Joint distraction in treatment of osteoarthritis: a two-year follow-up of the ankle.
OBJECTIVE
Osteoarthritis (OA) is a degenerative joint disease with an incidence exceeding 10% of the adult population. In end stages, OA can result in severe restriction of activity and consequent disability. For these severe cases of OA, no effective remedy is available yet. Joint distraction is a new experimental approach in treatment of OA. Studied in retrospect it appeared that this treatment results in prolonged clinical improvement in the case of ankle OA. Presently the results of a prospective two-year follow-up are given.


METHODS
Patients with severe ankle OA, who were considered for joint fusion (arthrodesis), were treated with distraction, by use of an Ilizarov external ring fixator. Distraction was carried out for 3 months during which full weight bearing (walking) was allowed. Standardized clinical examination was conducted before and at yearly intervals after treatment, including physical examination, functional ability questionnaire, pain scale, joint mobility, and radiographic evaluation.


RESULTS
More than two thirds of the patients improved significantly as shown by physical examination, functional ability questionnaires and pain scale; effects were progressive in the second year of follow-up. On average, joint mobility and radiographic joint space were preserved, whilst improvement was observed in a significant number of patients.


CONCLUSIONS
Results of the present prospective study confirm the findings of the previous retrospective study and suggest that Ilizarov joint distraction is a promising treatment for severe ankle OA, at least delaying the need for a joint fusion. Considering the high prevalence of OA and the lack of a remedy for this disorder, Ilizarov joint distraction as a treatment for OA may have great medical, social and economic impact.
van Valburg
A A
AA
The Department of Rheumatology & Clinical Immunology, University Medical Centre of Utrecht, Utrecht, GA, 3508, The Netherlands.
van Roermund
P M
PM
Marijnissen
A C
AC
van Melkebeek
J
J
Lammens
J
J
Verbout
A J
AJ
Lafeber
F P
FP
Bijlsma
J W
JW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome