<p>The role of joint distraction in the treatment of knee osteoarthritis: a systematic review and quantitative analysis</p>

Abstract

Introduction: Knee osteoarthritis is a major cause of pain and disability for which joint distraction is a potential treatment to delay the need for knee arthroplasty. This systematic review aims to assess the short-and long-term clinical and structural outcomes following knee joint distraction (KJD). Methods: MEDLINE, EMBASE, Scopus, and Web of Science databases were searched from the date of inception to 26th June 2019. Clinical studies investigating joint distraction for knee osteoarthritis with outcomes including ΔWOMAC index, ΔVAS pain score, and Δjoint space width were included. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO)-CRD42018087032. Results: Nine studies comprising a total of 507 patients were included. There were four randomized controlled trials (RCTs), five open prospective cohort studies, and one case series. Overall, there were significant improvements in WOMAC index, VAS pain score and joint space width following KJD, which persisted up to 9 years. KJD also demonstrated comparable clinical outcomes with high tibial osteotomy and total knee arthroplasty. Conclusion: There is moderate quality evidence supporting the beneficial outcomes of joint distraction for knee osteoarthritis. Larger RCTs with longer follow-up (>1 year) are necessary to establish the true effect size of this procedure.

Return to Sport and Work after Randomization for Knee Distraction versus High Tibial Osteotomy: Is There a Difference?

“…Although KJD has shown promise in the treatment of knee OA, the current scientific basis remains small and literature on long-term outcomes is lacking. 39 Therefore, patient counseling should include these existing uncertainties, and the fact that TKA showed an overall better response in clinical outcome parameters at 2 years, including the total KOOS, VAS pain, and EQ-5D, compared with KJD in the only RCT to date. 28 Yet, 15 out of 18 patients in the KJD group, who were initially indicated for TKA, had still not undergone TKA at 5-year follow-up.…”

Gene Expression Signatures of Synovial Fluid Multipotent Stromal Cells in Advanced Knee Osteoarthritis and Following Knee Joint Distraction

“…Novel therapeutic interventions based on the modulation of local biomechanical or biological environments within the OA-affected joint have recently emerged as potential joint-sparing alternatives to joint replacement surgery ( Sánchez et al, 2012 ; Jansen et al, 2018 ; Goh et al, 2019 ; Jansen et al, 2019 ; Takahashi et al, 2019 ). Harnessing endogenous joint repair mechanisms following biomechanical correction of OA joints following KJD appears to hold particular promise ( Mastbergen et al, 2013 ; McGonagle et al, 2017 ).…”

Subchondral Bone Remodeling: A Therapeutic Target for Osteoarthritis

“…Intema et al ( 2011 ) reported a decrease in subchondral bone density on the OA affected compartment after KJD for 12 months, delaying the progression of late OA. Goh et al ( 2019 ) recently reviewed the role of KJD in OA management and summarized available supportive evidence for the beneficial outcomes. Therefore, KJD could be a promising, clinically available therapy for OA patients, based on the reduction of mechanical stimuli to prevent OA development.…”