Non-invasive/churgical treatment for osteoarthritis patients

Che Hsin Falkenström (OIM Orthopedie)

Based on a research project by

Lena Dürling (UMCG), Edsko Hekman (UT), Roel Kuijer (UMCG), Bart Verkerke (UMCG/UT), Sjoerd Bulstra (UMCG)

Anatomy of the knee

Largest joint in the human body

Consists of two articulations:• Between femur and tibia• Between femur and patella

Ligaments holding the bones of the knee in place

Hyaline cartilage is located on the end of femur and tibia

Menisci protect the ends of the bones from rubbing on each other

Osteoarthritis

Degenerative joint disease characterized by destruction of articular cartilage

Cartilage cushion causes friction between bones, causing pain and stiffness of the joint

Causes osteoarthritis

Veroudering

Aangeboren standafwijking

Trauma like sportblessures Chronic overbelasting obesitas

Ontstekingsreacties van het lichaam

Prevalence & incidence osteoarthritis in the Netherlands (2007)

Incidence (per 1.000)

Male Female Age (years)

Prevalence (per 1.000)

Male Female Age (years)

Nationaal Kompas Volksgezondheid, versie 4.3, 6 april 2011, © RIVM, Bilthoven

Male Female Male FemalePer 1000 14,3 23,8 1,6 3,1

Total numbers 115.000 197.000 13.300 25.700

IncidencePrevalence

Expected growth 2000 – 2020: 38%

Current treatments osteoarthritis

Physical therapy

Medication

Lifestyle modification

Churgical treatment Knee replacement Cartilage transplantation

Hypothesis of cartilage regeneration treatment

„osteoarthritic cartilage has some regenerative activity when the damaged cartilage is mechanical unloaded while intermittent fluid pressure and flow is maintained“

Unloading the affected knee joint during movement

Alternative treatment?!Research on the regenerative activity osteoarthritic cartilage

Joint distraction in canine experimentally induced osteoarthritis leads to cartilagerepair accompanied by sustained relieve of pain.S.C. Mastbergen, F. Intema, P. van Roermund, H. Hazewinkel, F.P.J.G. Lafeber; Utrecht/NL

Distraction arthroplasty for treatment of the osteoarthritic kneeA. Nakamae, M. Deie, N. Adachi, T. Nakasa, H. Shibuya, T. Niimoto, A. Okuhara, M. Ochi; Hiroshima/JP

Clinical Benefit of Joint Distraction in the Treatment of Severe Osteoarthritis of the Ankle: Proof of Concept in an Open Prospective Study and in aRandomized Controlled StudyAnne C. A. Marijnissen,1 Peter M. van Roermund,1 Jan van Melkebeek,2 Willem Schenk,3Abraham J. Verbout,1 Johannes W. J. Bijlsma,1 and Floris P. J. G. Lafeber; Utrecht/NL

Prolonged clinical benefit from joint distraction in the treatmentof ankle osteoarthritisJ. J. W. Ploegmakers M.Sc., P. M. van Roermund M.D., Ph.D.z, J. van Melkebeek M.D.,J. Lammens M.D., Ph.D., Professork, J. W. J. Bijlsma M.D., Ph.D., Professory,F. P. J. G. Lafeber Ph.D. and A. C. A. Marijnissen Ph.D.

Joint Distraction

External fixation of the knee joint• Monolateral• Bilateral

Pins are placed in the bones above and below the knee joint

An external system creates a gap of 5mm between the femur and the tibia

Other systems unload the knee joint with springs on both sides of the knee

Improvement Joint Distraction treatment

- Patient can not use it for daily activities

- Very uncomfortable

- Possible inflammation/infection

- Expensive treatment

Patient can use it for daily activities

Comfortable

No inflammation/infection (non-invasisve treatement)

Considerable cost reduction

Problems Goals and wishes

Prototype Joint Distraction Orthosis

Socket: Individual prosthetic socket

Framework: Stainless steel bars

Hinge: Dynamic type hinge

Foot: Ground plate is somewhat rounded to provide an even better degree of foot roll-over

Fixation mechanism for the leg: Strap between these bars

Shoe: Patient has to wear a special shoe at the other leg to compensate the height difference

Follow-up

2011 Further development of prototype

2012 Testing treatment on 10 patients

This is why we are doing this!

Thank you for your attention!