Knee joint distraction as standard of care treatment for knee osteoarthritis: a comparison with clinical trial patients

Abstract

Purpose: For successful total knee arthroplasty (TKA), good soft tissue balance is one of the most important factors; however, it is unknown whether the coronal ligament balance acquired at the time of surgery is maintained with time even in varus placement TKA. We hypothesize that postoperative varus alignment increases the risk of loosening of lateral ligament. The purpose of this study is to evaluate the correlation between postoperative coronal alignment and the change of lateral ligament laxity at 1-month and 1-year after TKA surgery. Methods: We evaluated varus osteoarthritis knees undergone primary TKA with LEGION PS (Smith & Nephew). The patients with flexion contracture of 15 degrees or more after surgery were excluded and 110 knees were included in this study. Postoperative lateral ligament laxity was measured by varus stress radiograph (100 N) using Telos SE at 1month and 1-year after surgery. The angle formed by the line in contact with the bottom of the femoral prosthesis and the line in contact with the upper surface of the tibial prosthesis were measured. We defined the value of this angle of the lateral joint opening as the "lateral ligament laxity". Postoperative coronal alignment was confirmed by measuring mechanical axis of the leg, hip-knee-ankle (HKA) angle, from bilateral weight-bearing anteroposterior long-leg radiographs. HKAs with a positive value were in varus and those with a negative value were in valgus. HKAs were categorized into neutral, varus and valgus. Neutral alignment was defined as -3 to 3 . Results: The average of the lateral ligament laxity at 1-month and 1-year after TKA was 3.8±1.9 and 3.6±1.9 , respectively, in the neutral alignment group (61 knees), and was 3.6±2.2 and 3.6±1.8 , respectively, in the varus alignment group (43 knees [HKA: 3-13.3 ]). In both groups, there was no significant change of the lateral ligament laxity between the two periods. However, subsequence analysis of individual cases demonstrated that the lateral ligament laxity decreased by 3 or more in 10 cases (9%) and increased by 3 or more in 6 cases (5%). We examined risk factors (BMI, age, sex, change in the range of motion before and after TKA, and the coronal alignment after TKA) for loosening lateral ligament, but there was no evidence for an increased risk of the lateral ligament laxity. Conclusions: In some cases, post-operative lateral ligament laxity has changed. Altogether, our data indicate that post-operative varus alignment does not increase the risk of the lateral ligament laxity.

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

“…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.…”

“…Only the RCTs [20][21][22] had a low selection bias and only Jansen et al same research group. Last, Jansen et al 12,14 had a lot of unclear bias since they are conference abstracts and as such did not report all information required to judge. No indication for publication bias was found.…”

“…21 In regular care, 40 patients were treated with KJD and evaluated after 1 year, without control group, reported in a conference abstract. 12 Last, a subgroup of 16 KJD patients and 17 HTO patients from the previously mentioned RCTs were evaluated and compared on an additional outcome measure (MRI cartilage thickness) after 2 years in a conference abstract. 14 The risk of bias for the included articles is shown in same research group.…”

“…The majority of infections could be treated with oral antibiotics, resulting in a 57% (95% CI 33-82) risk of an infection requiring oral antibiotics and a 10% (95% CI 1-18) risk of an infection (including osteomyelitis, n = 1) requiring intravenous antibiotics. Also, 1 patient experienced postoperative foot drop, 20 54.9 (SeM 1.8) 11:9 27.4 (SeM 0.9) 0:1:8:11 6 Van der Woude 2017 22 51.2 (SeM 1.1) 6:16 27.5 (SeM 0.7) 6:4:11:1 6.1 (range 5.6-7.1) Jansen 2019 12 54.3 (SD 6.8) 17:23 27.7 (SD 3.9) 0:7:23:10 6.5 (SD 0.6) Jansen 2019 14 Median 3 (iQr 1)…”

Instructive cartilage regeneration modalities with advanced therapeutic implantations under abnormal conditions

“…In some cases with severe cartilage damage and long-term joint space stenosis, achieving an appropriate soft tissue balance remains challenging. Thus, joint distraction can ameliorate soft tissue contraction and restore the tissue tension balance [ 151 ]. However, the complications of joint distraction must be considered, including pin tract infection and joint stiffness.…”