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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 01-03-2017 | Knee

Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial

Authors: J. A. D. van der Woude, K. Wiegant, R. J. van Heerwaarden, S. Spruijt, P. M. van Roermund, R. J. H. Custers, S. C. Mastbergen, F. P. J. G. Lafeber

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2017

Abstract

Purpose

Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported.

Methods

Sixty-nine patients with medial knee joint OA with a varus axis deviation of <10° were randomized to either knee joint distraction (n = 23) or HTO (n = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up.

Results

All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p < 0.02) in both groups. At 1 year, the HTO group showed slightly greater improvement in 4 of the 16 PROMS (p < 0.05). The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group (p = 0.001) and 0.4 ± 0.5 mm in the HTO group (p < 0.001), with minimum JSW improvement in favour of knee joint distraction (p = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only (p < 0.02).

Conclusion

Cartilaginous repair activity, as indicated by JSW, and clinical outcome improvement occurred with both, knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment.

Level of evidence

Randomized controlled trial, Level I.

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Title: Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial
Authors: J. A. D. van der Woude
K. Wiegant
R. J. van Heerwaarden
S. Spruijt
P. M. van Roermund
R. J. H. Custers
S. C. Mastbergen
F. P. J. G. Lafeber
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-016-4131-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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