title: Knee joint distraction compared with total knee arthroplasty: a randomised controlled trial.
abstract: OBJECTIVE
  Knee joint distraction (KJD) is a relatively new, knee-joint preserving procedure with the goal of delaying total knee arthroplasty (TKA) in young and middle-aged patients. We present a randomised controlled trial comparing the two.
  
  
  METHODS
  The 60 patients ≤ 65 years with end-stage knee osteoarthritis were randomised to either KJD (n = 20) or TKA (n = 40). Outcomes were assessed at baseline, three, six, nine, and 12 months. In the KJD group, the joint space width (JSW) was radiologically assessed, representing a surrogate marker of cartilage thickness.
  
  
  RESULTS
  In total 56 patients completed their allocated treatment (TKA = 36, KJD = 20). All patient reported outcome measures improved significantly over one year (p < 0.02) in both groups. At one year, the TKA group showed a greater improvement in only one of the 16 patient-related outcome measures assessed (p = 0.034). Outcome Measures in Rheumatology-Osteoarthritis Research Society International clinical response was 83% after TKA and 80% after KJD. A total of 12 patients (60%) in the KJD group sustained pin track infections. In the KJD group both mean minimum (0.9 mm, standard deviation (sd) 1.1) and mean JSW (1.2 mm, sd 1.1) increased significantly (p = 0.004 and p = 0.0003).
  
  
  CONCLUSIONS
  In relatively young patients with end-stage knee osteoarthritis, KJD did not demonstrate inferiority of outcomes at one year when compared with TKA. However, there is a high incidence of pin track infection associated with KJD. Cite this article: Bone Joint J 2017;99-B:51-8.
authors.affiliation: Maartenskliniek Woerden, Woerden, The Netherlands.
authors.forename: J A D
authors.initials: JA
authors.lastname: van der Woude
authors.affiliation: UMC Utrecht, Utrecht, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Wiegant
authors.affiliation: Maartenskliniek Woerden, Woerden, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: van Heerwaarden
authors.affiliation: Maartenskliniek Woerden, Woerden, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Spruijt
authors.affiliation: MUMC Maastricht, Maastricht, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: Emans
authors.affiliation: UMC Utrecht, Utrecht, The Netherlands.
authors.forename: S C
authors.initials: SC
authors.lastname: Mastbergen
authors.affiliation: UMC Utrecht, Utrecht, The Netherlands.
authors.forename: F P J G
authors.initials: FP
authors.lastname: Lafeber
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D002358:Cartilage, Articular / Q000601:surgery; D016267:External Fixators; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology; D017060:Patient Satisfaction; D016059:Range of Motion, Articular / Q000502:physiology; D014143:Traction / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
keywords: Cartilage repair; Joint distraction; Knee osteoarthritis; Randomised controlled trial; Total knee arthroplasty