TY - JOUR
T1 - Knee Joint Distraction as Treatment for Osteoarthritis Results in Clinical and Structural Benefit
T2 - A Systematic Review and Meta-Analysis of the Limited Number of Studies and Patients Available
AU - Jansen, Mylène P.
AU - Boymans, Tim A.E.J.
AU - Custers, Roel J.H.
AU - Van Geenen, Rutger C.I.
AU - Van Heerwaarden, Ronald J.
AU - Huizinga, Maarten R.
AU - Nellensteijn, Jorm M.
AU - Sollie, Rob
AU - Spruijt, Sander
AU - Mastbergen, Simon C.
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Unrestricted funding by ZonMW and FOREUM supported this work; funders had no involvement with this article.
Publisher Copyright:
© The Author(s) 2020.
PY - 2021/12
Y1 - 2021/12
N2 - OBJECTIVE: Knee joint distraction (KJD) is a joint-preserving osteoarthritis treatment that may postpone a total knee arthroplasty (TKA) in younger patients. This systematic review and meta-analysis evaluates short- and long-term clinical benefit and tissue structure changes after KJD.DESIGN: MEDLINE, EMBASE, and Web of Science were searched for eligible clinical studies evaluating at least one of the primary parameters: WOMAC, VAS-pain, KOOS, EQ5D, radiographic joint space width or MRI cartilage thickness after KJD. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies.RESULTS: Eleven articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups with multiple follow-up moments were included, of which 2 were randomized controlled trials. Significant improvements in all primary parameters were found and benefit lasted up to at least 9 years. Overall, outcomes were comparable with control groups, including high tibial osteotomy, although TKA showed better clinical response.CONCLUSIONS: Current, still limited, evidence shows KJD causes clear benefit in clinical and structural parameters, both short- and long-term. Longer follow-up with more patients is necessary, to validate outcome and to potentially improve patient selection for this intensive treatment. Thus far, for younger knee osteoarthritis patients, KJD may be an option to consider.
AB - OBJECTIVE: Knee joint distraction (KJD) is a joint-preserving osteoarthritis treatment that may postpone a total knee arthroplasty (TKA) in younger patients. This systematic review and meta-analysis evaluates short- and long-term clinical benefit and tissue structure changes after KJD.DESIGN: MEDLINE, EMBASE, and Web of Science were searched for eligible clinical studies evaluating at least one of the primary parameters: WOMAC, VAS-pain, KOOS, EQ5D, radiographic joint space width or MRI cartilage thickness after KJD. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies.RESULTS: Eleven articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups with multiple follow-up moments were included, of which 2 were randomized controlled trials. Significant improvements in all primary parameters were found and benefit lasted up to at least 9 years. Overall, outcomes were comparable with control groups, including high tibial osteotomy, although TKA showed better clinical response.CONCLUSIONS: Current, still limited, evidence shows KJD causes clear benefit in clinical and structural parameters, both short- and long-term. Longer follow-up with more patients is necessary, to validate outcome and to potentially improve patient selection for this intensive treatment. Thus far, for younger knee osteoarthritis patients, KJD may be an option to consider.
KW - Arthroplasty, Replacement, Knee
KW - Humans
KW - Knee Joint/surgery
KW - Osteoarthritis, Knee/surgery
KW - Osteotomy/methods
KW - Randomized Controlled Trials as Topic
KW - Treatment Outcome
KW - joint-preserving treatment
KW - osteoarthritis
KW - review
KW - meta-analysis
KW - knee joint distraction
UR - http://www.scopus.com/inward/record.url?scp=85088373037&partnerID=8YFLogxK
U2 - 10.1177/1947603520942945
DO - 10.1177/1947603520942945
M3 - Review article
C2 - 32698704
AN - SCOPUS:85088373037
SN - 1947-6035
VL - 13
SP - 1113S-1123S
JO - Cartilage
JF - Cartilage
IS - 1_suppl
ER -