vs. HTO, and identifies factors predicting cartilage restoration. Patients indicated for HTO were randomized to KJD (KJDHTO) or HTO treatment. Patients indicated for total knee arthroplasty received KJD (KJDTKA). Outcomes were the MRI mean MAC cartilage thickness and percentage of denuded bone area (dABp) change two years after treatment, using radiographic joint space width (JSW) as the reference. Cohen’s d was used for between-group effect sizes. Post-treatment, KJDHTO patients (n = 18) did not show significant changes. HTO patients (n = 33) displayed a decrease in MAC cartilage thickness and an increase in dABp, but an increase in JSW. KJDTKA (n = 18) showed an increase in MAC cartilage thickness and JSW, and a decrease in dABp. Osteoarthritis severity was the strongest predictor of cartilage restoration. Kellgren–Lawrence grade ≥3 showed significant restoration (p < 0.01) after KJD; grade ≤2 did not. Effect sizes between severe KJD and HTO patients were large for MAC MRI cartilage thickness (d = 1.09; p = 0.005) and dABp (d = 1.13; p = 0.003), but not radiographic JSW (d = 0.28; p = 0.521). This suggests that in knee osteoarthritis patients with high disease severity, KJD may be more efficient in restoring cartilage thickness.

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POS1091 KNEE JOINT DISTRACTION RESULTS IN MRI CARTILAGE THICKNESS INCREASE UP TO TEN YEARS AFTER TREATMENT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1321 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 825.1-825

Author(s):

M. Jansen ◽

S. Mastbergen ◽

T. D. Turmezei ◽

J. W. Mackay ◽

F. Lafeber

Keyword(s):

Cartilage Regeneration ◽

Cartilage Thickness ◽

Short Term ◽

Thickness Increase ◽

Time Points ◽

Joint Distraction ◽

Mri Scans ◽

Pre Treatment ◽

Changes Over Time

Background:Knee joint distraction (KJD) is a joint-preserving treatment option for younger (age <65 years) knee osteoarthritis (OA) patients. It has shown clinical improvement for up to nine years after treatment. Radiographs and MRI scans have previously shown cartilage regeneration activity, especially in the first two years after treatment. However, MRIs have not been evaluated more than five years after this treatment.Objectives:To evaluate MRI cartilage thickness up to ten years after KJD treatment.Methods:Patients (n=20) with end-stage knee OA, indicated for total knee arthroplasty (TKA) but <60 years old, were treated with KJD. 3T MRIs with 3D spoiled gradient recalled imaging sequence with fat suppression (SPGR-fs) were acquired before and one, two, five, seven and ten years after surgical treatment. Stradview v6.0 was used for semi-automatic cartilage segmentation; wxRegSurf v18 was used for surface registration. MATLAB R2020a and the SurfStat MATLAB package were used for data analysis and visualization. For changes over time, linear mixed models were used. Two separate linear regression models were used to show the influence of baseline Kellgren-Lawrence grade and sex on the changes over time. Statistical significance was calculated with statistical parametric mapping; a p-value <0.05 was considered statistically significant. Since KJD has previously shown significant results mostly in the patients’ most affected compartment (MAC), patients were separated in two groups based on whether their MAC was the medial or lateral compartment.Results:The MAC was predominantly the medial side (medial MAC n=18; lateral n=2). The 18 patients with a medial MAC all had MRI scans at baseline, one and two years after treatment. After two years, some patients were lost to follow-up, decreasing data availability at five (n=15), seven (n=11) and ten years (n=7). Figure 1 (top) shows the average cartilage thickness at the different time points for all medial MAC patients together. One and two years after treatment the cartilage in the medial weight-bearing region was on average thicker than before treatment. While from five years after treatment the cartilage thickness gradually decreased, even at ten years the medial cartilage thickness seemed slightly higher than pre-treatment. Figure 1 (bottom) shows cartilage thickness changes compared to baseline for patients with a medial MAC. Patients with a lateral MAC showed a similar pattern, with the biggest changes showing on the lateral side. As indicated by the dark blue areas, the medial femoral cartilage thickness increase, which was up to 0.5 mm after one year and 0.6 mm after two years, was largely statistically significant at both these time points. While the medial tibia showed an increase of up to 0.5 mm at these time points as well, this was not statistically significant at two years. Surprisingly, long-term results showed areas of the lateral (less affected) compartment were significantly thicker, up to 0.7 mm, compared to pre-treatment in both the femur and tibia compared to baseline. Kellgren-Lawrence grade and sex were shown to influence the changes, albeit not statistically significantly. Patients with a higher Kellgren-Lawrence grade and male sex showed a higher short-term (one and two year) but a lower long-term (seven and ten year) cartilage thickness increase.Conclusion:KJD treatment results in significant short-term cartilage regeneration in the most affected compartment. While after two years this initial gain in cartilage thickness is gradually lost, likely as a result of natural progression, even ten years after treatment the cartilage is thicker than before treatment. In the less affected compartment, a delayed cartilage response seems to take place, with significantly increased cartilage thickness in the long term. In conclusion, in these young OA patients indicated for TKA, KJD results in femoral and tibial cartilaginous tissue regeneration both short- and long-term and in both sides of the joint.Disclosure of Interests:None declared.

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FRI0408 KNEE JOINT DISTRACTION AS TREATMENT FOR OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1317 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 803.1-803

Author(s):

M. Jansen ◽

T. Boymans ◽

R. Custers ◽

R. Van Geenen ◽

R. Van Heerwaarden ◽

...

Keyword(s):

Knee Joint ◽

Cartilage Thickness ◽

Control Groups ◽

Younger Patients ◽

Time Points ◽

Joint Distraction ◽

Short And Long Term ◽

Tract Infections

Background:Knee osteoarthritis (OA) is a common cause of invalidity and is often treated with a total knee arthroplasty (TKA). While TKA is cost-effective, reduces pain and improves function, it brings a greater risk of a future revision surgery when performed in younger patients. Knee joint distraction (KJD) is a joint-preserving OA treatment that may postpone TKA and possibly prevent a revision. In the past years, multiple studies have investigated this surgical treatment.Objectives:To evaluate short- and long-term clinical benefit and tissue structure changes after KJD treatment for knee OA.Methods:MEDLINE, EMBASE and Web of Science were searched for eligible clinical studies evaluating a change in at least one of: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Score of pain (VAS-pain), Knee injury and Osteoarthritis Outcome Score (KOOS), EuroQol-5D (EQ5D), radiographic joint space width (JSW) or MRI cartilage thickness after KJD. The primary clinical and structural outcome parameters were the WOMAC and minimum JSW, respectively. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies. For continuous data the mean difference (MD) and 95% confidence interval (95%CI) were calculated and for dichotomous data the risk difference and 95%CI, following the Cochrane handbook.Results:In total 11 articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups at multiple follow-up moments were included, with 2 of the studies being randomized controlled trials (RCTs). The WOMAC (figure 1) was compared to pre-treatment in 3 cohorts after 1 year (patients n=62) and 2 years (n=59) and in 1 cohort after 5 years (n=20) and 9 years (n=8), showing a significant increase at all time points (all p<0.001). The VAS-pain showed similar results at the same 4 time points, as did the KOOS and EQ5D, which were evaluated only after 1 (n=42) and 2 (n=39) years.The minimum (figure 2) and mean JSW are reported in 3 cohorts after 1 (n=59) and 2 (n=59) years and in 1 cohort after 5 (n=20) and 7 (n=8) years. Both JSW measures were statistically significantly increased after 1 and 2 years, but after 5 and 7 years the JSW increase was no longer statistically significant. Similarly, the MRI cartilage thickness showed an increase at 1 and 2 years, but not at 5 years (all n=20).Complications were reported in 5 studies with 87 patients, with 57 patients developing one or more pin tract skin infections, giving a risk of pin tract infections of 63% (95%CI 45-81), the majority of which could be treated with oral antibiotics. Only a small amount of other complications occurred and were all treated successfully.Overall, clinical and structural outcomes were comparable with control groups, including high tibial osteotomy and TKA as compared after 1 and 2 years in the two RCTs. Apart from pin tract infections, complications were not different in severity and number between control groups and KJD.Conclusion:KJD causes clear benefit in clinical and structural parameters over time, short- and long-term. Although the total number of patients is limited, effect sizes are large. Longer follow-up with more patients is necessary and could improve patient selection for this intensive treatment, while preventing pin tract infections could lighten the patients’ treatment burden. Irrespectively, KJD provides an additional option in joint-preserving treatments for OA and a viable alternative to joint replacement, especially in younger patients.Figure:Disclosure of Interests:Mylène Jansen: None declared, Tim Boymans: None declared, Roel Custers: None declared, Rutger Van Geenen: None declared, Ronald Van Heerwaarden: None declared, Maarten Huizinga: None declared, Jorm Nellensteijn: None declared, Rob Sollie: None declared, Sander Spruijt Consultant of: Consultancy to Zimmer Biomet Inc., Simon Mastbergen: None declared

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Knee joint distraction is more efficient in rebuilding cartilage thickness in the more affected compartment than high tibial osteotomy in patients with knee osteoarthritis

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2019.02.736 ◽

2019 ◽

Vol 27 ◽

pp. S330-S331 ◽

Cited By ~ 2

Author(s):

M.P. Jansen ◽

S. Maschek ◽

R.J. Van Heerwaarden ◽

S.C. Mastbergen ◽

W. Wirth ◽

...

Keyword(s):

Knee Joint ◽

Knee Osteoarthritis ◽

High Tibial Osteotomy ◽

Cartilage Thickness ◽

Tibial Osteotomy ◽

Joint Distraction

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Visualization of Cartilage from Knee Joint Magnetic Resonance Images and Quantitative Assessment to Study the Effect of Age, Gender and Body Mass Index (BMI) in Progressive Osteoarthritis (OA)

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666181018123251 ◽

2019 ◽

Vol 15 (6) ◽

pp. 565-572

Author(s):

Mallikarjunaswamy Shivagangadharaiah Matada ◽

Mallikarjun Sayabanna Holi ◽

Rajesh Raman ◽

Sujana Theja Jayaramu Suvarna

Keyword(s):

Body Mass Index ◽

Magnetic Resonance ◽

Knee Joint ◽

Body Mass ◽

3D Visualization ◽

Cartilage Degradation ◽

Magnetic Resonance Images ◽

Cartilage Thickness ◽

Knee Joints ◽

Data Set

Background: Osteoarthritis (OA) is a degenerative disease of joint cartilage affecting the elderly people around the world. Visualization and quantification of cartilage is very much essential for the assessment of OA and rehabilitation of the affected people. Magnetic Resonance Imaging (MRI) is the most widely used imaging modality in the treatment of knee joint diseases. But there are many challenges in proper visualization and quantification of articular cartilage using MRI. Volume rendering and 3D visualization can provide an overview of anatomy and disease condition of knee joint. In this work, cartilage is segmented from knee joint MRI, visualized in 3D using Volume of Interest (VOI) approach. Methods: Visualization of cartilage helps in the assessment of cartilage degradation in diseased knee joints. Cartilage thickness and volume were quantified using image processing techniques in OA affected knee joints. Statistical analysis is carried out on processed data set consisting of 110 of knee joints which include male (56) and female (54) of normal (22) and different stages of OA (88). The differences in thickness and volume of cartilage were observed in cartilage in groups based on age, gender and BMI in normal and progressive OA knee joints. Results: The results show that size and volume of cartilage are found to be significantly low in OA as compared to normal knee joints. The cartilage thickness and volume is significantly low for people with age 50 years and above and Body Mass Index (BMI) equal and greater than 25. Cartilage volume correlates with the progression of the disease and can be used for the evaluation of the response to therapies. Conclusion: The developed methods can be used as helping tool in the assessment of cartilage degradation in OA affected knee joint patients and treatment planning.

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