Knee joint distraction in the treatment of severe osteoarthritis

Abstract

There is a need for joint-preserving techniques, such as knee joint distraction (KJD), to treat knee osteoarthritis (OA) in relatively young patients. Because of the increased risk for revision surgery and the lower clinical efficacy in this patient category, it is important to avoid knee arthroplasty in patients younger than 65 years of age. With the use of an external distraction device (KneeReviver, ArthroSave, Culemborg, The Netherlands), contact stresses between both cartilage surfaces from the femur and the tibia are strongly reduced over a temporary, 6‑week treatment period. The built-in springs used in this device cause intermittent pressure changes during loading, which stimulates cartilage regeneration. At the 1‑year follow-up, a significant decrease of pain and increase of knee function were documented, comparable with total knee arthroplasty (TKA) and high tibial osteotomy. Structural parameters showed intrinsic cartilage repair on weight-bearing X‑rays and magnetic resonance imaging (MRI). A treatment strategy starting with KJD for knee OA has a large potential for being a cost-effective intervention. Knee joint distraction is a clinically proven, effective joint-preserving treatment. Clinical and structural results last for approximately 5–10 years, hereby postponing the need for a primary TKA to a later (st)age and reducing the risk for TKA revision surgery later in life.