Knee joint distraction compared with total knee arthroplasty: a randomised controlled trial

Bone Joint J. 2017 Jan;99-B(1):51-58. doi: 10.1302/0301-620X.99B1.BJJ-2016-0099.R3.


Aims: Knee joint distraction (KJD) is a relatively new, knee-joint preserving procedure with the goal of delaying total knee arthroplasty (TKA) in young and middle-aged patients. We present a randomised controlled trial comparing the two.

Patients and methods: The 60 patients ≤ 65 years with end-stage knee osteoarthritis were randomised to either KJD (n = 20) or TKA (n = 40). Outcomes were assessed at baseline, three, six, nine, and 12 months. In the KJD group, the joint space width (JSW) was radiologically assessed, representing a surrogate marker of cartilage thickness.

Results: In total 56 patients completed their allocated treatment (TKA = 36, KJD = 20). All patient reported outcome measures improved significantly over one year (p < 0.02) in both groups. At one year, the TKA group showed a greater improvement in only one of the 16 patient-related outcome measures assessed (p = 0.034). Outcome Measures in Rheumatology-Osteoarthritis Research Society International clinical response was 83% after TKA and 80% after KJD. A total of 12 patients (60%) in the KJD group sustained pin track infections. In the KJD group both mean minimum (0.9 mm, standard deviation (sd) 1.1) and mean JSW (1.2 mm, sd 1.1) increased significantly (p = 0.004 and p = 0.0003).

Conclusion: In relatively young patients with end-stage knee osteoarthritis, KJD did not demonstrate inferiority of outcomes at one year when compared with TKA. However, there is a high incidence of pin track infection associated with KJD. Cite this article: Bone Joint J 2017;99-B:51-8.

Keywords: Cartilage repair; Joint distraction; Knee osteoarthritis; Randomised controlled trial; Total knee arthroplasty.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Arthroplasty, Replacement, Knee / methods*
  • Cartilage, Articular / surgery
  • External Fixators
  • Female
  • Humans
  • Knee Joint / surgery*
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / diagnostic imaging
  • Osteoarthritis, Knee / physiopathology
  • Osteoarthritis, Knee / surgery*
  • Pain, Postoperative / etiology
  • Pain, Postoperative / physiopathology
  • Patient Satisfaction
  • Range of Motion, Articular / physiology
  • Traction / instrumentation
  • Traction / methods
  • Treatment Outcome