Journal Article

Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial

Wiegant, K., van Heerwaarden, R. J., Spruijt, S., Mastbergen, S. C., Lafeber, F. P. J. G., van der Woude, J. A. D., van Roermund, P. M., Custers, R. J. H.

2017

Overview

Purpose Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported. Methods Sixty-nine patients with medial knee joint OA with a varus axis deviation of <10° were randomized to either knee joint distraction ( n  = 23) or HTO ( n  = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up. Results All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p  < 0.02) in both groups. At 1 year, the HTO group showed slightly greater improvement in 4 of the 16 PROMS ( p  < 0.05). The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group ( p  = 0.001) and 0.4 ± 0.5 mm in the HTO group ( p  < 0.001), with minimum JSW improvement in favour of knee joint distraction ( p  = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only ( p  < 0.02). Conclusion Cartilaginous repair activity, as indicated by JSW, and clinical outcome improvement occurred with both, knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment. Level of evidence Randomized controlled trial, Level I.

• Publisher: Springer Berlin Heidelberg,John Wiley & Sons, Inc
• Subject: Arthritis / Bone surgery / Cartilage / Clinical trials / External Fixators / Female / Humans / Knee / Knee Joint - diagnostic imaging / Knee Joint - physiology / Knee Joint - surgery / Male / Medicine / Medicine & Public Health / Middle Aged / Orthopedics / Osteoarthritis / Osteoarthritis, Knee - diagnostic imaging / Osteoarthritis, Knee - physiopathology / Osteoarthritis, Knee - surgery / Osteotomy - instrumentation / Osteotomy - methods / Radiography / Range of Motion, Articular / Stem cells / Tibia - surgery / Traction - instrumentation / Traction - methods / Treatment Outcome