Knee joint distraction with marrow stimulation may improve outcomes for advanced knee OA
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Published results showed knee joint distraction combined with marrow stimulating techniques significantly improved clinical and radiographic outcomes among patients with advanced knee osteoarthritis.
Researchers evaluated clinical scores, including the Japanese Orthopaedic Association (JOA) score, KOOS subscales, range of motion, joint space width and semiquantitative MRI, among 16 patients with advanced knee OA who underwent knee joint distraction combined with marrow stimulating techniques and who had more than 2 years of follow-up. Researchers also analyzed all factors affecting clinical outcomes.
Results showed significant postoperative improvements in the JOA score and the individual scores of the KOOS subscales. At the time of device removal, researchers noted deterioration in joint flexion, which recovered to preoperative levels at final follow-up. Researchers found no change in knee extension throughout the follow-up period. Joint space width had a statistically significant improvement from approximately 2.4 mm to 3.3 mm at final follow-up, according to results. Results also showed a significant improvement in postoperative semiquantitative MRI score. Researchers reported several complications during the follow-up period and noted an association between patients with a high BMI and poor clinical outcomes.
“The most important finding of this study was the significant improvement in midterm clinical outcomes, as demonstrated by the improved clinical scores and widened joint widths, after [knee joint distraction] combined with microfracture in patients with advanced knee OA,” the authors wrote. “There were significant negative correlations between BMI and several clinical scores. However, there were no correlations between the clinical scores and an increase in joint space, age at the time of surgery and [femorotibial angle]. Therefore, we should be careful about applying [knee joint distraction] combined with marrow stimulating techniques for obese patients.”
Perspective
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I read this article by Nobuo Adachi, MD, PhD, and colleagues on knee joint distraction arthroplasty paired with stem cell therapy with great interest as our limb lengthening and complex reconstruction service at Hospital for Special Surgery has one of the largest experiences with ankle distraction arthroplasty. Joint distraction is a non-prosthetic arthroplasty, biologic solution for knee osteoarthritis that harnesses the body’s own ability to regenerate tissue.
Although this is a short-term study, the findings of the researchers echo data from our ankle distraction cohort: patient-reported improvement in the majority of cases, a tendency toward maintaining preoperative joint motion, a joint space increase by 1 mm and improved articular surface fill in specific areas on MRI. Our investigations were unable to assess BMI as a risk factor for failure but were pleased to see that this variable could be studied in the knee. The patient-reported poor results seen in BMI greater than 25 kg/m2 may be attributable to the chronic inflammatory state generated by adipose tissue. Reported complications were expected secondary to wearing an external fixator for 3 months.
Joint distraction will find a more mainstream role in the management of osteoarthritic joints as articular cartilage restoration techniques evolve. The two methods will likely have a synergy greater than current bone marrow applications.
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