Distraction to treat knee osteoarthritis

Flouzat-Lachaniette, Charles-Henri; Roubineau, François; Heyberger, Clémence; Bouthors, Charlie

doi:10.1016/j.jbspin.2016.03.004

Cited by 16 publications

(18 citation statements)

References 32 publications

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“…shoulder, but nearly half of those (46%, 6/13) required arthroplasty. A similar finding was reported previously, in adults diagnosed with symptomatic glucocorticoid-induced ONs that were followed for an average of 15 years [25]. In addition, our findings were consistent with those of Miettunen et al, who suggested that shoulder involvement may occur more frequently than previously appreciated [6].…”

Section: Discussionsupporting

confidence: 93%

The radiological and clinical follow-up of osteonecrosis in cancer patients

et al. 2019

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Background: In patients with cancer, osteonecrosis (ON) lesions can affect multiple sites throughout the skeleton, including the long and short bones and the joints. The aims of this study were to explore the natural course of ON in patients treated for cancer by using radiological classification suitable for multisite ON lesions and to assess correlations between the ON grade and surgical procedures. Material and methods: Data were retrieved from hospital databases on 233 ON lesions in 54 patients (aged 2-73 years at cancer diagnosis; mean age: 25 years). ONs were graded according to the Niinim€ aki classification, based on magnetic resonance images. Medical records were reviewed to identify surgical procedures. Results: A total of 14 different ON sites were detected; the hip was the most common site (n ¼ 51), followed by the femur (n ¼ 45), tibia (n ¼ 41) and knee (n ¼ 37). Among the 233 ON lesions, 78.1% did not require surgical procedures. The remaining lesions required total joint arthroplasty (TJA; 40/233, 17.2%), core decompression (3.4%) and arthroscopy (1.3%). Most TJAs (33/40, 82.5%) were performed on the hip. ONs of the knee required TJAs only once; grade 3 knee ONs frequently healed (58%, 11/ 19). None of the diaphyseal or metaphyseal (grade 1-2) ONs of the long bones required surgery, and no fractures of those bones were identified. Conclusions: In conclusion, the natural history of ONs varied by the grade and site. Based on our findings, we would not recommend routine radiological follow-ups for grades 1-2 ON lesions that do not affect the joints, because the clinical consequences of those lesions appear to be minimal, although pain relief would be warranted. In contrast, joint deformations (grade 5) require surgery; therefore, intervention studies should focus on grades 3-4 ON lesions.

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Section: Discussionsupporting

confidence: 93%

The radiological and clinical follow-up of osteonecrosis in cancer patients

et al. 2019

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“…Furthermore, several animal studies have demonstrated the superior repair potential of joint tissues upon joint distraction, including cartilage degeneration and subchondral bone remodelling. 27 – 29 The mechanism was supposedly attributed to the fact that joint distraction was able to reduce abnormal stress and allow cartilage tissue repair at the joint. Since joint distraction needs invasive operation and pin track infection may complicate knee joint arthroplasty surgery, 29 these two considerations indicate a need for a non-invasive strategy to reduce joint mechanical loading.…”

Section: Discussionmentioning

confidence: 99%

“… 27 – 29 The mechanism was supposedly attributed to the fact that joint distraction was able to reduce abnormal stress and allow cartilage tissue repair at the joint. Since joint distraction needs invasive operation and pin track infection may complicate knee joint arthroplasty surgery, 29 these two considerations indicate a need for a non-invasive strategy to reduce joint mechanical loading. We found that intermittent periods of no mechanical loading of knee joint could slow down OA progression.…”

Section: Discussionmentioning

confidence: 99%

Less mechanical loading attenuates osteoarthritis by reducing cartilage degeneration, subchondral bone remodelling, secondary inflammation, and activation of NLRP3 inflammasome

Nie

et al. 2020

Bone & Joint Research

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Aims Osteoarthritis (OA) is a disabling joint disorder and mechanical loading is an important pathogenesis. This study aims to investigate the benefits of less mechanical loading created by intermittent tail suspension for knee OA. Methods A post-traumatic OA model was established in 20 rats (12 weeks old, male). Ten rats were treated with less mechanical loading through intermittent tail suspension, while another ten rats were treated with normal mechanical loading. Cartilage damage was determined by gross appearance, Safranin O/Fast Green staining, and immunohistochemistry examinations. Subchondral bone changes were analyzed by micro-CT and tartrate-resistant acid phosphatase (TRAP) staining, and serum inflammatory cytokines were evaluated by enzyme-linked immunosorbent assay (ELISA). Results Our radiographs showed that joint space was significantly enlarged in rats with less mechanical loading. Moreover, cartilage destruction was attenuated in the less mechanical loading group with lower histological damage scores, and lower expression of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-5, matrix metalloproteinase (MMP)-3, and MMP-13. In addition, subchondral bone abnormal changes were ameliorated in OA rats with less mechanical loading, as reduced bone mineral density (BMD), bone volume/tissue volume (BV/TV), and number of osteophytes and osteoclasts in the subchondral bone were observed. Finally, the level of serum inflammatory cytokines was significantly downregulated in the less mechanical loading group compared with the normal mechanical loading group, as well as the expression of NACHT, LRR, and PYD domains-containing protein 3 (NLRP3), caspase-1, and interleukin 1β (IL-1β) in the cartilage. Conclusion Less mechanical loading alleviates cartilage destruction, subchondral bone changes, and secondary inflammation in OA joints. This study provides fundamental insights into the benefit of non-weight loading rest for patients with OA. Cite this article: Bone Joint Res 2020;9(10):731–741.

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“…However, this procedure is associated with an increased risk of failure in these patients due to the higher functional demands [ 11 ]. In recent years, joint distraction has emerged as a viable alternative in the treatment of knee osteoarthritis [ 12 – 14 ]. In this surgical procedure, the two bony ends of the joint are gradually pulled over a variable distance for a period using an external fixator, thereby temporarily unloading the joint cartilage by eliminating contact between the joint surfaces [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Joint distraction for knee osteoarthritis: protocol for a systematic review and meta-analysis

et al. 2018

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BackgroundOsteoarthritis is a degenerative joint disease that is highly prevalent worldwide. Knee osteoarthritis is the most common form of osteoarthritis and is a major cause of pain and disability. However, there remains a lack of treatments available that have demonstrated effectiveness in stopping or reversing the degenerative process. Joint distraction has emerged as a viable alternative in the treatment of knee osteoarthritis to delay the need for knee arthroplasty.MethodsAn electronic search will be conducted on MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane and EBSCO databases. Clinical studies investigating joint distraction for knee osteoarthritis, which reported clinical or structural outcomes including ∆WOMAC index, ∆VAS pain score and ∆joint space width will be included. Risk of bias will be assessed using the Newcastle-Ottawa Scale for observational studies and Cochrane Collaboration tool for randomised controlled trials. Quality of studies will be assessed using the modified Coleman methodology score.DiscussionThis systematic review will summarise the short- and long-term clinical and structural outcomes following joint distraction for knee osteoarthritis. The findings from this review will establish the quality of currently available evidence, which will determine the need for further studies to establish the true effect size of this procedure.Systematic review registrationPROSPERO CRD42018087032

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Distraction to treat knee osteoarthritis

Cited by 16 publications

References 32 publications

The radiological and clinical follow-up of osteonecrosis in cancer patients

The radiological and clinical follow-up of osteonecrosis in cancer patients

Less mechanical loading attenuates osteoarthritis by reducing cartilage degeneration, subchondral bone remodelling, secondary inflammation, and activation of NLRP3 inflammasome

Joint distraction for knee osteoarthritis: protocol for a systematic review and meta-analysis

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