scholarly journals Five-Year Follow-up of Knee Joint Distraction: Clinical Benefit and Cartilaginous Tissue Repair in an Open Uncontrolled Prospective Study

Cartilage ◽  
2016 ◽  
Vol 8 (3) ◽  
pp. 263-271 ◽  
Author(s):  
Jan-Ton A.D. van der Woude ◽  
Karen Wiegant ◽  
Peter M. van Roermund ◽  
Femke Intema ◽  
Roel J.H. Custers ◽  
...  
Keyword(s):  
Knee Joint ◽  
Clinical Benefit ◽  
Tissue Repair ◽  
Magnetic Resonance Images ◽  
Cartilage Thickness ◽  
Cartilaginous Tissue ◽  
X Ray ◽  
Natural Progression ◽  
Joint Distraction

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.

THU0440 Clinical Benefit and Cartilaginous Tissue Repair After Knee Joint Distration: 5 Years Follow-Up

2015 ◽  
Vol 74 (Suppl 2) ◽  
pp. 359.1-359 ◽  
Author(s):  
N.O. Kuchuk ◽  
K. Wiegant ◽  
J.-T. van der Woude ◽  
P.M. van Roermund ◽  
F. Eckstein ◽  
...  
Keyword(s):  
Knee Joint ◽  
Clinical Benefit ◽  
Tissue Repair ◽  
Cartilaginous Tissue

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

The Knee ◽  
2016 ◽  
Vol 23 (5) ◽  
pp. 785-791 ◽  
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

scholarly journals Prediction of degree of cartilaginous tissue repair as observed by knee joint distraction

2016 ◽  
Vol 24 ◽  
pp. S427
Author(s):  
J.-T. van der Woude ◽  
P.M. Welsing ◽  
P.M. van Roermund ◽  
R.J. Custer ◽  
N.O. Kuchuk ◽  
...  
Keyword(s):  
Knee Joint ◽  
Tissue Repair ◽  
Cartilaginous Tissue ◽  
Joint Distraction

Prediction of cartilaginous tissue repair after knee joint distraction

The Knee ◽  
2016 ◽  
Vol 23 (5) ◽  
pp. 792-795 ◽  
Author(s):  
J.A.D. van der Woude ◽  
P.M. Welsing ◽  
P.M. van Roermund ◽  
R.J.H. Custers ◽  
N.O. Kuchuk ◽  
...  
Keyword(s):  
Knee Joint ◽  
Tissue Repair ◽  
Cartilaginous Tissue ◽  
Joint Distraction

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

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

scholarly journals Cartilage Quality (dGEMRIC Index) Following Knee Joint Distraction or High Tibial Osteotomy

Cartilage ◽  
2018 ◽  
Vol 11 (1) ◽  
pp. 19-31 ◽  
Author(s):  
Nick J. Besselink ◽  
Koen L. Vincken ◽  
L. Wilbert Bartels ◽  
Ronald J. van Heerwaarden ◽  
Arno N. Concepcion ◽  
...  
Keyword(s):  
Knee Joint ◽  
High Tibial Osteotomy ◽  
Clinical Benefit ◽  
Joint Space Width ◽  
Joint Space ◽  
Tibial Osteotomy ◽  
Limited Information ◽  
Cartilaginous Tissue ◽  
Joint Distraction

Objective High tibial osteotomy (HTO) and knee joint distraction (KJD) are treatments to unload the osteoarthritic (OA) joint with proven success in postponing a total knee arthroplasty (TKA). While both treatments demonstrate joint repair, there is limited information about the quality of the regenerated tissue. Therefore, the change in quality of the repaired cartilaginous tissue after KJD and HTO was studied using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). Design Forty patients (20 KJD and 20 HTO), treated for medial tibiofemoral OA, were included in this study. Radiographic outcomes, clinical characteristics, and cartilage quality were evaluated at baseline, and at 1- and 2-year follow-up. Results Two years after KJD treatment, clear clinical improvement was observed. Moreover, a statistically significant increased medial (Δ 0.99 mm), minimal (Δ 1.04 mm), and mean (Δ 0.68 mm) radiographic joint space width (JSW) was demonstrated. Likewise, medial (Δ 1.03 mm), minimal (Δ 0.72 mm), and mean (Δ 0.46 mm) JSW were statistically significantly increased on radiographs after HTO. There was on average no statistically significant change in dGEMRIC indices over two years and no difference between treatments. Yet there seemed to be a clinically relevant, positive relation between increase in cartilage quality and patients’ experienced clinical benefit. Conclusions Treatment of knee OA by either HTO or KJD leads to clinical benefit, and an increase in cartilage thickness on weightbearing radiographs for over 2 years posttreatment. This cartilaginous tissue was on average not different from baseline, as determined by dGEMRIC, whereas changes in quality at the individual level correlated with clinical benefit.

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)

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.

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

2021 ◽  
Vol 29 ◽  
pp. S331-S332
Author(s):  
M. Jansen ◽  
S.C. Mastbergen ◽  
T.D. Turmezei ◽  
J.W. MacKay ◽  
F.P. Lafeber
Keyword(s):  
Knee Joint ◽  
Cartilage Thickness ◽  
Thickness Increase ◽  
Joint Distraction

scholarly journals 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 ◽  
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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