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Joint distraction promotes structural repair in patients with severe knee osteoarthritis

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Researchers used knee distraction for the first time to strengthen and promote cartilage repair in severe end-stage knee osteoarthritis, according to a report at the European League Against Rheumatism (EULAR) 2008 Annual Congress in Paris.

In the study, a group of Dutch investigators used an external fixation frame with springs to bridge the knee joint in 19 patients younger than 60 years with osteoarthritis. The frame was distracted by 5 mm over a period of 2 months with the goal of promoting cartilage repair by removing mechanical stress on the knee.

The functional ability and pain scores of the patients were poor prior to treatment (40% and 30% of the maximum WOMAC score, respectively). However, both scores increased to more than 80% following joint distraction, which is equivalent to almost complete normalization in terms of symptoms experienced, said presenter Floris Lafeber, PhD, of the University Medical Center Utrecht.

MRI and digital X-ray evaluation carried out at baseline and at 1-year follow-up showed evidence of cartilage repair. Cartilage volume and subchondral bone covered with cartilage increased by 50% and 40%, respectively, and mean cartilage thickness increased from baseline to 1-year follow-up, according to a EULAR news release.

Biomarkers of cartilage and bone breakdown and synthesis, measured in serum and urine, also demonstrated an increased level of cartilage and bone turnover during distraction that returned to normal in the months after treatment, with a gradual increase in cartilage synthesis markers over time. This is indicative of structural repair due to distraction, he said.

"We are delighted to report such an impressive outcome in the use of joint distraction for severe osteoarthritis of the knee. Positive results have been sustained over the 2-year follow-up period, suggesting the potential for joint distraction to delay the need for a joint prosthesis in these relatively young patients," Lafeber said in the news release.

"Our data are very promising, demonstrating the clinical efficacy and potential for structural repair. The logical next step should be the implementation of a prolonged prospective multicenter study on the procedure."

For more information:

• Intema F, Marijnissen ACA, Beekhuizen M, et al. Joint distraction in the treatment of severe knee osteoarthritis; the first results on clinical efficacy and structural repair. Paper OP-0151. Presented at the European League Against Rheumatism 2008 Annual Congress. June 11-14, 2008. Paris.