Knee joint distraction compared with total knee arthroplasty
A RANDOMISED CONTROLLED TRIAL
J. A. D. van der Woude, K. Wiegant, R. J. van Heerwaarden,
S. Spruijt, P. J. Emans, S. C. Mastbergen, F. P. J. G. Lafeber
Bone Joint J 2017;99-B:51–8.
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.
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 patientrelated 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).
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.