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

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.

scholarly journals Effect of unicompartmental knee arthroplasty and high tibial osteotomy with tomofix internal fixation in the treatment of unicompartmental knee osteoarthritis

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0054
Author(s):  
Yingzhou Hou ◽  
Shaohua Wang ◽  
Aiguo Wang
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Internal Fixation ◽  
Range Of Motion ◽  
High Tibial Osteotomy ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Tibial Osteotomy ◽  
Unicompartmental Knee ◽  
Active Range Of Motion

Introduction: Knee osteoarthritis is a common degenerative disease in the elderly clinically. Cartilage damage, osteophyte formation, joint space narrowing and bone exposure are the main pathological changes, mainly manifested as joint cartilage degeneration [1]. Since the knee joint load of normal people is mainly conducted through the medial side of the knee joint, it is easy to cause degeneration of the medial compartment and then narrow the joint space, which leads to the medial deviation of the lower limb line and the varus deformity of the knee joint. For patients aged 55-65 years with unilateral ventricular osteoarthritis of the knee, the current surgical methods are mostly high tibial osteotomy (HTO) or unicomartmental knee arthroplasty (UKA)[2,3]. HTO always thought to improve lower limb power line to correct deformities, effectively relieve pain and improve function, is an effective method for treatment of osteoarthritis knee inside, high cut bone is typically used in younger patients and patients from physical activity, can effectively reduce the load and delay of knee joint cartilage lesion replacement time, while UKA is more suitable for old age is not active, activity, and patients needs more intense in terms of pain relief. Hypotheses: To investigate the clinical effect of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with tomofix internal fixation in the treatment of unicompartmental knee osteoarthritis. Methods: 60 patients with unicompartmental knee osteoarthritis and varus deformity of the knee joint were randomly divided into two groups: the UKA group (30 cases) and the HTO group (30 cases). The average follow-up time was 6 months, Scores preoperative and postoperative knee joint function, postoperative complications and postoperative pain satisfaction were compared. Results: The scores of HSS, VAS, femorotibial angle(FTA) and active range of motion(ROM) were 82.6 ± 12.9, 1.9 ± 0.8,173.2 ± 1.4,135.2 ± 1.6 in the group of unicompartmental knee arthroplasty (UKA);The scores of HSS, VAS(Visual Analogue Score), femorotibial angle(FTA) and active range of motion(ROM) after tomofix internal fixation used in the group of high tibial osteotomy (HTO)were 81.9 ± 14.3, 1.8 ± 0.9, 174.5 ± 1.8 and 121.1 ± 2.7 . There was no significant difference between the UKA group and HTO group in the scores of HSS, VAS and femorotibial angle(FTA) (P > 0.05). The active range of motion(ROM) of the HTO group was better than that of UKA group (P < 0.05). Conclusion: Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with tomofix internal fixation can improve the knee joint function and symptoms in the treatment of medial compartment osteoarthritis, but the active range of motion(ROM) in HTO group is better than UKA group.

scholarly journals Changes in Cartilage Quality (Dgemric) Following Knee Joint Distraction or High Tibial Osteotomy

2017 ◽  
Vol 25 ◽  
pp. S243-S244
Author(s):  
N.J. Besselink ◽  
S.C. Mastbergen ◽  
K.L. Vincken ◽  
L.W. Bartels ◽  
A.N. Concepcion ◽  
...  
Keyword(s):  
Knee Joint ◽  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Joint Distraction

scholarly journals Knee joint distraction compared with high tibial osteotomy: A randomized controlled trial

2016 ◽  
Vol 24 ◽  
pp. S30-S31
Author(s):  
J.-T. van der Woude ◽  
K. Wiegant ◽  
R.J. van Heerwaarden ◽  
S. Spruijt ◽  
P.M. van Roermund ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Knee Joint ◽  
High Tibial Osteotomy ◽  
Controlled Trial ◽  
Tibial Osteotomy ◽  
Randomized Controlled ◽  
Joint Distraction

scholarly journals Knee joint distraction compared with high tibial osteotomy: A randomized controlled trial.

2015 ◽  
Vol 23 ◽  
pp. A406
Author(s):  
J.A. van der Woude ◽  
R.J. van Heerwaarden ◽  
S. Spruijt ◽  
K. Wiegant ◽  
P.M. van Roermund ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Knee Joint ◽  
High Tibial Osteotomy ◽  
Controlled Trial ◽  
Tibial Osteotomy ◽  
Randomized Controlled ◽  
Joint Distraction

scholarly journals OP0185 KNEE JOINT DISTRACTION IS MORE EFFICIENT IN RESTORING CARTILAGE THICKNESS THAN HIGH TIBIAL OSTEOTOMY IN PATIENTS WITH SEVERE KNEE OSTEOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 114.2-115
Author(s):  
M. Jansen ◽  
S. Maschek ◽  
R. Van Heerwaarden ◽  
S. Mastbergen ◽  
W. Wirth ◽  
...  
Keyword(s):  
Stock Options ◽  
Joint Space Width ◽  
Joint Space ◽  
Cartilage Thickness ◽  
Tibial Osteotomy ◽  
Knee Oa ◽  
Leg Axis ◽  
Cartilage Restoration ◽  
Joint Distraction ◽  
Space Width

Background:Both high tibial osteotomy (HTO) and knee joint distraction (KJD) are joint preserving surgical techniques unloading the affected femorotibial compartment in patients with knee osteoarthritis (OA). While HTO permanently unloads the more affected compartment (MAC) by overcorrecting the leg axis, KJD temporarily unloads the whole joint by separating the tibia and femur for 5 mm for 6 weeks. In a previous randomized controlled trial (RCT), comparable clinical benefit and radiographic joint space width (JSW) increase over 2 years follow-up were demonstrated for both treatments1. Yet, comparison of JSW before and after HTO may be unreliable, as pseudo-widening of the unloaded compartment may occur due to the induced leg axis change. Therefore, direct cartilage thickness measurements need to be compared between KJD and HTO, to accurately evaluate the efficacy of both treatment options on cartilage structure.Objectives:To compare two-year cartilage thickness changes after treatment with KJDvsHTO and identify factors predicting cartilage thickness restoration.Methods:Patients indicated for HTO were randomized to KJD (KJDHTO) or HTO treatment. Patients indicated for total knee arthroplasty received KJD (KJDTKA). Standardized semi-flexed weight-bearing radiographs and 3T MRIs with 3D spoiled gradient recalled imaging sequence with fat suppression (SPGR-fs) were acquired before and two years after surgical treatment. Cartilage thickness in the knee was measured using Chondrometrics Works 3.0 software. On the radiographs the mean JSW in the MAC were measured with KIDA software. Readers were blinded to the type of intervention and acquisition order. The primary and secondary outcomes were the mean MAC cartilage thickness (ThCtAB) and percentage of denuded bone area (dABp) change before and two years after treatment (MRI), with radiographic joint space width (JSW) used as a reference.Results:No statistically significant differences in the baseline characteristics were seen between KJDHTO(n=18) and HTO (n=33). The KJDTKAgroup (n=18) had a higher age and Kellgren-Lawrence grade (KLG) than the HTO and KJDHTOgroups.KJDHTOpatients did not show significant changes in MAC cartilage thickness, dABp, or JSW over time (all p>0.10; figure 1). HTO patients displayed a decrease in MAC cartilage thickness and an increase in dABp (both p<0.03), but an increase in JSW (p=0.006). KJDTKAshowed a significant increase in MAC cartilage thickness and JSW and decrease in dABp (all p<0.01). Baseline OA severity was the strongest predictor of cartilage restoration. KJD patients with severe OA (KJDsevere; KLG ≥3) showed significant restoration (all p<0.01; figure 2); mild OA patients (KJDmild; KLG ≤2) showed a slight deterioration. KJDsevereshowed a significantly greater cartilage restoration response in the MAC than HTOseverefor cartilage thickness (p=0.005) and dABp (p=0.003), but not JSW change (p=0.521). The changes in all three parameters did not differ significantly between KJDmildand HTOmild(all p>0.08).Conclusion:In patients with severe knee OA, KJD is more efficient in restoring cartilage thickness than HTO is. In these patients, KJD causes significant cartilage restoration while HTO, despite shifting the leg axis and demonstrating radiographic joint space widening, shows loss of cartilage as measured on MRI. In patients with mild knee OA, neither HTO nor KJD treatment results in significant cartilage restoration and both treatments show a slight deterioration that is likely the result of natural OA progression. As such, this research promotes the choice KJD as joint-preserving surgery in case of knee OA patients with more severe structural damage.References:[1]MP Jansenet al, Cartilage 2019.Disclosure of Interests:Mylène Jansen: None declared, Susanne Maschek Shareholder of: Stock/stock options at Condrometrics GmbH, Employee of: Employment at Condrometrics GmbH, Ronald Van Heerwaarden: None declared, Simon Mastbergen: None declared, Wolfgang Wirth Shareholder of: Stock/stock options at Condrometrics GmbH, Consultant of: Consultancy to Galapagos NV, Employee of: Employment at Condrometrics GmbH, Floris Lafeber Shareholder of: Co-founder and shareholder of ArthroSave BV, Felix Eckstein Shareholder of: Stock/stock options at Condrometrics GmbH, Consultant of: Consultancy at Merck KGaA, Samumed, Bioclinica, Galapagos, Servier, Novartis, Employee of: Employment at Condrometrics GmbH, Speakers bureau: Development of educational presentations for Medtronic

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