Aims Knee joint distraction (KJD) is a relatively new, knee-joint preserving procedure with the goal of delaying total knee arthroplasty (TKA) in young and middle-aged patients. We present a randomised controlled trial comparing the two.
Patients and Methods The 60 patients ≤ 65 years with end-stage knee osteoarthritis were randomised to either KJD (n = 20) or TKA (n = 40). Outcomes were assessed at baseline, three, six, nine, and 12 months. In the KJD group, the joint space width (JSW) was radiologically assessed, representing a surrogate marker of cartilage thickness.
Results In total 56 patients completed their allocated treatment (TKA = 36, KJD = 20). All patient reported outcome measures improved significantly over one year (p < 0.02) in both groups. At one year, the TKA group showed a greater improvement in only one of the 16 patient-related outcome measures assessed (p = 0.034). Outcome Measures in Rheumatology-Osteoarthritis Research Society International clinical response was 83% after TKA and 80% after KJD. A total of 12 patients (60%) in the KJD group sustained pin track infections. In the KJD group both mean minimum (0.9 mm, standard deviation (sd) 1.1) and mean JSW (1.2 mm, sd 1.1) increased significantly (p = 0.004 and p = 0.0003).
Conclusion In relatively young patients with end-stage knee osteoarthritis, KJD did not demonstrate inferiority of outcomes at one year when compared with TKA. However, there is a high incidence of pin track infection associated with KJD.
Cite this article: Bone Joint J 2017;99-B:51–8.
- Joint distraction
- Knee osteoarthritis
- Total knee arthroplasty
- Cartilage repair
- Randomised controlled trial
J. A. D. van der Woude: Gathered and analysed all the data, Wrote the initial draft of the manuscript and managed the study.
K. Wiegant: Designed the study and revised the manuscript.
R. J. van Heerwaarden: Designed the study and revised the manuscript.
S. Spruijt: Designed the study and revised the manuscript.
P. J. Emans: Revised the manuscript.
S. C. Mastbergen: Designed the study and revised the manuscript.
F. P. J. G. Lafeber: Conceived the study, Ensured the accuracy of the data and the analysis, Wrote and revised the manuscript.
This study was funded by ZonMw (The Netherlands Organisation for Health Research and Development). The study sponsor had no involvement in the study design, collection, analysis and interpretation of data, in writing of the manuscript, and in the decision to submit the manuscript for publication.
Although none of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article, benefits have been or will be received but will be directed solely to a research fund, foundation, educational institution, or other non- profit organization with which one or more of the authors are associated.
This article was primary edited by P. Page and first proof edited by G. Scott.
Supplementary material. A table showing the patient reported outcome measures scores for three, six and nine months after treatment can be found alongside the online version of this paper at http://www.bjj.boneandjoint.org.uk
- Received March 17, 2016.
- Accepted September 13, 2016.
- ©2017 The British Editorial Society of Bone & Joint Surgery