Joint distraction versus custom-made unloading orthosis for knee osteoarthritis - A clinical and radiological study

A promising treatment option to postpone knee replacement is knee joint distraction (KJD). This treatment shows clinical and radiological improvements, but is invasive, with substantial adverse effects. A custom-made orthosis was developed for unloading the knee, striving for comparable clinical outcomes with KJD with less side effects. The aim of this study is to evaluate the effectiveness of a KJD for 6 weeks compared to a knee-unloading orthosis for 8 weeks on clinical outcomes, progression of osteoarthritis and adverse events.

Two cohort studies investigating different treatments (KJD vs orthosis) for patient with severe knee osteoarthritis (Kellgren-Lawrence grades 2-4), age ≤ 65 were compared. During the 2 year follow-up, clinical outcome was assessed using the Western Ontario and McMaster Universities Osteoarthritis and numeric rating scale for pain. Progression of osteoarthritis was determined by the radiographic minimum joint space width (mJSW); adverse events were obtained from the charts.

In both patient groups (KJD: n = 21; orthosis: n = 10) significant clinical improvement was found during the 2-years follow-up. For the KJD group the median mJSW increased from 0.0 at baseline to 0.9 mm at one- and two-year follow-up; in the orthosis group the mJSW remained 0.0 during all time-points. Adverse events were reported in 86 % of the KJD patients versus 30 % in the orthosis group.

Both KJD and unloading orthosis treatment improves clinical outcome for at least 2 years in patients ≤ 65 years. Only KJD influenced progression of osteoarthritis, but had more side effects compared with the orthosis treatment.