Initial tissue repair predicts long-term clinical success of knee joint distraction as treatment for knee osteoarthritis.

Autor: Jansen MP; Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: m.p.jansen-36@umcutrecht.nl., van der Weiden GS; Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: g.s.vanderweiden@gmail.com., Van Roermund PM; Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: P.M.vanRoermund@umcutrecht.nl., Custers RJH; Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: rcuster2@umcutrecht.nl., Mastbergen SC; Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: s.mastbergen@umcutrecht.nl., Lafeber FPJG; Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: f.lafeber@umcutrecht.nl.
Jazyk: angličtina
Zdroj: Osteoarthritis and cartilage [Osteoarthritis Cartilage] 2018 Dec; Vol. 26 (12), pp. 1604-1608. Date of Electronic Publication: 2018 Aug 21.
DOI: 10.1016/j.joca.2018.08.004
Abstrakt: Objective: Knee joint distraction (KJD), a joint-preserving surgery for severe osteoarthritis (OA), provides clinical and structural improvement and postpones the need for total knee arthroplasty (TKA). This study evaluates 9-year treatment outcome and identifies characteristics predicting long-term treatment success.
Design: Patients with severe tibiofemoral OA (n = 20; age<60 years) indicated for TKA were treated with KJD. Questionnaires, radiographs, and magnetic resonance imaging (MRI) were used for evaluation. Survival after treatment was analyzed, where 'failure' was defined by TKA over time.
Results: 9-year survival was 48%, and 72% for men (compared to 14% for women; P = 0.035) and 73% for those with a first-year minimum joint space width (JSW) increase of >0.5 mm (compared to 0% for <0.05 mm; P = 0.002). Survivors still reported clinical improvement compared to baseline (ΔWOMAC +29.9 points (95%CI 16.9-42.9; P = 0.001), ΔVAS -46.8 mm (-31.6-61.9; P < 0.001)). Surprisingly, patients getting TKA years after KJD still reported clinical improvement although less pronounced (ΔWOMAC +20.5 points (-1.8-42.8; P = 0.067), ΔVAS -25.4 mm (-3.2-47.7; P = 0.030)). Survivors showed long-lasting minimum JSW increase (baseline 0.3 mm (IQR 1.9), follow-up 1.3 mm (2.5); P = 0.017) while 'failures' did not (baseline 0.4 mm (1.8), follow-up 0.2 mm (1.5); P = 0.161). First-year minimum JSW on radiographs and cartilage thickness increase on MRI predict 9-year survival (HR 0.05 and 0.12, respectively; both P < 0.026). Male gender was associated with survival (HR 0.24; P = 0.050).
Conclusions: KJD shows long-lasting clinical and structural improvement. In addition to a greater survival rate for males (>two out of three), the initial cartilage repair activity appears to be important for long-term clinical success.
(Copyright © 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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