Knee joint distraction in the treatment of severe osteoarthritis

Kniegelenkdistraktion bei der Behandlung schwerer Arthrose

Abstract

Problem

There is a need for joint-preserving techniques, such as knee joint distraction (KJD), to treat knee osteoarthritis (OA) in relatively young patients. Because of the increased risk for revision surgery and the lower clinical efficacy in this patient category, it is important to avoid knee arthroplasty in patients younger than 65 years of age.

Methods

With the use of an external distraction device (KneeReviver, ArthroSave, Culemborg, The Netherlands), contact stresses between both cartilage surfaces from the femur and the tibia are strongly reduced over a temporary, 6‑week treatment period. The built-in springs used in this device cause intermittent pressure changes during loading, which stimulates cartilage regeneration.

Results

At the 1‑year follow-up, a significant decrease of pain and increase of knee function were documented, comparable with total knee arthroplasty (TKA) and high tibial osteotomy. Structural parameters showed intrinsic cartilage repair on weight-bearing X‑rays and magnetic resonance imaging (MRI). A treatment strategy starting with KJD for knee OA has a large potential for being a cost-effective intervention.

Conclusion

Knee joint distraction is a clinically proven, effective joint-preserving treatment. Clinical and structural results last for approximately 5–10 years, hereby postponing the need for a primary TKA to a later (st)age and reducing the risk for TKA revision surgery later in life.

Zusammenfassung

Problem

Es besteht ein Bedarf an gelenkerhaltenden Techniken wie der Kniegelenkdistraktion (KJD) zur Behandlung der Gonarthrose bei relativ jungen Patienten. Wegen des erhöhten Risikos für Revisionsoperationen und der geringeren klinischen Wirksamkeit bei dieser Patientengruppe ist es wichtig, eine Knieendoprothese bei Patienten unter 65 Jahren zu vermeiden.

Methoden

Mit Hilfe eines externen Distraktionsdevice (KneeReviver, ArthroSave, Culemborg, Niederlande) werden die Kontaktbelastungen zwischen den beiden Knorpeloberflächen von Femur und Tibia über einen temporären 6‑wöchigen Behandlungszeitraum stark reduziert. Die in diesem Device verwendeten eingebauten Federn verursachen während der Belastung intermittierende Druckänderungen, was die Knorpelregeneration stimuliert.

Ergebnisse

Bei der 1‑Jahres-Nachbeobachtung wurde eine signifikante Abnahme der Schmerzen und eine Zunahme der Kniefunktion dokumentiert, vergleichbar mit der totalen Knieendoprothese (TKA) und der hohen Tibiaosteotomie. Strukturelle Parameter zeigten eine intrinsische Knorpelreparatur auf den belastenden Röntgenaufnahmen und in der Magnetresonanztomographie (MRT). Eine Behandlungsstrategie, die mit der KJD bei Gonarthrose beginnt, besitzt ein großes Potenzial für eine kosteneffektive Intervention.

Schlussfolgerung

Die Kniegelenkdistraktion ist eine klinisch erprobte, wirksame gelenkerhaltende Behandlung. Die klinischen und strukturellen Ergebnisse halten etwa 5 bis 10 Jahre an, wodurch die Notwendigkeit einer primären TKA auf ein späteres Alter bzw. Stadium verschoben und das Risiko einer TKA-Revisionsoperation im späteren Leben reduziert wird.

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Corresponding author

Correspondence to Dr. R. J. van Heerwaarden MD, PhD.

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Conflict of interest

R.J. van Heerwaarden and W. Verra declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

Additional information

The German version of this article can be found under https://doi.org/10.1007/s00142-020-00389-9.

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van Heerwaarden, R.J., Verra, W. Knee joint distraction in the treatment of severe osteoarthritis. Arthroskopie (2020). https://doi.org/10.1007/s00142-020-00382-2

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Keywords

  • Arthralgia
  • Joint diseases
  • Joint preservation
  • Total knee arthroplasty
  • Cartilage

Schlüsselwörter

  • Arthralgie
  • Gelenkerkrankungen
  • Gelenkerhaltung
  • Knietotalendoprothese
  • Knorpel