van der Woude Jan-Ton A D, Wiegant Karen, van Roermund Peter M, Intema Femke, Custers Roel J H, Eckstein Felix, van Laar Jaap M, Mastbergen Simon C, Lafeber Floris P J G
1 Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
2 Department of Orthopedics, Maartenskliniek Woerden, the Netherlands.
Cartilage. 2017 Jul;8(3):263-271. doi: 10.1177/1947603516665442. Epub 2016 Aug 26.
Objective In end-stage knee osteoarthritis, total knee arthroplasty (TKA) may finally become inevitable. At a relatively young age, this comes with the risk of future revision surgery. Therefore, in these cases, joint preserving surgery such as knee joint distraction (KJD) is preferred. Here we present 5-year follow-up data of KJD. Design Patients ( n = 20; age <60 years) with conservative therapy resistant tibiofemoral osteoarthritis considered for TKA were treated. Clinical evaluation was performed by questionnaires. Change in cartilage thickness was quantified on radiographs and magnetic resonance images (MRI). The 5-year changes after KJD were evaluated and compared with the natural progression of osteoarthritis using Osteoarthritis Initiative data. Results Five-years posttreatment, patients still reported clinical improvement from baseline: ΔWOMAC (Western Ontario and McMaster Universities Arthritis Index) +21.1 points (95% CI +8.9 to +33.3; P = 0.002), ΔVAS (visual analogue scale score) pain -27.6 mm (95%CI -13.3 to -42.0; P < 0.001), and minimum radiographic joint space width (JSW) of the most affected compartment (MAC) remained increased as well: Δ +0.43 mm (95% CI +0.02 to +0.84; P = 0.040). Improvement of mean JSW (x-ray) and mean cartilage thickness (MRI) of the MAC, were not statistically different from baseline anymore (Δ +0.26 mm; P = 0.370, and Δ +0.23 mm; P = 0.177). Multivariable linear regression analysis indicated that KJD treatment was associated with significantly less progression in mean and min JSW (x-ray) and mean cartilage thickness (MRI) compared with natural progression (all Ps <0.001). Conclusions KJD treatment results in prolonged clinical benefit, potentially explained by an initial boost of cartilaginous tissue repair that provides a long-term tissue structure benefit as compared to natural progression. Level of evidence, II.
目的 在终末期膝骨关节炎中，全膝关节置换术（TKA）最终可能不可避免。在相对年轻的年龄段，这伴随着未来翻修手术的风险。因此，在这些病例中，诸如膝关节撑开术（KJD）等保留关节的手术更受青睐。在此，我们展示了KJD的5年随访数据。设计 对考虑行TKA的保守治疗无效的胫股关节骨关节炎患者（n = 20；年龄<60岁）进行治疗。通过问卷调查进行临床评估。在X线片和磁共振成像（MRI）上对软骨厚度变化进行定量分析。评估KJD术后5年的变化，并使用骨关节炎倡议数据与骨关节炎的自然进展进行比较。结果 治疗5年后，患者仍报告临床状况较基线有所改善：WOMAC（西安大略和麦克马斯特大学骨关节炎指数）变化+21.1分（95%CI +8.9至+33.3；P = 0.002），视觉模拟量表（VAS）疼痛评分变化-27.6 mm（95%CI -13.3至-42.0；P < 0.001），最受累关节间室（MAC）的最小X线关节间隙宽度（JSW）也仍保持增加：变化量+0.43 mm（95%CI +0.02至+0.84；P = 0.040）。MAC的平均JSW（X线）和平均软骨厚度（MRI）的改善与基线相比不再有统计学差异（变化量+0.26 mm；P = 0.370，变化量+0.23 mm；P = 0.177）。多变量线性回归分析表明，与自然进展相比，KJD治疗与平均和最小JSW（X线）以及平均软骨厚度（MRI）的进展显著减少相关（所有P值<0.001）。结论 KJD治疗可带来长期临床益处，这可能是由于软骨组织修复的初始促进作用，与自然进展相比，其为组织结构带来了长期益处。证据级别，II级。
