ABSTRACT
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.
Subject(s)
Knee Joint/surgery , Osteoarthritis, Knee/surgery , Osteogenesis, Distraction/methods , Aged , Arthroplasty, Replacement, Knee/statistics & numerical data , External Fixators , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Knee Joint/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Osteoarthritis, Knee/diagnostic imaging , Prognosis , Prospective Studies , Radiography , Severity of Illness Index , Sex Factors , Treatment OutcomeABSTRACT
PURPOSE: Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported. METHODS: Sixty-nine patients with medial knee joint OA with a varus axis deviation of <10° were randomized to either knee joint distraction (n = 23) or HTO (n = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up. RESULTS: All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p < 0.02) in both groups. At 1 year, the HTO group showed slightly greater improvement in 4 of the 16 PROMS (p < 0.05). The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group (p = 0.001) and 0.4 ± 0.5 mm in the HTO group (p < 0.001), with minimum JSW improvement in favour of knee joint distraction (p = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only (p < 0.02). CONCLUSION: Cartilaginous repair activity, as indicated by JSW, and clinical outcome improvement occurred with both, knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment. LEVEL OF EVIDENCE: Randomized controlled trial, Level I.
Subject(s)
Knee Joint/surgery , Osteoarthritis, Knee/surgery , Osteotomy , Tibia/surgery , Traction , External Fixators , Female , Humans , Knee Joint/diagnostic imaging , Knee Joint/physiology , Male , Middle Aged , Osteoarthritis, Knee/diagnostic imaging , Osteoarthritis, Knee/physiopathology , Osteotomy/instrumentation , Osteotomy/methods , Radiography , Range of Motion, Articular , Traction/instrumentation , Traction/methods , Treatment OutcomeABSTRACT
BACKGROUND: Treatment of severe osteoarthritis (OA) in relatively young patients is challenging. Although successful, total knee prosthesis has a limited lifespan, with the risk of revision surgery, especially in active young patients. Knee joint distraction (KJD) provides clinical benefit and tissue structure modification at 1-year follow-up. The present study evaluates whether this benefit is preserved during the second year of follow-up. METHODS: Patients included in this study presented with end-stage knee OA and an indication for total knee replacement (TKR); they were less than 60 years old with a VAS pain ≥60 mm (n = 20). KJD was applied for 2 months (range 54-64 days) and clinical parameters assessed using the WOMAC questionnaire and VAS pain score. Changes in cartilage structure were measured using quantitative MRI, radiography, and biochemical analyses of collagen type II turnover (ELISA). RESULTS: Average follow-up was 24 (range 23-25) months. Clinical improvement compared with baseline (BL) was observed at 2-year follow-up: WOMAC improved by 74% (P < 0.001) and VAS pain decreased by 61% (P < 0.001). Cartilage thickness observed by MRI (2.35 mm (95%CI, 2.06-2.65) at BL) was significantly greater at 2-year follow-up (2.78 mm (2.50-3.09); P = 0.03). Radiographic minimum joint space width (JSW) (1.1 mm (0.5-1.7) at BL) was significantly increased at 2-year follow-up as well (1.7 mm (1.1-2.3); P = 0.03). The denuded area of subchondral bone visualized by MRI (22% (95%CI, 12.5-31.5) at BL) was significantly decreased at 2-year follow-up (8% (3.6-12.2); P = 0.004). The ratio of collagen type II synthesis over breakdown was increased at 2-year follow-up (P = 0.07). CONCLUSION: Clinical improvement by KJD treatment is sustained for at least 2 years. Cartilage repair is still present after 2 years (MRI) and the newly formed tissue continues to be mechanically resilient as shown by an increased JSW under weight-bearing conditions.
Subject(s)
Osteoarthritis, Knee/surgery , Osteogenesis, Distraction/methods , Adult , Cartilage, Articular/metabolism , Cartilage, Articular/pathology , Collagen Type II/metabolism , External Fixators , Female , Follow-Up Studies , Humans , Knee Joint/diagnostic imaging , Knee Joint/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Osteoarthritis, Knee/diagnostic imaging , Osteoarthritis, Knee/pathology , Osteogenesis, Distraction/adverse effects , Radiography , Severity of Illness Index , Treatment OutcomeABSTRACT
The incidence of haemophilic arthropathy in multiple joints decreased due to treatment with clotting factor. Nowadays patients are enabled to live a rather normal life, resulting in more (sports) trauma-induced arthropathy in isolated joints like the ankle. As surgical treatment options, fusion of the tibiotalar joint and total ankle replacement are available. Both standard treatments have complications and therefore an alternative treatment is desired. In this study, treatment of haemophilic ankle arthropathy with joint distraction was explored. Three patients with haemophilic ankle arthropathy were treated with joint distraction using an Ilizarov external fixator. Clinical outcomes like function, participation and pain were evaluated in retrospect with three different questionnaires: haemophilia activities list, impact on participation and autonomy and the Van Valburg questionnaire. Structural changes were assessed blinded on X-ray by the Pettersson score and ankle images digital analysis (AIDA) and by an MRI score. All three patients were very satisfied with the clinical outcome of the procedure. They reported a clear improvement for self-perceived functional health, participation in society and autonomy and pain. Partial ankle joint mobility was preserved in the three patients. The Pettersson score remained the same in one patient and slightly improved in the two other patients, while joint space width measured by AIDA and the MRI score demonstrated improvement for all three patients after ankle distraction. This study suggests that joint distraction is a promising treatment for individual cases of haemophilic ankle arthropathy, without additional risk of bleedings during treatment.
Subject(s)
Hemophilia A/complications , Hemophilia B/complications , Joint Diseases/etiology , Joint Diseases/surgery , Adolescent , Adult , Ankle Joint/diagnostic imaging , Ankle Joint/physiopathology , Ankle Joint/surgery , External Fixators , Hemarthrosis/etiology , Hemarthrosis/surgery , Humans , Joint Diseases/diagnostic imaging , Joint Diseases/physiopathology , Male , Radiography , Range of Motion, ArticularABSTRACT
BACKGROUND: Knee osteoarthritis is a highly prevalent degenerative joint disorder characterized by joint tissue damage and pain. Knee joint distraction has been introduced as a joint preserving surgical procedure to postpone knee arthroplasty. An often used standard externally fixation device for distraction poses a burden to patients due to the absence of joint flexion during the 6weeks treatment. Therefore, a personalized articulating distraction device was developed. The aim of this study was to test technical feasibility of this device. METHODS: Based on an often applied rigid device, using equal bone pin positions and connectors, a hinge mechanism was developed consisting of a cam-following system for reproducing the complex joint-specific knee kinematics. In support, a device was developed for capturing the joint-specific sagittal plane articulation. The obtained kinematic data were translated into joint-specific cam shapes that were installed bilaterally in the hinge mechanism of the distraction device, as such providing personalized knee motion. Distraction of 5mm was performed within a range of motion of 30deg. joint flexion. Pre-clinical evaluation of the working principle was performed on human cadaveric legs and system stiffness characteristics were biomechanically evaluated. FINDINGS: The desired range of motion was obtained and distraction was maintained under physiologically representative loading. Moreover, the joint-specific approach demonstrated tolerance of deviations from anatomical and alignment origin during initial placement of the developed distraction device. INTERPRETATION: Articulation during knee distraction is considered technically feasible and has potential to decrease burden and improve acceptance of distraction therapy. Testing of clinical feasibility is warranted.
Subject(s)
Arthroplasty, Replacement, Knee/instrumentation , Knee Joint/physiopathology , Osteoarthritis, Knee/surgery , Arthroplasty, Replacement, Knee/methods , Biomechanical Phenomena , Bone Nails , External Fixators , Feasibility Studies , Female , Humans , Knee/surgery , Male , Middle Aged , Motion , Osteoarthritis, Knee/physiopathology , Range of Motion, Articular/physiologyABSTRACT
BACKGROUND: For young patients (<65years), knee joint distraction (KJD) may be a joint-saving treatment option for end-stage knee osteoarthritis. Distracting the femur from the tibia by five millimeters for six to eight weeks using an external fixation frame results in cartilaginous tissue repair, in addition to clinical benefits. This study is a first attempt to predict the degree of cartilaginous tissue repair after KJD. METHODS: Fifty-seven consecutive patients received KJD. At baseline and at one year of follow-up, mean and minimum joint space width (JSW) of the most-affected compartment was determined on standardized radiographs. To evaluate the predictive ability of baseline characteristics for JSW at one year of follow-up, multivariable linear regression analysis was performed. RESULTS: Mean JSW±SD of the most affected compartment increased by 0.95±1.23mm to 3.08±1.43mm at one year (P<0.001). The minimum JSW increased by 0.94±1.03mm to 1.63±1.21mm at one year of follow-up (P<0.001). For a larger mean JSW one year after KJD, only Kellgren & Lawrence grade (KLG) at baseline was predictive (Regression coefficient (ß)=0.47, 95% CI=0.18 to 0.77, P=0.002). For a larger minimum JSW, KLG (ß=0.46, 95% CI=0.19 to 0.73, P=0.001) and male gender (ß=0.52, 95% CI=0.06 to 0.99, P=0.028) were statistically predictive. Eight weeks of distraction time neared significance (ß=0.44, 95% CI=-0.05 to 0.93, P=0.080). CONCLUSIONS: In our cohort of patients treated with KJD, males with higher KLG had the best chance of cartilaginous tissue repair by distraction.
Subject(s)
Cartilage, Articular/surgery , Knee Joint/surgery , Osteoarthritis, Knee/surgery , Osteogenesis, Distraction , Adult , Aged , Female , Femur/surgery , Humans , Middle Aged , Tibia/surgeryABSTRACT
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±0.3mm in the six-week group and 1.1±0.3mm in the eight-week group (p=0.729 between groups). The increase in mean cartilage thickness on MRI was 0.6±0.2mm in the eight-week group and 0.4±0.1mm 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 KJD.
Subject(s)
Cartilage, Articular/surgery , Knee Joint/surgery , Osteoarthritis, Knee/surgery , Osteogenesis, Distraction/methods , Cohort Studies , External Fixators , Female , Humans , Male , Middle Aged , Traction , Wound HealingABSTRACT
A study of limb lengthening by distraction epiphysiolysis in the rabbit tibia is presented. A special external distraction device was developed that allowed 10 mm lengthening of the leg. Bone formation in the elongated zone was studied by computed tomography and [99mTc] methylene diphosphonate (MDP) scintigraphy. Computed tomography showed bone formation proceeding for several weeks after the end of the distraction period, followed by a decrease in the amount of bone during a remodeling phase leading to the formation of a solid cortical structure. The uptake of [99mTc]MDP increased parallel to, but preceeding the actual accretion of bone, followed by a decrease during the bone remodeling phase. Uptake of the tracer will partly reflect bone metabolism, but other factors, like trauma, determine much of the uptake.
Subject(s)
Bone Lengthening/methods , Bone and Bones/physiology , Epiphyses/surgery , Animals , Bone and Bones/diagnostic imaging , Rabbits , Radionuclide Imaging , Technetium Tc 99m Medronate , Tomography, X-Ray Computed , Wound HealingABSTRACT
The effect of direct current stimulation on bone formation during limb lengthening was tested in a lower leg lengthening model in the rabbit. Limb lengthening was performed by distraction epiphysiolysis. A specially designed external distraction device was placed at the tibia. The distractor allowed 10 mm of lengthening in 4 weeks. Two weeks after starting the distraction, a platinum electrode was passed through the anterior cortex below the tibial tuberosity and advanced via the medullary cavity so that the tip rested in the elongated zone. Stimulation started at the time of placement of the electrodes and was continued for 3 weeks. The electrode in the elongated zone served as the cathode; the anode was placed subcutaneously. A 20 microA stimulus was selected. A control group received the same treatment without stimulation. Bone formation in the elongated zone was evaluated by histology and scintigraphy. The data from this experiment show that direct current stimulation in the early phase of a limb lengthening procedure had no effect on the extent of bone formation in the elongated zone.
Subject(s)
Bone Lengthening/methods , Electric Stimulation , Tibia/growth & development , Animals , Female , Osteogenesis , Rabbits , Radiography , Radionuclide Imaging , Tibia/diagnostic imagingABSTRACT
We treated 15 patients by arthrodesis of the knee after removal of an infected total knee arthroplasty, using an Ilizarov ring fixator. Eight had a failed arthrodesis by another technique. The mean age of the patients was 75 years, the mean duration of retention of the frame was 28 weeks, the mean treatment time 51 weeks, and the mean follow-up 52 months. All but one knee fused at the first attempt, a rate of union of 93%. The incidence of complications related to treatment was 80%. The length of treatment and rates of complication were attributed to advanced age and the adverse local clinical factors in these patients. The Ilizarov method is a promising technique for achieving arthrodesis under these circumstances.
Subject(s)
Arthrodesis , Arthroplasty, Replacement, Knee , Ilizarov Technique , Postoperative Complications/surgery , Prosthesis-Related Infections/surgery , Aged , Aged, 80 and over , External Fixators , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Prosthesis-Related Infections/diagnostic imaging , Radiography , Treatment OutcomeABSTRACT
We applied joint distraction using an Ilizarov apparatus in 11 patients with post-traumatic osteoarthritis of the ankle to try to delay the need for an arthrodesis. Distraction for three months resulted in clinical improvement in pain and mobility for a mean of two years, with an increase in the joint space. We considered that these effects may be produced by the absence of mechanical stress on the cartilage combined with the intra-articular hydrostatic pressures during distraction. We measured these pressures during walking with distraction, and found levels very similar to those reported to improve osteoarthritic cartilage when applied in vitro.
Subject(s)
Ankle Joint/surgery , Ilizarov Technique , Osteoarthritis/surgery , Adult , Aged , Ankle Joint/diagnostic imaging , Ankle Joint/physiopathology , Biomechanical Phenomena , Equinus Deformity/complications , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteoarthritis/complications , Osteoarthritis/diagnostic imaging , Pressure , Radiography , Retrospective Studies , Stress, MechanicalABSTRACT
We report a sporadic case of tetramelic mirror-image polydactyly in combination with unilateral tibial aplasia. No chromosomal or other associated abnormalities were found. The appearance and function of the upper and lower limbs were improved by surgery.
Subject(s)
Abnormalities, Multiple/surgery , Fingers/abnormalities , Hand Deformities, Congenital/surgery , Polydactyly/surgery , Tibia/abnormalities , Toes/abnormalities , Humans , MaleABSTRACT
Chronic osteomyelitis is characterized by cicatrization of the focus of infection with deteriorating vascularization, which makes the disease increasingly difficult to treat. The treatment in chronic osteomyelitis consists primarily in surgical debridement of the scarified focus of infection; stabilization with external fixation allows better treatment. Following debridement, local antibiotic treatment is possible with gentamicin containing cement beads, if necessary combined with systemic antibiotic treatment. If the infection heals well, a reconstruction may, if necessary, be carried out: bone defects frequently necessitate bone transplantation, bone segment shifting (Ilizarov method) or free muscle flap grafts. In the future, resistant bacteria will make healing harder. There will be more possibility to use resorbable antibiotic vehicles and bone-replacing biomaterials.
Subject(s)
Osteomyelitis/therapy , Antibiotic Prophylaxis/methods , Chronic Disease , Debridement/methods , Female , History, 19th Century , History, 20th Century , Humans , Male , Methicillin Resistance , Netherlands , Orthopedics/history , Osteomyelitis/history , Remission InductionABSTRACT
A leg length inequality of 5 cm was compensated by lengthening of the proximal tibia by distraction epiphysiolysis. During the first 7 weeks of lengthening the distraction force was monitored continuously by strain gauges attached to the extension bars of the external distraction device. The increase in length was 1.25 mm a day. The force registration showed a visco-elastic response of the tissue to distraction. In the first week the distraction force increased up to 791 N. Then lysis occurred, followed by a sudden decrease in force to an average level of 150 N. During subsequent distraction, pain and clinical symptoms could be associated with increasing tension and inadequate stress relaxation of soft tissues. Adjusting the distraction rate decreased the build-up of force in the tissue and ameliorated the clinical symptoms. These results show that force measurements can be clinically useful for appropriately adjusting the distraction rate.
Subject(s)
Bone Lengthening/methods , External Fixators , Leg Length Inequality/therapy , Adolescent , Epiphyses/physiopathology , Humans , Leg Length Inequality/physiopathology , Male , Tibia/physiopathology , Traction/methodsABSTRACT
Uptake of 99mTc-MDP was measured in the proximal and distal growth plate of the rabbit tibia during the final phase of growth. Scintigraphic data were compared with roentgenographically measured tibial length and signs of bony fusion of the growth plates. Uptake by the proximal tibial growth plate was higher than in the distal tibial plate. Uptake decreased on cessation of growth and during subsequent bony fusion. In particular in the proximal tibial region, uptake was still high after cessation of longitudinal growth, which illustrates that during the final period of growth uptake of 99mTc-MDP by a roentgenographically still open growth plate does not necessarily indicate that such a growth plate still contributes to longitudinal growth. Decrease in uptake during the final phase of growth should be considered, when bone scanning is part of a research protocol.
Subject(s)
Growth Plate/diagnostic imaging , Technetium Tc 99m Medronate/metabolism , Tibia/diagnostic imaging , Tibia/growth & development , Animals , Rabbits , Radiography , Radionuclide Imaging , Reproducibility of ResultsABSTRACT
Osteoarthritis (OA) is a slowly progressive joint disease. Joint distraction can be a treatment of choice in case of severe OA. Prediction of failure will facilitate implementation of joint distraction in clinical practice. Patients with severe ankle OA, who underwent joint distraction were included. Survival analysis was performed over 12 years (n = 25 after 12 years). Regression analyses were used to predict failures and clinical benefit at 2 years after joint distraction (n = 111). Survival analysis showed that 44% of the patients failed, 17% within 2 years and 37% within 5 years after joint distraction (n = 48 after 5 years). Survival analysis in subgroups showed that the percentage failure was only different in women (30% after 2 years) versus men (after 11 years still no 30% failure). In the multivariate analyses female gender was predictive for failure 2 years after joint distraction. Gender and functional disability at baseline predicted more pain. Functional disability and pain at baseline were associated with more functional disability. Joint distraction shows a long-term clinical beneficial outcome. However, failure rate is considerable over the years. Female patients have a higher chance of failure during follow-up. Unfortunately, not all potential predictors could be investigated and other clinically significant predictors were not found.
Subject(s)
Ankle Joint/physiopathology , Ankle Joint/surgery , Osteoarthritis/physiopathology , Osteoarthritis/surgery , Osteogenesis, Distraction/methods , Adult , Disability Evaluation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Prospective Studies , Recovery of Function , Regression Analysis , Severity of Illness Index , Survival Analysis , Treatment OutcomeSubject(s)
Ankle Joint , Ilizarov Technique , Osteoarthritis/therapy , Adolescent , Adult , Animals , Cartilage, Articular , Disease Models, Animal , Dogs , Humans , Middle Aged , Treatment OutcomeABSTRACT
OBJECTIVE: In vitro studies showed a beneficial effect of celecoxib on proteoglycan turnover and content of osteoarthritic cartilage. In the present study we evaluated whether these favourable effects of celecoxib could also be demonstrated in vivo. METHODS: In 24 Beagle dogs, osteoarthritis (OA) was induced in one knee according to the groove model. The animals were divided into three groups and received oral placebo or 100 or 200 mg celecoxib daily, starting directly after surgery. After 15 weeks joint tissue from all dogs was analysed. RESULTS: Induction of OA resulted in macroscopic and histological damage of cartilage, changes in cartilage proteoglycan turnover, loss of cartilage matrix proteoglycans and slight synovial inflammation, all characteristic of early OA. Surprisingly, none of the parameters was significantly changed upon celecoxib treatment. Synovial fluid prostaglandin E(2) levels were dose-dependently diminished by celecoxib, demonstrating that the celecoxib had reached the joint in sufficient amounts. Using an in vitro setup, canine cartilage under degenerative conditions was favourably influenced by celecoxib, demonstrating that canine cartilage is sensitive to celecoxib. CONCLUSION: The present study showed a chondroneutral effect of celecoxib on the characteristics of experimentally induced OA in vivo, in contrast to the observed beneficial effect in vitro. It could be that celecoxib had been beneficial to degenerated cartilage in vivo but that these effects were counteracted by increased loading of the affected joint and the associated progression of OA, occurring because of the well-known analgesic effects of celecoxib.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Cyclooxygenase 2 Inhibitors/therapeutic use , Osteoarthritis/drug therapy , Pyrazoles/therapeutic use , Sulfonamides/therapeutic use , Animals , Cartilage, Articular/drug effects , Cartilage, Articular/pathology , Celecoxib , Cyclooxygenase 2/metabolism , Dinoprostone/analysis , Disease Models, Animal , Dogs , Dose-Response Relationship, Drug , Female , Hindlimb , Osteoarthritis/enzymology , Osteoarthritis/pathology , Proteoglycans/metabolism , Synovial Fluid/metabolism , Synovitis/complications , Synovitis/drug therapy , Synovitis/pathologyABSTRACT
OBJECTIVE: Osteoarthritis (OA) is a degenerative disabling joint disease affecting more than 10% of the adult population. No validated disease-modifying treatment is available. Joint distraction is a relatively new approach to the treatment of severe ankle OA. Short-term (3 years) clinical benefit has been proven, but long-term effects remain to be evaluated. METHODS: Patients with severe OA of the tibio-talar joint, who had been treated with Ilizarov joint distraction more than 7 years previously, were included. Pre-treatment data were obtained by retrospective analysis using questionnaires and patients' charts. Post-treatment assessments were undertaken using the same questionnaires and by physical examination. Three approaches were used and results were compared: the van Valburg score, the Ankle Osteoarthritis Scale (AOS), and a patient satisfaction questionnaire. Retrospectively and prospectively obtained data were available from eight patients for comparison. RESULTS: Twenty-five out of 27 patients with severe ankle OA treated with Ilizarov joint distraction could be traced. Appropriate retrospective data could not be obtained from three patients. Six out of the 22 patients (27%) were failures. In 16 patients (73%), significant improvement in all clinical parameters was observed using each of the three approaches. Good correlations were found between the results of the three methods of assessment and retrospectively obtained pre-treatment values were very similar to the prospective data. CONCLUSIONS: In 73% of the patients, significant clinical benefit from joint distraction of severe OA ankles was maintained for at least 7 years. There is, however, a need for further research to try and predict which patients will not respond to this unconventional form of major surgical intervention.