Citation Information :
Chowdhury JM, Lineham B, Pallett M, Pandit HG, Stewart TD, Harwood PJ. Comparison of Mechanical Performance between Circular Frames and Biplanar Distraction Devices for Knee Joint Distraction. 2021; 16 (2):71-77.
Aim and objective: This study was designed to test and compare the mechanical performance of the biplanar ArthroSave KneeReviver and a circular frame construct with the intended use of providing a mechanically favourable environment for cartilage regeneration across a knee joint.
Materials and methods: Three similar constructs of the two devices were applied to biomechanical testing sawbones, with the knee distracted by 8 mm. The constructs were vertically loaded to 800 N in an Instron testing machine at 20 mm/minute. Tests were conducted in neutral hip flexion and at 12° of hip flexion and extension, to mimic leg position in gait. Displacement measurements were taken from the Instron machine, and three-dimensional joint motion was recorded using an Optotrak Certus motion capture system.
Results: Overall axial rigidity was similar between the two devices (circular frame, 81.6 N/mm ± 5.9; and KneeReviver, 79.5 N/mm ± 25.1 with hip neutral) and similar in different hip positions. At the point of joint contact, the overall rigidity of the circular frame increased significantly more than the KneeReviver (491 N/mm ± 27 and 93 N/mm ± 32, respectively, p <0.001). There was more variability between models in the KneeReviver. There was more off-axis motion in the KneeReviver, mainly due to increasing knee flexion on loading. This was exacerbated with the hip in flexion and extension but remained small, with the maximal off-axis displacement being 7 mm/3°.
Conclusion: The circular frame provides a similar mechanical environment to the novel KneeReviver device, for which most clinical data are available. These findings suggest that both devices appear a viable option for knee joint distraction (KJD). Further clinical data will help inform mode of application.
Clinical significance: KJD is a relatively novel technique for use in osteoarthritis (OA), and it remains unclear which distraction devices provide appropriate mechanics. Our testing gives evidence to support either option for further use.
Versus Arthritis. The state of musculoskeletal health 2019. 2020. 31–32 p. Available from: https://www.versusarthritis.org/media/14594/state-of-musculoskeletal-health-2019.pdf.
Singer SP, Dammerer D, Krismer M, et al. Maximum lifetime body mass index is the appropriate predictor of knee and hip osteoarthritis. Arch Orthop Trauma Surg 2018;138(1):99–103. DOI: 10.1007/s00402-017-2825-5.
Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008;58(1):26–35. DOI: 10.1002/art.23176.
Service NH. Statistics on obesity, physical activity and diet. England, 2020. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/england-2020/part-3-adult-obesity-copy#overweight-and-obesity-prevalence.
Skou ST, Roos EM, Laursen MB, et al. A randomized, controlled trial of total knee replacement. N Engl J Med 2015;373(17):1597–1606. DOI: 10.1056/NEJMoa1505467.
Baker PN, van der Meulen JH, Lewsey J, et al. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br 2007;89(7):893–900. DOI: 10.1302/0301-620X.89B7.19091.
Bayliss LE, Culliford D, Monk AP, et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet 2017;389(10077):1424–1430. DOI: 10.1016/S0140-6736(17)30059-4.
Stambough JB, Clohisy JC, Barrack RL, et al. Increased risk of failure following revision total knee replacement in patients aged 55 years and younger. Bone Joint J 2014;96-B(12):1657–1662. DOI: 10.1302/0301-620X.96B12.34486.
Deehan DJ, Murray JD, Birdsall PD, et al. Quality of life after knee revision arthroplasty. Acta Orthop 2006;77(5):761–766. DOI: 10.1080/17453670610012953.
Van Valburg AA, van Roermund PM, Lammens J, et al. Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle? A preliminary report. J Bone Joint Surg Br 1995;77(5):720–725. Available from: https://doi.org/10.1302/0301-620X.77B5.7559696.
Van Valburg AA, van Roermund PM, Marijnissen AC, et al. Joint distraction in treatment of osteoarthritis: a two-year follow-up of the ankle. Osteoarthritis Cartilage 1999;7(5):474–479. DOI: 10.1053/joca.1998.0242.
Marijnissen AC, Van Roermund PM, Van Melkebeek J, et al. Clinical benefit of joint distraction in the treatment of severe osteoarthritis of the ankle: proof of concept in an open prospective study and in a randomized controlled study. Arthritis Rheum 2002;46(11):2893–2902. DOI: 10.1002/art.10612.
Ploegmakers JJ, van Roermund PM, van Melkebeek J, et al. Prolonged clinical benefit from joint distraction in the treatment of ankle osteoarthritis. Osteoarthritis Cartilage 2005;13(7):582–588. DOI: 10.1016/j.joca.2005.03.002.
Tellisi N, Fragomen AT, Kleinman D, et al. Joint preservation of the osteoarthritic ankle using distraction arthroplasty. Foot Ankle Int 2009;30(4):318–325. DOI: 10.3113/FAI.2009.0318.
Greenfield S, Matta KM, McCoy TH, et al. Ankle distraction arthroplasty for ankle osteoarthritis: a survival analysis. Strategies Trauma Limb Reconstr 2019;14(2):65–71. DOI: 10.5005/jp-journals-10080-1429.
Van Valburg AA, van Roy HL, Lafeber FP, et al. Beneficial effects of intermittent fluid pressure of low physiological magnitude on cartilage and inflammation in osteoarthritis. An in vitro study. J Rheumatol 1998;25(3):515–520. PMID: 9517773.
Van der Woude JAD, Wiegant K, van Roermund PM, et al. Five-year follow-up of knee joint distraction: clinical benefit and cartilaginous tissue repair in an open uncontrolled prospective study. Cartilage 2017;8(3):263–271. DOI: 10.1177/1947603516665442.
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. DOI: 10.1016/j.joca.2013.08.006.
Van der Woude JAD, Wiegant 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. DOI: 10.1007/s00167-016-4131-0.
Research NIfH. Knee arthroplasty versus joint distraction study (KARDS) for Osteoarthritis 2020. Available from: https://fundingawards.nihr.ac.uk/award/17/122/06.
Van Heerwaarden RJ, Verra W. Knee joint distraction in the treatment of severe osteoarthritis. Arthroskopie 2020;33:10077. DOI: 10.1007/s00142-020-00382-2.
ArthroSave. ArthroSave joint reviving medical treatment. Available from: https://www.arthrosave.com.
Solomin L. The basic principles of external skeletal fixation using the ilizarov and other devices. Springer Milan; 2017.
Nayagam S. Safe corridors in external fixation: the lower leg (tibia, fibula, hindfoot and forefoot). Strategies Trauma Limb Reconstr 2007;2(2–3):105–110. DOI: 10.1007/s11751-007-0023-7.
Van der Woude JA, Wiegant K, van Heerwaarden RJ, et al. Knee joint distraction compared with total knee arthroplasty: a randomised controlled trial. Bone Joint J 2017;99-B(1):51–58. DOI: 10.1302/0301-620X.99B1.BJJ-2016-0099.R3.
Deie M, Ochi M, Adachi N, et al. A new articulated distraction arthroplasty device for treatment of the osteoarthritic knee joint: a preliminary report. Arthroscopy 2007;23(8):833–838. DOI: 10.1016/j.arthro.2007.02.014.
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. DOI: 10.1136/ard.2010.142364.
Henderson DJ, Rushbrook JL, Stewart TD, et al. What are the biomechanical effects of half-pin and fine-wire configurations on fracture site movement in circular frames? Clin Orthop Relat Res 2016;474(4):1041–1049. DOI: 10.1007/s11999-015-4652-8.
Bliven EK, Greinwald M, Hackl S, et al. External fixation of the lower extremities: Biomechanical perspective and recent innovations. Injury 2019;50(Suppl. 1):S10–S17. DOI: 10.1016/j.injury.2019.03.041.
Van Valburg AA, van Roermund PM, Marijnissen AC, et al. Joint distraction in treatment of osteoarthritis (II): effects on cartilage in a canine model. Osteoarthritis Cartilage 2000;8(1):1–8. DOI: 10.1053/joca.1999.0263.
Van Roermund PM, van Valburg AA, Duivemann E, et al. Function of stiff joints may be restored by Ilizarov joint distraction. Clin Orthop Relat Res 1998(348):220–227. PMID: 9553556.
Heiner AD. Structural properties of fourth-generation composite femurs and tibias. J Biomech 2008;41(15):3282–3284. DOI: 10.1016/j.jbiomech.2008.08.013.
Gardner MP, Chong AC, Pollock AG, et al. Mechanical evaluation of large-size fourth-generation composite femur and tibia models. Ann Biomed Eng 2010;38(3):613–620. DOI: 10.1007/s10439-009-9887-7.
Zdero R, Shah S, Mosli M, et al. The effect of load application rate on the biomechanics of synthetic femurs. Proc Inst Mech Eng H 2010;224(4):599–605. DOI: 10.1243/09544119JEIM742.
Lucas EM. Clinical, kinematic, and kinetic analysis of knee arthrodesis in support of the design of a novel treatment alternative [PhD Dissertation]. Clemson, USA: Clemson University; 2014.
Kaufman KR, An K-N, Litchy WJ, et al. Dynamic joint forces during knee isokinetic exercise. Am J Sports Med 1991;19(3):305–316. DOI: 10.1177/036354659101900317.
Fragomen AT, McCoy TH, Meyers KN, et al. Minimum distraction gap: how much ankle joint space is enough in ankle distraction arthroplasty? HSS J 2014;10(1):6–12. DOI: 10.1007/s11420-013-9359-3.
Besselink NJ, Vincken KL, Bartels LW, et al. Cartilage Quality (dGEMRIC Index) following knee joint distraction or high tibial osteotomy. Cartilage 2020;11(1):19–31. DOI: 10.1177/1947603518777578.
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. DOI: 10.1002/art.38906.
Green SA, Jackson JM, Wall DM, et al. Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop Relat Res 1992(280):136–142. PMID: 1611733.
Song HR, Cho SH, Koo KH, et al. Tibial bone defects treated by internal bone transport using the Ilizarov method. Int Orthop 1998;22(5):293–297. DOI: 10.1007/s002640050263.
Cattaneo R, Catagni M, Johnson EE. The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clin Orthop Relat Res 1992(280):143–152. PMID: 1611734.