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OP0104 Knee Joint Distraction Compared with High Tibial Osteotomy: A Randomized Controlled Trial
  1. J.-T. van der Woude1,
  2. R.J. van Heerwaarden2,
  3. S. Spruijt2,
  4. K. Wiegant1,
  5. P.M. van Roermund3,
  6. D.B. Saris4,
  7. S.C. Mastbergen1,
  8. F.P. Lafeber1
  1. 1Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht
  2. 2Orthopedics, Maartenskliniek, Woerden
  3. 3Orthopedics, Medical Centre, Amstelveen
  4. 4Orthopedics, UMC Utrecht, Utrecht, Netherlands

Abstract

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

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