BEFORE you consider Knee Distraction Surgery

Ross Hauser, MD

In their quest to get stem cell therapy into the operating theater, doctors are exploring different surgical aspects to see if the surgery and stem cell therapy, used in combination, will accelerate healing and repair cartilage.

One such surgical experiment involves “Joint Distraction Surgery.” What is this surgery? How does it work?

Knee distraction surgery is being presented as an option to total knee replacement, especially to patients who will likely outlive their knee replacement.

In this surgery, the shin and thigh bones are slightly pulled apart and held into place by pins that protrude from the skin in an external fixation. (Patient’s wear these pins for 6 to 8 weeks to allow cartilage to repair – full recovery can take up to a year). With the bone-on-bone alleviated – the articular cartilage can now go about its business of repairing itself without the weight and mechanical stress of the “bone on bone,” situation.

This is a huge step in admission, as Prolotherapists have maintained for years that articular cartilage and meniscal tissue are regenerative. The whole purpose of surgical removal of tissue was based on the principle that it could not heal itself.

What makes this so exciting to surgeons is that they can offer a “self-repair cartilage procedure” as an alternative to microfracture surgery which has had, at best, limited results.

So surgery to pull the knee apart, external cage fixation for at least three months, one year to recovery. But one study suggests this may all be worth it if you add hyaluronic acid into the stem cell mix.1

Another study says let’s just see how the stem cells do on their own. Doctors writing in Advanced Therapies for Musculoskeletal Disorders say that using a non-surgical distraction technique combined with stem cell therapy leads to cartilage regeneration in the knees AND may provide an alternative to the knee fixation external cage.  The things sticking out of the knee in the above picture.

In their study, traction is used to keep the shin and thigh apart during the sleeping hours and no traction is used during awake hours.2 Results are being compiled.

Should you consider knee distraction surgery?
Researchers in France published their findings in March 2017 and gave these answers:

• In published studies, joint distraction provided substantial clinical and structural improvements in patients with knee osteoarthritis, delaying joint replacement surgery for at least 2 years.

Nevertheless, several considerations invite caution when considering the more widespread use of joint distraction.

• There are no studies on whether this surgery works in the long-term. The research is showing only two years of benefit.
• High frequency of pin tract infection is of concern since most patients eventually require knee replacement surgery.3

So in the end, why go through all this if you will need a knee replacement anyway?

We have pioneered the use of Stem Cell Therapy, Platelet Plasma Therapy, and Prolotherapy as non-surgical techniques to regenerate cartilage without traction and surgery. Our own research has validated our findings — please continue this subject at the companion article Stem Cell Therapy for Knee Osteoarthritis and Cartilage Regeneration

References:
1. Baboolal TG, Mastbergen SC, Jones E, Calder SJ, Lafeber FP, McGonagle D. Synovial fluid hyaluronan mediates MSC attachment to cartilage, a potential novel mechanism contributing to cartilage repair in osteoarthritis using knee joint distraction.  Ann Rheum Dis. 2015 May 6. pii: annrheumdis-2014-206847. [Pubmed]

2. Tiku ML, Sabaawy HE. Cartilage regeneration for treatment of osteoarthritis: a paradigm for nonsurgical intervention. Ther Adv Musculoskelet Dis. 2015 Jun;7(3):76-87. [Pubmed]

3 Flouzat-Lachaniette CH, Roubineau F, Heyberger C, Bouthors C. Distraction to treat knee osteoarthritis. Joint Bone Spine. 2017 Mar;84(2):141-144. [Pubmed]

• Surgery
• NSAIDs
• Cortisone Shots
• R.I.C.E.