Knee Joint Distraction Compared with High Tibial Osteotomy and Total Knee Arthroplasty: Two-Year Clinical, Radiographic, and Biochemical Marker Outcomes of Two Randomized Controlled Trials

Cartilage. 2021 Apr;12(2):181-191. doi: 10.1177/1947603519828432. Epub 2019 Feb 13.

Abstract

Objective: Both, knee joint distraction (KJD) and high tibial osteotomy (HTO) are joint-preserving surgeries that postpone total knee arthroplasty (TKA) in younger osteoarthritis (OA) patients. Here we evaluate the 2-year follow-up of KJD versus TKA and KJD versus HTO in 2 noninferiority studies.

Design: Knee OA patients indicated for TKA were randomized to KJD (n = 20; KJDTKA) or TKA (n = 40). Medial compartmental knee OA patients considered for HTO were randomized to KJD (n = 23; KJDHTO) or HTO (n = 46). Patient-reported outcome measures were assessed over 2 years of follow-up. The radiographic joint space width (JSW) was measured yearly. In the KJD groups, serum-PIIANP and urinary-CTXII levels were measured as collagen type-II synthesis and breakdown markers. It was hypothesized that there was no clinically important difference in the primary outcome, the total WOMAC, when comparing KJD with HTO and with TKA.

Results: Both trials were completed, with 114 patients (19 KJDTKA; 34 TKA; 20 KJDHTO; 41 HTO) available for 2-year analyses. At 2 years, the total WOMAC score (KJDTKA: +30.4 [95% CI 23.0-37.9] points; TKA: +42.4 [95% CI 38.1-46.8]; KJDHTO: +21.6 [95% CI 13.8-29.4]; HTO: +29.2 [95% CI 23.6-34.8]; all: P < 0.05) and radiographic minimum JSW (KJDTKA: +0.9 [95% CI 0.2-1.6] mm; KJDHTO: +0.9 [95% CI 0.5-1.4]; HTO: +0.6 [95% CI 0.3-0.9]; all: P < 0.05) were still increased for all groups. The net collagen type-II synthesis 2 years after KJD was increased (P < 0.05). Half of KJD patients experienced pin tract infections, successfully treated with oral antibiotics.

Conclusions: Sustained improvement of clinical benefit and (hyaline) cartilage thickness increase after KJD is demonstrated. KJD was clinically noninferior to HTO and TKA in the primary outcome.

Keywords: distraction; joint-preserving surgery; knee joint distraction (KJD); randomized controlled trial (RCT).

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Arthroplasty, Replacement, Knee / statistics & numerical data
  • Biomarkers / analysis
  • Collagen Type II / metabolism
  • Equivalence Trials as Topic
  • Female
  • Follow-Up Studies
  • Humans
  • Hyaline Cartilage / pathology
  • Hyaline Cartilage / surgery
  • Knee Joint / metabolism
  • Knee Joint / surgery*
  • Male
  • Middle Aged
  • Minimal Clinically Important Difference
  • Osteoarthritis, Knee / pathology
  • Osteoarthritis, Knee / surgery*
  • Osteotomy / methods*
  • Radiography / methods
  • Radiography / statistics & numerical data*
  • Randomized Controlled Trials as Topic
  • Tibia / metabolism
  • Tibia / surgery*
  • Treatment Outcome

Substances

  • Biomarkers
  • Collagen Type II

Associated data

  • NTR/NTR2809
  • NTR/NTR2900