Technical feasibility of personalized articulating knee joint distraction for treatment of tibiofemoral osteoarthritis. (November 2017)

• Record Type: Journal Article
• Authors: Struik, T.; Jaspers, J.E.N.; Besselink, N.J.; van Roermund, P.M.; Plomp, S.; Rudert, M.J.; Lafeber, F.P.J.G.; Mastbergen, S.C.
• Is Part Of: Clinical biomechanics. Volume 49(2017)
• Page Start: 40
• Page End: 47
• Publication Date: 2017-11
• Subjects: Joint distraction -- Knee osteoarthritis -- Joint specific -- Personalized -- Articulating -- Biomechanical testing; Biomechanics -- Periodicals; Osteopathic medicine -- Periodicals; Biomechanics -- Periodicals; Osteopathic Medicine -- Periodicals; 612.76
• DOI: 10.1016/j.clinbiomech.2017.08.002
• Languages: English
• ISSNs: 0268-0033

Abstract

Abstract: Background: Knee osteoarthritis is a highly prevalent degenerative joint disorder characterized by joint tissue damage and pain. Knee joint distraction has been introduced as a joint preserving surgical procedure to postpone knee arthroplasty. An often used standard externally fixation device for distraction poses a burden to patients due to the absence of joint flexion during the 6 weeks treatment. Therefore, a personalized articulating distraction device was developed. The aim of this study was to test technical feasibility of this device. Methods: Based on an often applied rigid device, using equal bone pin positions and connectors, a hinge mechanism was developed consisting of a cam-following system for reproducing the complex joint-specific knee kinematics. In support, a device was developed for capturing the joint-specific sagittal plane articulation. The obtained kinematic data were translated into joint-specific cam shapes that were installed bilaterally in the hinge mechanism of the distraction device, as such providing personalized knee motion. Distraction of 5 mm was performed within a range of motion of 30 deg. joint flexion. Pre-clinical evaluation of the working principle was performed on human cadaveric legs and system stiffness characteristics were biomechanically evaluated. Findings: The desired range of motion was obtained and distraction was maintained under physiologically representative loading. Moreover, the joint-specific approach demonstrated tolerance of deviations from anatomical and alignment origin during initial placement of the developed distraction device. Interpretation: Articulation during knee distraction is considered technically feasible and has potential to decrease burden and improve acceptance of distraction therapy. Testing of clinical feasibility is warranted. Highlights: Joint distraction for knee osteoarthritis can postpone a total knee prosthesis. More comfort during distraction is demanded, such as an articulating frame. A joint-specific articulating knee distractor was tested for technical feasibility. Sagittal reproduction of joints-specific articulation was demonstrated. Biomechanical equality confirmed technical feasibility of the articulating device.