safety and procedure

 Saftey and procedure

  1. Total knee prosthesis after joint distraction treatment.

Wiegant K, van Roermund PM, van Heerwaarden R, Spruijt S, Custers R, Kuchuk N, Mastbergen S, Lafeber FPJG.

Journal of Surgery and Surgical Research; 2015; 1: 066-071.

Background and purpose: During knee joint distraction (KJD) treatment, using an external fixation-frame, pin-tract infections frequently occur. These local skin infections, although treated successfully with oral antibiotics, might lead to latent infections. This raises concern about subsequent placement of a total knee prosthesis (TKP). This study evaluates the first five cases in which patients had to be treated with TKO after KJD failure.

Patients and methods: An overall survival analysis of the first 26 patients treated with KJD revealed five failures, because of declining efficacy over time. These patients were treated with TKP. Complications of these TKPs are described and all cases were compared with age and gender matched primary-TKP-controls. WOMAC and VAS pain scores were assessed before and after TKP treatment.

Results: The mean survival time of the five KJD before TKP was 61 ± 15 months (range 45-84 months). No peri-operative complications were registered and none of the patients suffered from an infection post-TKP. There were no differences between baseline characteristics of patients with primary TKP compared to those with TKP after KJD except for a higher VAS pain score (p<0.02) for primary TKP. Mean follow-up after TKP was 21 ± 12 months (range 9-39 months). Efficacy after TKP was similar for patients with primary TKP compared to those with TKP after KJD.

Conclusion: Based on the first five cases it appears safe to treat patients several years after KJD with a TKP. There is no indication these patients have a higher infection risk and post-operative outcome is comparable with primary TKP.

  1. Six weeks continuous joint distraction appears sufficient for clinical benefit

and cartilage tissue repair in the treatment of knee osteoarthritis.

Van der Woude JAD, Van Heerwaarden RJ, Spruijt S Eckstein F, Maschek S, van Roermund PM, Custers RJ, van Spil WE, Mastbergen SC, Lafeber FP.

Knee 2016; May  26 [Epub ahead of print].

Background: Knee joint distraction (KJD) is a surgical joint-preserving treatment in which the knee joint is temporarily distracted by an external frame. It is associated with joint tissue repair and clinical improvement. Initially, patients were submitted to an eight-week distraction period, and currently patients are submitted to a six-week distraction period. This study evaluates whether a shorter distraction period influences the outcome.

Methods: Both groups consisted of 20 patients. Clinical outcome was assessed by WOMAC questionnaires and VAS-pain. Cartilaginous tissue repair was assessed by radiographic joint space width (JSW) and MRI-observed cartilage thickness.

Results: Baseline data between both groups were comparable. Both groups showed an increase in total WOMAC score; 24 ± 4 in the six-week group and 32 ± 5 in the eight-week group (both p < 0.001). Mean JSW increased 0.9 ± 0.3 mm in the six-week group and 1.1 ± 0.3 mm in the eight-week group (p = 0.729 between groups). The increase in mean cartilage thickness on MRI was 0.6 ± 0.2 mm in the eight-week group and 0.4 ± 0.1 mm in the six-week group (p = 0.277).

Conclusions: A shorter distraction period does not influence short-term clinical and structural outcomes statistically significantly, although effect sizes tend to be smaller in six week KJD as compared to eight week KJDKnee joint distraction compared with high tibial osteotomy: a randomized controlled trial.