Background Knee joint distraction (KJD) results in clinical improvement and cartilage repair in young, active patients with knee OA. Another knee preserving treatment, in medial compartment knee osteoarthritis, is a high tibial osteotomy (HTO), which has good mid-term and longer follow-up results. However, no comparative data on efficacy is available. A RCT was set out and determined whether there was a clinical relevant difference in functional outcome after 1-year between KJD and HTO.
Methods 69 patients with medial osteoarthritis were included and randomized to KJD (23 patients) or HTO (46 patients). A WOMAC questionnaire (100 being the best) was assessed at baseline (BL) and 12 months. EQ-5D index score was used to assess improvement in the quality of life (1 being the best). Joint space width (JSW) of the medial compartment was determined on standardized semi-flexed x-rays at BL and 1-year.
Results 45 patients received HTO (mean age at surgery 49.4±1.0, mean BMI 27.2±0.5 kg/m2 and mean Kellgren & Lawrence grade 2.5±0.1). 22 patients received KJD (mean age at surgery 51.2±1.1, mean BMI 27.5±0.7, mean Kellgren and Lawrence grade 2.3±0.2). Total WOMAC scores demonstrated significant clinical improvement in both groups. The KJD group increased from 57±17 points at BL to 76±17 points at 1-year (p<0.001). Similarly, the HTO group had a score of 52±16 points at BL, which increased to 81±16 points (p<0.001). Parallel results were seen for the VAS and the quality of life (table 2). None of the parameters showed a statistical significant difference between the two groups at 1-year (p=0.318, p=0.170 and p=0.787 resp.). Both the minimum and mean JSW showed a steeper increase in the KJD-group (table 2).
Conclusions Six weeks of KJD does not lead to a clinical relevant difference in outcome compared with HTO after 1-year. Importantly both KJD and HTO lead to substantial newly formed cartilage-like tissue with superiority of KJD. Thus KJD is an alternative option in patients less suitable for HTO.
Disclosure of Interest None declared