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Objective: Knee joint distraction (KJD), a joint-preserving surgery for severe osteoarthritis (OA), provides clinical and structural improvement and postpones the need for total knee arthroplasty (TKA). This study evaluates 9-year treatment outcome and identifies characteristics predicting long-term treatment success.Design: Patients with severe tibiofemoral OA (n = 20; age<60 years) indicated for TKA were treated with KJD. Questionnaires, radiographs, and magnetic resonance imaging (MRI) were used for evaluation. Survival after treatment was analyzed, where 'failure' was defined by TKA over time.Results: 9-year survival was 48%, and 72% for men (compared to 14% for women; P = 0.035) and 73% for those with a first-year minimum joint space width (JSW) increase of >0.5 mm (compared to 0% for <0.05 mm; P = 0.002). Survivors still reported clinical improvement compared to baseline (ΔWOMAC +29.9 points (95%CI 16.9-42.9; P = 0.001), ΔVAS -46.8 mm (-31.6-61.9; P < 0.001)). Surprisingly, patients getting TKA years after KJD still reported clinical improvement although less pronounced (ΔWOMAC +20.5 points (-1.8-42.8; P = 0.067), ΔVAS -25.4 mm (-3.2-47.7; P = 0.030)). Survivors showed long-lasting minimum JSW increase (baseline 0.3 mm (IQR 1.9), follow-up 1.3 mm (2.5); P = 0.017) while 'failures' did not (baseline 0.4 mm (1.8), follow-up 0.2 mm (1.5); P = 0.161). First-year minimum JSW on radiographs and cartilage thickness increase on MRI predict 9-year survival (HR 0.05 and 0.12, respectively; both P < 0.026). Male gender was associated with survival (HR 0.24; P = 0.050).Conclusions: KJD shows long-lasting clinical and structural improvement. In addition to a greater survival rate for males (>two out of three), the initial cartilage repair activity appears to be important for long-term clinical success. [ABSTRACT FROM AUTHOR]

Background Modification of joint tissue damage is challenging in late-stage osteoarthritis (OA). Few options are available for treating end-stage knee OA other than joint replacement. Objectives To examine whether joint distraction can effectively modify knee joint tissue damage and has the potential to delay prosthesis surgery. Methods 20 patients (<60 years) with tibiofemoral OA were treated surgically using joint distraction. Distraction (∼5 mm) was applied for 2 months using an external fixation frame. Tissue structure modification at 1 year of follow-up was evaluated radiographically (joint space width (JSW)), by MRI (segmentation of cartilage morphology) and by biochemical markers of collagen type II turnover, with operators blinded to time points. Clinical improvement was evaluated by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS) pain score. Results Radiography demonstrated an increase in mean and minimum JSW (2.7 to 3.6 mm and 1.0 to 1.9 mm; p<0.05 and <0.01). MRI revealed an increase in cartilage thickness (2.4 to 3.0 mm; p<0.001) and a decrease of denuded bone areas (22% to 5%; p<0.001). Collagen type II levels showed a trend towards increased synthesis (+103%; p<0.06) and decreased breakdown (-11%; p<0.08). The WOMAC index increased from 45 to 77 points, and VAS pain decreased from 73 to 31 mm (both p<0.001). Conclusions Joint distraction can induce tissue structure modification in knee OA and could result in clinical benefit. No current treatment is able to induce such changes. Larger, longer and randomised studies on joint distraction are warranted. [ABSTRACT FROM AUTHOR]

Background and purpose Failed treatment of fractures may be corrected by the Ilizarov technique but complications are common. In 52 patients with compromised healing of femoral and tibial fractures, the results of secondary reconstruction with Ilizarov treatment were investigated retrospectively in order to identify the factors that contribute to the risk of complications. Methods 52 consecutive patients was analyzed. The median interval between injury and secondary reconstruction was 3 (0.1-27) years. The patients had failed fracture treatment resulting in bone defects, pseudarthrosis, infection, limb length discrepancy (LLD) caused by bone consolidation after bone loss, malunion, soft-tissue loss, and stiff joints. Most patients had a combination of these deformities. The results were analyzed by using logistic regression in a polytomous universal mode (PLUM) logistic regression model. Results The median treatment time was 9 (4-30) months, and the obstacle and complication rate was 105% per corrected bone segment. In 2 patients treatment failed, which resulted in amputation. In all other patients healing of nonunion could be established, malunion could be corrected, and infections were successfully treated. The statistical analysis revealed that relative bone loss of the affected bone was the only predictor for occurrence of complications. From these data, we constructed a simple graph that shows the relationship between relative bone loss of the affected bone and risk of complications. Interpretation Relative bone loss of the affected bone segment is the main predictor of complications after Ilizarov treatment of previously failed fracture treatment. The visualization of the analysis in a simple graph may assist comparison of the complication rates in the literature. [ABSTRACT FROM AUTHOR]

We studied the psychological and social impact of the Ilizarov leg lengthening procedure in 26 patients (aged 6-17 years), who had completed the treatment at least 2 months previously. Measurements of depression and anxiety were performed preoperatively and at follow-up. Questions about functioning at school, daily life activities and treatment-related experiences were answered by the patient and his/her parents. The school or work results showed no significant decline during the lengthening procedure. Serious sleeping problems occurred during the procedure. There was no subjective improvement in physical skill after the procedure and almost one-fourth of the children still had complaints about their leg. We conclude that the Ilizarov procedure caused no serious psychological disturbances. [ABSTRACT FROM AUTHOR]

Limb length discrepancy (LLD) and other patient factors are thought to influence the complication rate in (paediatric) limb deformity correction. In the literature, information is conflicting. This study was performed to identify clinical factors that affect the complication rate in paediatric lower-limb lengthening. A consecutive group of 37 children was analysed. The median proportionate LLD was 15 (4-42)%. An analysis was carried out on several patient factors that may complicate the treatment or end result using logistic regression in a polytomous logistic regression model. The factors analysed were proportionate LLD, cause of deformity, location of corrected bone, and the classification of the deformity according to an overall classification that includes the LLD and all concomitant deformity factors. The median age at the start of the treatment was 11 (6-17) years. The median lengthening index was 1.5 (0.8-3.8) months per centimetre lengthening. The obstacle and complication rate was 69% per lengthened bone. Proportionate LLD was the only statistically significant predictor for the occurrence of complications. Concomitant deformities did not influence the complication rate. From these data we constructed a simple graph that shows the relationship between proportionate LLD and risk for complications. This study shows that only relative LLD is a predictor of the risk for complications. The additional value of this analysis is the production of a simple graph. Construction of this graph using data of a patient group (for example, your own) may allow a more realistic comparison with results in the literature than has been possible before.

Objective: To predict the future number of knee and hip arthroplasties due to osteoarthritis (OA) in the Netherlands based on historical trends and demographic projections., Design: Data analysis and model calculations., Method: Two future projections were based on age and sex-specific number of hospital admissions for the placement of total knee or hip prostheses due to OA between 1995 and 2005; data were obtained from the Dutch National Medical Registration (LMR). The demographical projection was based on the incidence of arthroplasty in 2005 combined with demographic predictions from Statistics Netherlands regarding the time period between 2005 and 2030. The trend projection used the trend in the age and sex-specific incidence of surgery between 1995 and 2005., Results: Between 1995 and 2005, the annual number of knee arthroplasties in patients with a primary diagnose of OA increased from 4,916 to 14,565, an increase of 196%. The total number of hip arthroplasties increased from 13,785 to 20,715, an increase of 50%. The demographical projection suggests that the number of total hip arthroplasties will increase to 31,731 by 2030, an increase of 53%, and the number of knee arthroplasties to 22,183. The trend projection suggests that the numbers may increase to 51,680 for the hip (+149%) and to 57,893 for the knee (+297%)., Conclusion: The increase in the number of knee and hip arthroplasties due to OA will probably continue in the coming 20 years. The following developments will probably contribute to this: demographical changes, the increase in overweight, improved long-term outcomes of arthroplasty, more active lifestyle of the elderly and the increasing number of orthopaedic surgeons.