Effect of distraction arthroplasty on osteoarthritic goat models of the articular cartilage.

Background: Osteoarthritis (OA) is the most common knee degenerative disease, the number of OA patients increases along with the increase of life expectancy. Distraction arthroplasty is a less invasive alternatif for OA management by releaving mechanical stress while maintaining intermitten joint fluid pressure changes, thus halting the OA destructive cycle and inducing repair. This study aims to evaluate the anatomical and histopathological changes after distraction arthroplasty on osteoarthritic animal models. Methods: The study was performed on 32 goat stiffle joint (16 goats) with mechanically induced OA by lateral meniscectomy. During the study 6 goats were decreased. Distraction arthroplasty was performed using external fixation on 10 knees for 4 weeks, and the contralateral knees left untreated. The knees were anatomically and histopathologically examined using International Cartilage Repair Society (ICRS) staging and Osteoarthritis Research Society International (OARSI) scoring. The differences of the anatomical and histopathological changes are tested for significance using the Wilcoxon test. Results: There was anatomical and histopathological worsening of the OA on treated knees. The anatomical difference assessed using ICRS stage gave median values of 1.5 and 2.5 respectively (p < 0.002). The histopathological difference assessed using OARSI scoring was significant (6 vs 10; p < 0.002). Conclusion: Distraction arthroplasty in OA goat models in this study, worsens the OA instead of inducing repair. Further studies are required to find out a convincing biological basis of distraction arthroplasty as an alternative treatment for OA.

Surgical treatments of the ankle arthritis

Trauma, such as ankle fractures, has been the major etiology of ankle arthritis. It has been reported that 70-80% of ankle arthritis cases are due to lateral ankle instability and post-traumatic ankle arthritis. Ankle arthrodesis is the gold standard for end-stage ankle arthritis treatment, but it restricts ankle motion and leads to adjacent joint arthritis in the long term. Low tibial osteotomy is indicated for unicompartmental ankle osteoarthritis (OA) with varus/valgus deformity to realign the malalignment and redistribute the localized tibial plafond and malleolar pressure upon the talus and relieve ankle pain. Ankle distraction arthroplasty is another option for young patients with early ankle OA to widen the ankle joint space and decrease pain. Total ankle arthroplasty (TAA) is a viable surgical alternative for end-stage ankle OA to relieve ankle pain while preserving ankle motion. Recently, a 3-component total ankle system has been predominant, and the outcomes and survival of TAA have improved somewhat. Prospective comparative studies on ankle arthrodesis and TAA should be performed in the future, especially with critical evaluation of complications. Ankle arthrodesis and TAA are 2 major surgical options for end-stage ankle arthritis, but research on other possible alternatives for early stage OA should be performed in the future.

Hematoma Distraction Arthroplasty after Trapeziectomy in Advanced Osteoarthritis of the Trapeziometacarpal Joint / 대한정형외과학회잡지

PURPOSE: To investigate the clinical usefulness of hematoma distraction arthroplasty to treat advanced trapeoziometacarpal osteoarthritis of the thumb. MATERIALS AND METHODS: We studied 12 cases (1 male, 11 females) with osteoarthritis of the thumb that was managed with hematoma distraction arthroplasty using K-wire fixation. Of the 12 cases, 7 were Littler-Eaton stage III and 5 were Littler-Eaton stage IV. We investigated operation time, preoperative and postoperative visual analogue scale (VAS) score, preoperative and postoperative range of motion, grip power and radiologic changes. RESULTS: The mean patient age was 53.2 (39-61) years and the mean duration of follow-up was 19.5 (14-27) months. The average operation time was 52 minutes. The mean VAS scores at 6 and 12 months after the operation were 1.3 and 0.7, respectively. The range of motion and grip power of the finger improved postoperatively (15% in abduction, 18% in adduction, 25% in flexion, 14% in extension, 66% in grip power of the finger). On a simple 12-month postoperative radiologic exam, the interval between the scaphoid and first metacarpal bone had decreased 6.5 mm compared with the preoperative interval. CONCLUSION: The surgical treatment using hematoma distraction arthroplasty for trapeziometacarpal osteoarthritis is an effective method for pain relief, improvement of motion range and finger-grip power.

Operative Treatment of Post - traumatic Stiff Elbow / 대한정형외과학회잡지

Twenty-seven consecutive patients who had post-traumatic stiffness of the elbow were treated by operative soft tissue release or by soft tissue release and distraction arthroplasty. The purpose of this study was to describe the method of operation and postoperative management and to evaluate the results in the patients who had operative treatment for the post-traumatic stiffness of the elbow. The type of operative procedure was determined by whether the factors limiting motion were extra-articular (extrinsic) or intra-articular (intrinsic) and by pre-operative radiographic evaluation. The soft tissue release was performed by staged adhesiolysis through lateral or combined lateral and medial approaches. And if the factors limiting motion included a severe intraarticular lesions, distraction arthroplasty using the Judet or Oganesian apparatus was added to soft tissue release. The mean pre-operative arc of active motion was 42 degrees. At follow-up examination, nineteen to sixty-six months postoperatively, the mean post-operative arc of active motion was 103 degrees. There were nine complications (33 percent) in twenty-seven patients. All of them was transient ulnar nerve paresthesia. And we analysed the final results with Mayo elbow performance index for the evaluation of clinical outcome. Twenty-five (93%) of twenty-seven patients had satisfactory result according to Mayo elbow performance index. We conclude arthrolysis with or without distraction arthroplasty is useful for the treatment of posttraumatic elbow stiffness. However, the accurate anatomical knowledge, operative skill, and careful postoperative rehabilitation program were needed in the operative treatment of post-traumatic elbow stiffness.

Distraction Arthroplasty of the Elbow / 대한정형외과학회잡지

So many modalities have been suggested for the treatment of servere pain and ankylosis of the elbow with destruction of the articular surfaces. Among them, two major methods which have been widely used are resection arthroplasty and prosthetic replacement arthroplasty. However prosthetic replacement arthroplasty has some problems. Its indications are limited in the elderly inactive subjects. And there have been many kinds of complications including loosening and infection. Also, resection arthroplasty in now rarely indicated due to severe instability. From July 1980 to July 1987, we tried distraction arthroplasty in 8 cases of elbow with severe destruction of its articular surfaces, mainly in the young active persons. The average follow-up period was 45 months. The effect of distraction arthroplasty on relief of pain was not remarkable. The average increase in ROM, including that of one reankylosed elbow, was 51 ±22 degrees in flexion-extension and 48 ±23 degrees in pronstion-supinstion. No deep wound infection and instability which was main complication of resection arthroplasty were observed with our method of distraction arthroplasty. On the basis of functional results, the the results were excellent in 4, good in 1, fair in 2 and poor in 1 cases. In conclusion, distraction arthroplasty of the elbow can be one of the of effective methods reconstruction for the young active patients with the destruction of the elbow, if they are intelligent and motivated.