Joint distraction for the treatment of knee osteoarthritis
Knee osteoarthritis (OA) is a common degenerative joint disease characterized by cartilage destruction and changes in subchondral bone. Treatment options for end-stage OA are limited, with joint replacement and high tibial osteotomy as the common procedures. High tibial osteotomy may be preferable t...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Journal of Cartilage & Joint Preservation |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667254523000094 |
| _version_ | 1827987149857751040 |
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| author | Thun Itthipanichpong Ali Farooqi Samarth V. Menta Anil S. Ranawat |
| author_facet | Thun Itthipanichpong Ali Farooqi Samarth V. Menta Anil S. Ranawat |
| author_sort | Thun Itthipanichpong |
| collection | DOAJ |
| description | Knee osteoarthritis (OA) is a common degenerative joint disease characterized by cartilage destruction and changes in subchondral bone. Treatment options for end-stage OA are limited, with joint replacement and high tibial osteotomy as the common procedures. High tibial osteotomy may be preferable to joint replacement in the young active patient, malaligned knee, and limited to medial compartment OA. However, both procedures may lead to complications and have durability concerns in young patients. Fortunately, joint distraction (JD) has emerged as a joint-preserving treatment for end-stage OA. The reversal of tissue degeneration observed with JD could be the result of one or more proposed mechanisms, such as partial unloading, synovial fluid pressure oscillation, mechanical and biochemical changes in subchondral bone, or adhesion and chondrogenic commitment of joint-derived mesenchymal stem cells. The procedure involves the use of an external fixator to unload the cartilage and underlying bone for a short time period. In addition, new implantable knee devices, which create unloading instead of distraction and do not require removal, have also been developed. There is a lack of standardization for the JD technique which results in significant variation of implant type, duration of treatment, and rehabilitation. Nevertheless, clinical studies demonstrate long-term pain relief and improved patient outcomes. Interestingly, the increase in joint space width following treatment indicates that cartilage repair occurred throughout and after the distraction period. Although JD appears to be an effective therapeutic choice, the rate of complications remains high, with pin-tract infection being the most common. |
| first_indexed | 2024-04-09T23:42:27Z |
| format | Article |
| id | doaj.art-280e9d44ff1d46abbe64812732399345 |
| institution | Directory Open Access Journal |
| issn | 2667-2545 |
| language | English |
| last_indexed | 2024-04-09T23:42:27Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cartilage & Joint Preservation |
| spelling | doaj.art-280e9d44ff1d46abbe648127323993452023-03-18T04:43:08ZengElsevierJournal of Cartilage & Joint Preservation2667-25452023-03-0131100107Joint distraction for the treatment of knee osteoarthritisThun Itthipanichpong0Ali Farooqi1Samarth V. Menta2Anil S. Ranawat3The Hospital for Special Surgery, New York, NY, USA; Department of Orthopaedics, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, ThailandPerelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USAThe Hospital for Special Surgery, New York, NY, USAThe Hospital for Special Surgery, New York, NY, USA; Anil S. Ranawat, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021.Knee osteoarthritis (OA) is a common degenerative joint disease characterized by cartilage destruction and changes in subchondral bone. Treatment options for end-stage OA are limited, with joint replacement and high tibial osteotomy as the common procedures. High tibial osteotomy may be preferable to joint replacement in the young active patient, malaligned knee, and limited to medial compartment OA. However, both procedures may lead to complications and have durability concerns in young patients. Fortunately, joint distraction (JD) has emerged as a joint-preserving treatment for end-stage OA. The reversal of tissue degeneration observed with JD could be the result of one or more proposed mechanisms, such as partial unloading, synovial fluid pressure oscillation, mechanical and biochemical changes in subchondral bone, or adhesion and chondrogenic commitment of joint-derived mesenchymal stem cells. The procedure involves the use of an external fixator to unload the cartilage and underlying bone for a short time period. In addition, new implantable knee devices, which create unloading instead of distraction and do not require removal, have also been developed. There is a lack of standardization for the JD technique which results in significant variation of implant type, duration of treatment, and rehabilitation. Nevertheless, clinical studies demonstrate long-term pain relief and improved patient outcomes. Interestingly, the increase in joint space width following treatment indicates that cartilage repair occurred throughout and after the distraction period. Although JD appears to be an effective therapeutic choice, the rate of complications remains high, with pin-tract infection being the most common.http://www.sciencedirect.com/science/article/pii/S2667254523000094Distraction arthroplastyJoint distractionKnee distractionKnee joint distractionKnee unloading device |
| spellingShingle | Thun Itthipanichpong Ali Farooqi Samarth V. Menta Anil S. Ranawat Joint distraction for the treatment of knee osteoarthritis Journal of Cartilage & Joint Preservation Distraction arthroplasty Joint distraction Knee distraction Knee joint distraction Knee unloading device |
| title | Joint distraction for the treatment of knee osteoarthritis |
| title_full | Joint distraction for the treatment of knee osteoarthritis |
| title_fullStr | Joint distraction for the treatment of knee osteoarthritis |
| title_full_unstemmed | Joint distraction for the treatment of knee osteoarthritis |
| title_short | Joint distraction for the treatment of knee osteoarthritis |
| title_sort | joint distraction for the treatment of knee osteoarthritis |
| topic | Distraction arthroplasty Joint distraction Knee distraction Knee joint distraction Knee unloading device |
| url | http://www.sciencedirect.com/science/article/pii/S2667254523000094 |
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