Short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in treatment of knee osteoarthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DONG Peilong ^1,2 , TANG Xiaobo ² , WANG Jian ² , JIANG Yiqiu ¹ , YAO Wangxiang ¹ ,  GUI Jianchao ¹

1. Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China;
2. Department of Orthopedics, Jianhu Hospital Affiliated to Nantong University, Yancheng Jiangsu, 224700, P.R.China;

Corresponding author：

GUI Jianchao, Email: gui1977@126.com

Keywords：

Knee osteoarthritis; joint distraction; arthroscopy; Ilizarov technology

DOI：

10.7507/1002-1892.201701099

Video：

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Objective To investigate the short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in the treatment of knee osteoarthritis (KOA). Methods Between January 2014 and January 2015, 15 patients (15 knees) with KOA were treated using arthroscopic debridement assisting with the Ilizarov distraction technology. There were 7 males and 8 females, aged from 45 to 64 years (mean, 55 years). The left knee and the right knee were involved in 6 and 9 cases respectively. The disease duration was 2.0-9.5 years (median, 6 years). They all had received conservative treatment for 6 months and got poor clinical improvement. The preoperative visual analogue scale (VAS) score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, the knee injury and osteoarthritis outcome score (KOOS), the range of motion (ROM) for knee, and the radiographic joint space width were 76.2±8.8, 59.3±5.7, 44.3±7.2, (75±21)°, and (2.5±0.4) mm respectively. According to Kellgren-Lawrence grade system, 11 cases were rated as grade III and 4 cases as grade IV. Results There was no poor incision healing, infection, and deep vein thrombosis. All the 15 patients were followed up 12-18 months (mean, 15.5 months). Patients achieved pain relief. The knee activity was obviously improved. The postoperative VAS score, WOMAC score, KOOS score, and ROM at 12 months were 20.9±7.8, 38.2±5.5, 92.1±6.9, and (118±14)° respectively, showing significant difference when compared with preoperative ones (t=18.213, P=0.000; t=10.317, P=0.000; t=18.564, P=0.000; t=6.599, P=0.000). Postoperative X-ray film showed that joint space width at 12 months was (3.8±0.3) mm, showing significant difference when compared with preoperative one (t=10.070, P=0.000). Conclusion Joint distraction by Ilizarov combined with arthroscopic debridement can effectively relieve pain, improve the function and quality of life. It was beneficial to cartilaginous tissue repair and delaying the degenerative process of KOA. The short-term effectiveness is satisfactory.

Citation： DONG Peilong, TANG Xiaobo, WANG Jian, JIANG Yiqiu, YAO Wangxiang, GUI Jianchao. Short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in treatment of knee osteoarthritis. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(7): 794-798. doi: 10.7507/1002-1892.201701099 Copy

1.	Cooper C, Adachi JD, Bardin T, et al. How to define responders in osteoarthritis. Curr Med Res Opin, 2013, 29(6): 719-729.
2.	Robinson WH, Lepus CM, Wang Q, et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol, 2016, 12(10): 580-592.
3.	Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet, 2011, 377(9783): 2115-2126.
4.	Flouzat-Lachaniette CH, Roubineau F, Heyberger C, et al. Distraction to treat knee osteoarthritis. Joint Bone Spine, 2017, 84(2): 141-144.
5.	Kinds MB, Welsing PM, Vignon EP, et al. A systematic review of the association between radiographic and clinical osteoarthritis of hip and knee. Osteoarthritis Cartilage, 2011, 19(7): 768-778.
6.	Lohmander LS, Roos EM. Clinical update: treating osteoarthritis. Lancet, 2007, 370(9605): 2082-2084.
7.	Kirkley A, Birminghm TB, Litchfield RB, et al. A randomized trial of artroscopic surgery for osteoarthritis of the knee. N Ensl J Med, 2008, 359: 1097-1107.
8.	Chen Y, Sun Y, Pan X, et al. Joint distraction attenuates osteoarthritis by reducing secondary inflammation, cartilage degeneration and subchondral bone aberrant change. Osteoarthritis Cartilage, 2015, 23(10): 1728-1735.
9.	Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
10.	中华医学会骨科分会. 预防骨科大手术深静脉血栓形成指南(草案). 中华骨科杂志, 2007, 27(10): 790-792.
11.	杜健, 杨蕊菲, 隋磊, 等. 关节镜辅助 Ilizarov 牵张技术治疗踝关节创伤性骨关节炎疗效观察. 中国修复重建外科杂志, 2016, 30(2): 161-164.
12.	Jang KW, Ding L, Seol D, et al. Low-intensity pulsed ultrasound promotes chondrogenic progenitor cell migration via focal adhesion kinase pathway. Ultrasound Med Biol, 2014, 40(6): 1177-1186.
13.	Vinardell T, Rolfe RA, Buckley CT, et al. Hydrostatic pressure acts to stabilise a chondrogenic phenotype in porcine joint tissue derived stem cells. Eur Cell Mater, 2012, 23: 121-132.
14.	Nebelung S, Gavenis K, Lüring C, et al. Simultaneous anabolic and catabolic responses of human chondrocytes seeded in collagen hydrogels to long-term continuous dynamic compression. Ann Anat, 2012, 194(4): 351-358.
15.	Saito T, Nishida K, Furumatsu T, et al. Histone deacetylase inhibitors suppress mechanical stress-induced expression of RUNX-2 and ADAMTS-5 through the inhibition of the MAPK signaling pathway in cultured human chondrocytes. Osteoarthritis Cartilage, 2013, 21(1): 165-174.
16.	Beier F, Loeser RF. Biology and Pathology of Rho GTPase, PI-3 Kinase-Akt, and MAP Kinase Signaling Pathways in Chondrocytes. J Cell Biochem, 2010, 110(3): 573-580.
17.	Takebe K, Nishiyama T, Hayashi S, et al. Regulation of p38 MAPK phosphorylation inhibits chondrocyte apoptosis in response to heat stress or mechanical stress. Int J Mol Med, 2011, 27(3): 329-335.
18.	Lu Y, Xu Y, Yin Z, et al. Chondrocyte migration affects tissue-engineered cartilage integration by activating the signal transduction pathways involving Src, PLCy1, and ERK1/2. Tissue Eng Part A, 2013, 19(21-22): 2506-2516.
19.	Grad S, Eglin D, Alini M, et al. Physical stimulation of chondrogenic cells in vitro: a review. Clin Orthop Relat Res, 2011, 469(10): 2764-2772.
20.	Jeon JE, Schrobback K, Hutmacher DW, et al. Dynamic compression improves biosynthesis of human zonal chondrocytes from osteoarthritis patients. Osteoarthritis Cartilage, 2012, 20(8): 906-915.
21.	Wiegant K, Intema F, van Roermund PM, et al. Evidence of cartilage repair by joint distraction in a canine model of osteoarthritis. Arthritis Rheumatol, 2015, 67(2): 465-474.
22.	Baboolal TG, Mastbergen SC, Jones E, et al. Synovial fluid hyaluronan mediates MSC attachment to cartilage, a potential novel mechanism contributing tocartilage repair in osteoarthritis using knee joint distraction. Ann Rheum Dis, 2016, 75(5): 908-915.
23.	Intema F, Van Roermund PM, Marijnissen AC, et al. Tissue structure modification in knee osteoarthritis by use of joint distraction: an open 1-year pilot study. Ann Rheum Dis, 2011, 70(8): 1441-1446.
24.	Wiegant K, van Roermund PM, Intema F, et al. Sustained clinical and structural benefit after joint distraction in the treatment of severe knee osteoarthritis. Osteoarthritis Cartilage, 2013, 21(11): 1660-1667.
25.	Khademi-Kalantari K, Mahmoodi Aghdam S, Akbarzadeh Baghban A, et al. Effects of non-surgical joint distraction in the treatment of severe knee osteoarthritis. J Bodyw Mov Ther, 2014, 18(4): 533-539.
26.	Laroche D, Morisset C, Fortunet C, et al. Biomechanical effectiveness of a distraction-rotation knee brace in medial knee osteoarthritis: preliminary results. Knee, 2014, 21(3): 710-716.
27.	van der Woude JA, Wieqant K, van Heerwaarden RJ, et al. Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 876-886.
28.	Xing L, Jiang Y, Gui J, et al. Microfracture combined with osteochondral paste implantation was more effective than microfracture alone for full-thickness cartilage repair. Knee Surg Sports Traumatol Arthrosc, 2013, 21(8): 1770-1776.

1. Cooper C, Adachi JD, Bardin T, et al. How to define responders in osteoarthritis. Curr Med Res Opin, 2013, 29(6): 719-729.
2. Robinson WH, Lepus CM, Wang Q, et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol, 2016, 12(10): 580-592.
3. Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet, 2011, 377(9783): 2115-2126.
4. Flouzat-Lachaniette CH, Roubineau F, Heyberger C, et al. Distraction to treat knee osteoarthritis. Joint Bone Spine, 2017, 84(2): 141-144.
5. Kinds MB, Welsing PM, Vignon EP, et al. A systematic review of the association between radiographic and clinical osteoarthritis of hip and knee. Osteoarthritis Cartilage, 2011, 19(7): 768-778.
6. Lohmander LS, Roos EM. Clinical update: treating osteoarthritis. Lancet, 2007, 370(9605): 2082-2084.
7. Kirkley A, Birminghm TB, Litchfield RB, et al. A randomized trial of artroscopic surgery for osteoarthritis of the knee. N Ensl J Med, 2008, 359: 1097-1107.
8. Chen Y, Sun Y, Pan X, et al. Joint distraction attenuates osteoarthritis by reducing secondary inflammation, cartilage degeneration and subchondral bone aberrant change. Osteoarthritis Cartilage, 2015, 23(10): 1728-1735.
9. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
10. 中华医学会骨科分会. 预防骨科大手术深静脉血栓形成指南(草案). 中华骨科杂志, 2007, 27(10): 790-792.
11. 杜健, 杨蕊菲, 隋磊, 等. 关节镜辅助 Ilizarov 牵张技术治疗踝关节创伤性骨关节炎疗效观察. 中国修复重建外科杂志, 2016, 30(2): 161-164.
12. Jang KW, Ding L, Seol D, et al. Low-intensity pulsed ultrasound promotes chondrogenic progenitor cell migration via focal adhesion kinase pathway. Ultrasound Med Biol, 2014, 40(6): 1177-1186.
13. Vinardell T, Rolfe RA, Buckley CT, et al. Hydrostatic pressure acts to stabilise a chondrogenic phenotype in porcine joint tissue derived stem cells. Eur Cell Mater, 2012, 23: 121-132.
14. Nebelung S, Gavenis K, Lüring C, et al. Simultaneous anabolic and catabolic responses of human chondrocytes seeded in collagen hydrogels to long-term continuous dynamic compression. Ann Anat, 2012, 194(4): 351-358.
15. Saito T, Nishida K, Furumatsu T, et al. Histone deacetylase inhibitors suppress mechanical stress-induced expression of RUNX-2 and ADAMTS-5 through the inhibition of the MAPK signaling pathway in cultured human chondrocytes. Osteoarthritis Cartilage, 2013, 21(1): 165-174.
16. Beier F, Loeser RF. Biology and Pathology of Rho GTPase, PI-3 Kinase-Akt, and MAP Kinase Signaling Pathways in Chondrocytes. J Cell Biochem, 2010, 110(3): 573-580.
17. Takebe K, Nishiyama T, Hayashi S, et al. Regulation of p38 MAPK phosphorylation inhibits chondrocyte apoptosis in response to heat stress or mechanical stress. Int J Mol Med, 2011, 27(3): 329-335.
18. Lu Y, Xu Y, Yin Z, et al. Chondrocyte migration affects tissue-engineered cartilage integration by activating the signal transduction pathways involving Src, PLCy1, and ERK1/2. Tissue Eng Part A, 2013, 19(21-22): 2506-2516.
19. Grad S, Eglin D, Alini M, et al. Physical stimulation of chondrogenic cells in vitro: a review. Clin Orthop Relat Res, 2011, 469(10): 2764-2772.
20. Jeon JE, Schrobback K, Hutmacher DW, et al. Dynamic compression improves biosynthesis of human zonal chondrocytes from osteoarthritis patients. Osteoarthritis Cartilage, 2012, 20(8): 906-915.
21. Wiegant K, Intema F, van Roermund PM, et al. Evidence of cartilage repair by joint distraction in a canine model of osteoarthritis. Arthritis Rheumatol, 2015, 67(2): 465-474.
22. Baboolal TG, Mastbergen SC, Jones E, et al. Synovial fluid hyaluronan mediates MSC attachment to cartilage, a potential novel mechanism contributing tocartilage repair in osteoarthritis using knee joint distraction. Ann Rheum Dis, 2016, 75(5): 908-915.
23. Intema F, Van Roermund PM, Marijnissen AC, et al. Tissue structure modification in knee osteoarthritis by use of joint distraction: an open 1-year pilot study. Ann Rheum Dis, 2011, 70(8): 1441-1446.
24. Wiegant K, van Roermund PM, Intema F, et al. Sustained clinical and structural benefit after joint distraction in the treatment of severe knee osteoarthritis. Osteoarthritis Cartilage, 2013, 21(11): 1660-1667.
25. Khademi-Kalantari K, Mahmoodi Aghdam S, Akbarzadeh Baghban A, et al. Effects of non-surgical joint distraction in the treatment of severe knee osteoarthritis. J Bodyw Mov Ther, 2014, 18(4): 533-539.
26. Laroche D, Morisset C, Fortunet C, et al. Biomechanical effectiveness of a distraction-rotation knee brace in medial knee osteoarthritis: preliminary results. Knee, 2014, 21(3): 710-716.
27. van der Woude JA, Wieqant K, van Heerwaarden RJ, et al. Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 876-886.
28. Xing L, Jiang Y, Gui J, et al. Microfracture combined with osteochondral paste implantation was more effective than microfracture alone for full-thickness cartilage repair. Knee Surg Sports Traumatol Arthrosc, 2013, 21(8): 1770-1776.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in treatment of knee osteoarthritis

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