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

Jansen, M.; Weiden, G.S. Van der; Roermund, P.M. van; Custers, Roel J.H.; Mastbergen, S.C.; Lafeber, Floris P. J. G.

doi:10.1016/j.joca.2018.08.004

Cited by 36 publications

(64 citation statements)

References 16 publications

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“…The maximal effect regarding clinical benefit and structural repair has in all trials been obtained around one-year follow-up, sustaining for many years thereafter. [10,11] Therefore the one-year follow-up comparison with regular care outcome is considered predictive of the long-term outcome in regular care. Nevertheless, longer follow-up in regular care with larger number of patients is still warranted to proof this assumption.…”

Section: δWomac Mean (95%ci)mentioning

confidence: 99%

“…In over three quarters of the patients, TKA could be postponed for over five years, and half of the patients was still without prosthesis nine years after treatment. [8][9][10][11] After this trial the distraction period was shortened to six weeks, as this was considered sufficient. [12] Between 2011 and 2014, the six-week KJD was studied in comparison to TKA or to high tibial osteotomy (HTO) in two separate randomized controlled trials (RCTs).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Objectives Knee joint distraction (KJD) has been evaluated as a joint-preserving treatment to postpone total knee arthroplasty in knee osteoarthritis patients in three clinical trials. Since 2014 the treatment is used in regular care in some hospitals, which might lead to a deviation from the original indication and decreased treatment outcome. In this study, baseline characteristics, complications and clinical benefit are compared between patients treated in regular care and in clinical trials. Methods In our hospital, 84 patients were treated in regular care for 6 weeks with KJD. Surgical details, complications, and range of motion were assessed from patient hospital charts. Patient-reported outcome measures were evaluated in regular care before and one year after treatment. Trial patients (n = 62) were treated and followed as described in literature. Results Patient characteristics were not significantly different between groups, except for distraction duration (regular care 45.3±4.3; clinical trials 48.1±8.1 days; p = 0.019). Pin tract infections were the most occurring complication (70% regular care; 66% clinical trials), but there was no significant difference in treatment complications between groups (p>0.1). The range of motion was recovered within a year after treatment for both groups. WOMAC questionnaires showed statistically and clinically significant improvement for both groups (both p<0.001 and >15 points in all subscales) and no significant differences between groups (all differences p>0.05). After one year, 70% of patients were responders (regular care 61%, trial 75%; p = 0.120). Neither regular care compared to clinical trial, nor any other characteristic could predict clinical response.

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Section: δWomac Mean (95%ci)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Of these, 3 were excluded, since they reported on a subgroup from other included articles without reporting extra information on primary outcomes, leaving 11 articles included for analysis. [12][13][14][15][16][17][18][19][20][21][22] As multiple articles reported on different follow-up moments in the same patient cohorts, the overview of selected studies is separated per cohort of KJD-treated patients and control groups ( Table 1). 23 A total of 7 patient cohorts were treated with KJD, of which 2 in combination with another treatment: 1 cohort of 6 patients was treated with KJD and microfracture 13 and 1 cohort of 19 patients treated with KJD, microfracture, and debridement 15 that also had a control group of 42 patients treated with microfracture and debridement alone.…”

Section: Study Selectionmentioning

confidence: 99%

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

et al. 2020

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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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“…Studies of joint distraction have shown sustained and clinically significant improvement at a number of joint sites 13,14 . For knee OA, joint distraction improved knee symptoms for 5e9 years in individuals with established OA 15,16 . Remarkably, the 6 week intervention also led to apparent cartilage regeneration in the subsequent months and years, with increase in joint space width on X-ray, and increased articular cartilage thickness on magnetic resonance imaging (MRI) 14,16e18 .…”

Section: Introductionmentioning

confidence: 99%

The molecular profile of synovial fluid changes upon joint distraction and is associated with clinical response in knee osteoarthritis

Watt

Hamid

Garriga

et al. 2020

Osteoarthritis and Cartilage

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Objective: Surgical knee joint distraction (KJD) leads to clinical improvement in knee osteoarthritis (OA) and also apparent cartilage regeneration by magnetic resonance imaging. We investigated if alteration of the joint's mechanical environment during the 6 week period of KJD was associated with a molecular response in synovial fluid, and if any change was associated with clinical response. Method: 20 individuals undergoing KJD for symptomatic radiographic knee OA had SF sampled at baseline, midpoint and endpoint of distraction (6 weeks). SF supernatants were measured by immunoassay for 10 predefined mechanosensitive molecules identified in our previous pre-clinical studies. The composite Knee injury and OA Outcome Score-4 (KOOS 4) was collected at baseline, 3, 6 and 12 months. Results: 13/20 (65%) were male with mean age 54 ± 5yrs. All had KellgreneLawrence grade !2 knee OA. 6/10 analytes showed statistically significant change in SF over the 6 weeks distraction (activin A; TGFb-1; MCP-1; IL-6; FGF-2; LTBP2), P < 0.05. Of these, all but activin A increased. Those achieving the minimum clinically important difference of 10 points for KOOS 4 over 6 months showed greater increases in FGF-2 and TGFb-1 than non-responders. An increase in IL-8 during the 6 weeks of KJD was associated with significantly greater improvement in KOOS 4 over 12 months. Conclusion: Detectable, significant molecular changes are observed in SF following KJD, that are remarkably consistent between individuals. Preliminary findings appear to suggest that increases in some molecules are associated with clinically meaningful responses. Joint distraction may provide a potential opportunity in the future to define regenerative biomarker(s) and identify pathways that drive intrinsic cartilage repair.

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

Abstract: KJD shows long-lasting clinical and structural improvement. In addition to a greater survival rate for males (>two out of three), the initial cartilage repair activity appears to be important for long-term clinical success.

Cited by 36 publications

References 16 publications

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

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

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

The molecular profile of synovial fluid changes upon joint distraction and is associated with clinical response in knee osteoarthritis

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