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Knee Distraction for Managing Knee Osteoarthritis

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Surgical Management of Knee Arthritis

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Abstract

Background: Osteoarthritis is a common and disabling condition; commonly requiring surgical management with total knee arthroplasty (TKA) when conservative measures fail. Although TKA is a well-established and effective management, it is not without its issues, with a significant number of patients experiencing complications and need for complex revision procedures in later years.

Knee joint distraction (KJD) is an emerging technique used to mitigate symptoms of moderate to severe osteoarthritis. Patients who might otherwise be considering high tibial osteotomy (HTO) or TKA may be able to delay arthroplasty and reduce the necessity for multiple increasingly complex revision procedures.

Methods: Many different types of devices have been used for joint distraction. Ankle joint distraction (AJD) has been used to good effect with hinged and static devices. The most established technique for KJD is a spring-loaded static device with results described in 62 patients up to 5 years.

Outcomes: Pain and function scores show improvements at up to 5 years of follow up compared to the natural progression of OA managed with conservative measures. No inferiority was seen in pain and function scores at 1 year compared with HTO, or TKA.

Radiographs demonstrate sustained increases in joint space on follow up. Magnetic resonance imaging (MRI) demonstrates increases in mean cartilage thickness and improvements in the quality of the cartilaginous tissue.

Assessment of cartilage samples and breakdown products indicate varying results depending on markers used and the stage at which the sample was taken. There is some evidence of decreased cartilage breakdown products and increased proteoglycan synthesis following KJD.

Complications include pin-site infection with a small number of deep infections, deep vein thrombosis and pulmonary embolism, device failures and foot drop.

Uncertainties: There is currently no established technique for KJD, although several papers have used similar techniques with good outcomes. There are presently outcomes up to only 5 years of follow up.

Conclusion: Numerous advantageous outcomes have been demonstrated by the early work into KJD. As a last resort before moving to TKA, it appears to be an attractive alternative; however, the uncertainties and potential complications must be considered on an individual basis with further research being necessary before establishing this as a mainstream option.

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Authors and Affiliations

  1. Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK

    Beth Lineham & Hemant G. Pandit

  2. Department of Trauma and Orthopaedic Surgery, Leeds Teaching Hospitals, Leeds, UK

    Paul Harwood

Authors
  1. Beth Lineham
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  2. Paul Harwood
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  3. Hemant G. Pandit
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Correspondence to Beth Lineham .

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Editors and Affiliations

  1. Department of Orthopedic Surgery, Hospital For Joint Diseases, New York, NY, USA

    Ajit J. Deshmukh

  2. University Clinical Center of Kosovo, Pristina, Kosovo

    Bujar H. Shabani

  3. Orthopedic Clinic Paulinenhilfe, Diakonie Klinikum, Stuttgart, Germany

    Wenzel Waldstein

  4. Department of Orthopedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA

    Julius K. Oni

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Lineham, B., Harwood, P., Pandit, H.G. (2023). Knee Distraction for Managing Knee Osteoarthritis. In: Deshmukh, A.J., Shabani, B.H., Waldstein, W., Oni, J.K. (eds) Surgical Management of Knee Arthritis. Springer, Cham. https://doi.org/10.1007/978-3-031-47929-8_20

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  • DOI: https://doi.org/10.1007/978-3-031-47929-8_20

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