Joint distraction in treatment of osteoarthritis: a two-year follow-up of the ankle

Objective: Osteoarthritis (OA) is a degenerative joint disease with an inci dence exceeding 10% of the adult population. In end stages, OA can result i n severe restriction of activity and consequent disability. For these sever e cases of OA, no effective remedy is available yet. Joint distraction is a new experimental approach in treatment of OA. Studied in retrospect it app eared that this treatment results in prolonged clinical improvement in the case of ankle OA. Presently the results of a prospective two-year follow-up are given. Methods: Patients with severe ankle OA, who were considered for joint fusio n (arthrodesis), were treated with distraction, by use of an Ilizarov exter nal ring fixator. Distraction was carried out for 3 months during which ful l weight bearing (walking) was allowed. Standardized clinical examination w as conducted before and at yearly intervals after treatment, including phys ical examination, functional ability questionnaire, pain scale, joint mobil ity, and radiographic evaluation. Results: More than two thirds of the patients improved significantly as sho wn by physical examination, functional ability questionnaires and pain scal e; effects were progressive in the second year of follow-up. On average, jo int mobility and radiographic joint space were preserved, whilst improvemen t was observed in a significant number of patients. Discussion: Results of the present prospective study confirm the findings o f the previous retrospective study and suggest that Ilizarov joint distract ion is a promising treatment for severe ankle OA, at least delaying the nee d for a joint fusion. Considering the high prevalence of OA and the lack of a remedy for this disorder, Ilizarov joint distraction as a treatment for OA may have great medical, social and economic impact. (C) 1999 OsteoArthri tis Research Society International.