Knee joint distraction: moving forward

PhD thesis, Mylène P. Jansen

Knee joint distraction is a joint-preserving technique for relatively young knee osteoarthritis patients. In joint distraction, the two bony ends of a joint are temporarily (6-9 weeks) placed at a certain distance (generally 5 mm), using an external fixation frame. Knee joint distraction has been studied in several clinical trials and even applied in regular care conditions in a limited number of Dutch hospitals, aiming for not only on symptom relieve but cartilage regeneration as well. Research has shown that knee joint distraction is effective, and although the exact working mechanisms of the treatment are not yet clear, more details of the underlying processes become visible.

This thesis aims to take the next steps and move forward with knee joint distraction, in two directions. Part I focuses on clinical outcome and patient experience of knee joint distraction as treatment for severe osteoarthritis, while part II focuses on processes and potential working mechanisms occurring inside the joint as a result of this treatment. Knee joint distraction can bring long-lasting clinical efficacy and cartilage regeneration. Implementation in regular care is possible and is becoming increasingly patient-friendly. During treatment anabolic and catabolic changes in joint homeostasis are induced, showing whole-joint modifications involving bone, cartilage, and synovial fluid, followed by overall repair. Future studies should focus on deepening comprehension of the mechanisms induced by knee joint distraction to improve patient selection, as well as using this unique population showing high rate structural and clinical response to improve understanding of different osteoarthritis pathways in general.

The thesis can be found via: https://www.publicatie-online.nl/publicaties/mylene-jansen/