Joint distraction for osteoarthritis: clinical evidence and molecular mechanisms

Axial alignment is a critical regulator of knee osteoarthritis

“…Our results demonstrate a reduction in macroscopic and microscopic OA in the articular cartilage of the unloaded medial subregions. Therapeutic load modulations—both nonsurgically by shoes with lateral wedges, lateral wedge insoles ( 33 ), and unloader braces ( 34 ) and surgically by HTO ( 35 ) or knee joint distraction (KJD) using a (mostly rigid) temporal external fixator ( 36 )—represent reasonable approaches for treating symptomatic varus medial tibiofemoral knee OA ( 21 ). They primarily aim to reduce pain ( 33 – 37 ) and to improve knee function ( 34 – 37 ).…”

“…KJD may be valuable for patients with advanced OA (KL grade ≥ 3) in restoring cartilage thickness in the more affected compartment and in reducing the denuded bone area ( 39 ). HTO demands the integrity of the unaffected compartment ( 32 , 40 , 41 ), KJD often requires additional postoperative therapy because pin tract infections occur very frequently ( 36 ), and high-quality evidence based on RCTs comparing these measures against appropriate nonsurgical treatments is essentially lacking. Nevertheless, a physiological amount of loading and physical activity appear necessary to provide for an adequate stimulus for the cartilage to prevent OA degeneration, because reduced physical activity coupled with low body mass index is associated with a greater risk of worsening medial cartilage damage ( 42 ).…”

“…Therapeutic load modulations-both nonsurgically by shoes with lateral wedges, lateral wedge insoles (33), and unloader braces (34) and surgically by HTO (35) or knee joint distraction (KJD) using a (mostly rigid) temporal external fixator (36)-represent reasonable approaches for treating symptomatic varus medial tibiofemoral knee OA (21). They primarily aim to reduce pain (33)(34)(35)(36)(37) and to improve knee function (34)(35)(36)(37). Both HTO and KJD appear to have potential for articular cartilage recovery secondary to an improved mechanical environment (38,39).…”

Subchondral bone changes after joint distraction treatment for end stage knee osteoarthritis

“…The treatment has been evaluated in several clinical trials, where it has shown significant short-and long-term clinical improvement. [5][6][7][8] Furthermore, KJD has demonstrated the ability to reverse OA cartilage degradation, as radiographic JSW and MRI cartilage thickness measurements showed significant short-term cartilage regeneration, which was sustained for up to ten years after treatment. 6,[9][10][11] Bone changes have been evaluated on plain radiographs, showing a decrease in overall subchondral bone density one year after treatment with increased osteophyte formation in the first two years after treatment.…”

Chondroitin sulfate-functionalized lipid nanoreservoirs: a novel cartilage-targeting approach for intra-articular delivery of cassic acid for osteoarthritis treatment

“…Osteoarthritis (OA), a complex disease affecting multiple joint architectures, is characterized by cartilage deterioration and synovium inflammation causing impaired movement of the elderly (van den Bosch 2020 ; Peng et al. 2021 ; Jansen & Mastbergen 2022 ). OA therapy attempts failure arose from a shortage in delivery of antiosteoarthritic drugs to their target site inside the joint, to be able to modify the progression, and treat the structural changes associated with OA while avoiding systemic poor bioavailability and/or associated side effects (Latourte et al.…”