title: Unloading joints to treat osteoarthritis, including joint distraction.
abstract: OBJECTIVE
  Patients are increasingly becoming interested in nonpharmacologic approaches to manage their osteoarthritis. This review examines the recent literature on the potential beneficial effects of unloading joints in the treatment of osteoarthritis, with a focus on joint distraction.
  
  
  RESULTS
  Mechanical factors are involved in the development and progression of osteoarthritis. If "loading" is a major cause in development and progression of osteoarthritis, then "unloading" may be able to prevent progression. There is evidence that unloading may be effective in reducing pain and slowing down structural damage. This review describes unloading by footwear and bracing (nonsurgical), unloading by osteotomy (surgical), and has a focus on unloading by joint distraction. Excellent reviews in all these three fields have been published over the past few years. Recent studies argue for the usefulness of a biomechanical approach to improve function and possibly reduce disease progression in osteoarthritis.
  
  
  CONCLUSIONS
  To improve patient function and possibly reduce disease progression, a biomechanical approach should be considered in treating patients with osteoarthritis. Further research (appropriate high-quality clinical trials) and analysis (clinical as well as preclinical and fundamental) are still necessary, however, to understand, validate, and refine the different approaches of unloading to treat osteoarthritis.
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands. f.lafeber@umcutrecht.nl
authors.forename: Floris P J G
authors.initials: FP
authors.lastname: Lafeber
authors.forename: Femke
authors.initials: F
authors.lastname: Intema
authors.forename: Peter M
authors.initials: PM
authors.lastname: Van Roermund
authors.forename: Anne C A
authors.initials: AC
authors.lastname: Marijnissen
mesh_terms: D002986:Clinical Trials as Topic; D018450:Disease Progression; D006801:Humans; D007596:Joints; D010003:Osteoarthritis / Q000628:therapy*; D016474:Weight-Bearing