Download PDF
CC BY 4.0 · VCOT Open 2022; 05(01): e11-e17
DOI: 10.1055/s-0042-1742471
Case Report

Knee Joint Distraction in a Dog as Treatment for Severe Osteoarthritis

Michelle Teunissen
1   Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
,
Simon C. Mastbergen
2   Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, the Netherlands
,
Dennis C. Spoelman
3   Department of Clinical Sciences, Dierenartspraktijk IJ van Rijn, Nieuw-Vennep, the Netherlands
,
Floris P. Lafeber
2   Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, the Netherlands
,
Irene S. Ludwig
4   Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
,
Femke Broere
1   Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
4   Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
,
Marianna A. Tryfonidou
1   Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
,
Björn P. Meij
1   Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Osteoarthritis (OA) is the most common joint disease diagnosed in veterinary practice. There is no cure; where conservative treatment fails, a joint prosthesis is the last resort. In human OA patients, temporary distraction is a joint-preserving treatment which provides clinical and structural benefits, and postpones the need for total knee replacement for up to 9 years. In this single case, feasibility of knee joint distraction (KJD) was assessed in a 9-year-old female Dobermann with severe OA. Osteoarthritis of the left stifle joint was diagnosed clinically and radiographically. Knee joint distraction was applied for 7 weeks using a custom-made, hinged, external fixator. Follow-up of 1 year included owner questionnaires, orthopaedic examination, radiography, and force plate analysis. Additionally, synovial fluid biomarkers were assessed. Application and removal of the KJD frame were successfully accomplished without surgical complications. During KJD, the dog tolerated the frame well and maintained the use of the left hindlimb. Mild pin tract infection developed during the distraction period, which responded well to oral antibiotic medications. Owners reported clinical improvement during KJD and the follow-up period. This was confirmed by force plate analysis, demonstrating improvement from 3 months and onward. KJD proved to be a feasible strategy to treat end-stage OA in this single case; clinical efficacy remains to be determined in a larger cohort.

Keywords

dog - knee joint distraction - osteoarthritis - force plate - synovial fluid biomarkers

Supplementary Material



Publication History

Received: 06 June 2021

Accepted: 16 November 2021

Article published online:
25 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Anderson KL, O'Neill DG, Brodbelt DC. et al. Prevalence, duration and risk factors for appendicular osteoarthritis in a UK dog population under primary veterinary care. Sci Rep 2018; 8 (01) 5641
    CrossrefPubMedGoogle Scholar
  • 2 Allen MJ. Advances in total joint replacement in small animals. J Small Anim Pract 2012; 53 (09) 495-506
    CrossrefPubMedGoogle Scholar
  • 3 Liska WD, Doyle ND. Canine total knee replacement: surgical technique and one-year outcome. Vet Surg 2009; 38 (05) 568-582
    CrossrefPubMedGoogle Scholar
  • 4 Takahashi T, Baboolal TG, Lamb J, Hamilton TW, Pandit HG. Is knee joint distraction a viable treatment option for knee OA? - a literature review and meta-analysis. J Knee Surg 2019; 32 (08) 788-795
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Goh EL, Lou WCN, Chidambaram S, Ma S. The role of joint distraction in the treatment of knee osteoarthritis: a systematic review and quantitative analysis. Orthop Res Rev 2019; 11: 79-92
    PubMedGoogle Scholar
  • 6 Marijnissen ACA, van Roermund PM, van Melkebeek J, Lafeber FP. Clinical benefit of joint distraction in the treatment of ankle osteoarthritis. Foot Ankle Clin 2003; 8 (02) 335-346
    CrossrefPubMedGoogle Scholar
  • 7 Paley D, Lamm BM. Ankle joint distraction. Foot Ankle Clin 2005; 10 (04) 685-698 , ix
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Intema F, Van Roermund PM, Marijnissen ACA. et al. Tissue structure modification in knee osteoarthritis by use of joint distraction: an open 1-year pilot study. Ann Rheum Dis 2011; 70 (08) 1441-1446
    CrossrefPubMedGoogle Scholar
  • 10 van der Woude JTAD, 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 (03) 263-271
    CrossrefPubMedGoogle Scholar
  • 11 Jansen MP, van der Weiden GS, Van Roermund PM, Custers RJH, Mastbergen SC, Lafeber FPJG. Initial tissue repair predicts long-term clinical success of knee joint distraction as treatment for knee osteoarthritis. Osteoarthritis Cartilage 2018; 26 (12) 1604-1608
    CrossrefPubMedGoogle Scholar
  • 12 Mastbergen SC, Marijnissen AC, Vianen ME, van Roermund PM, Bijlsma JW, Lafeber FP. The canine ‘groove’ model of osteoarthritis is more than simply the expression of surgically applied damage. Osteoarthritis Cartilage 2006; 14 (01) 39-46
    CrossrefPubMedGoogle Scholar
  • 13 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 (02) 465-474
    CrossrefPubMedGoogle Scholar
  • 14 Mastbergen SC, Saris DBF, Lafeber FPJG. Functional articular cartilage repair: here, near, or is the best approach not yet clear?. Nat Rev Rheumatol 2013; 9 (05) 277-290
    CrossrefPubMedGoogle Scholar
  • 15 Rijnberk A, van Sluijs FJ. Medical History and Physical Examination in Companion Animals. 2nd edition.. Edinburgh: Saunders Ltd.; 2008: 167-171
    Google Scholar
  • 16 Morgan JP, Voss K, Damur DM, Guerrero T, Haessig M, Montavon PM. Correlation of radiographic changes after tibial tuberosity advancement in dogs with cranial cruciate-deficient stifles with functional outcome. Vet Surg 2010; 39 (04) 425-432
    CrossrefPubMedGoogle Scholar
  • 17 Brown DC, Boston RC, Coyne JC, Farrar JT. Development and psychometric testing of an instrument designed to measure chronic pain in dogs with osteoarthritis. Am J Vet Res 2007; 68 (06) 631-637
    CrossrefPubMedGoogle Scholar
  • 18 Suwankong N, Meij BP, Van Klaveren NJ. et al. Assessment of decompressive surgery in dogs with degenerative lumbosacral stenosis using force plate analysis and questionnaires. Vet Surg 2007; 36 (05) 423-431
    CrossrefPubMedGoogle Scholar
  • 19 Vezzoni L, Vezzoni A, Boudrieau RJ. Long-term outcome of Zürich cementless total hip arthroplasty in 439 cases. Vet Surg 2015; 44 (08) 921-929
    CrossrefPubMedGoogle Scholar
  • 20 Allen MJ, Leone KA, Lamonte K, Townsend KL, Mann KA. Cemented total knee replacement in 24 dogs: surgical technique, clinical results, and complications. Vet Surg 2009; 38 (05) 555-567
    CrossrefPubMedGoogle Scholar
  • 21 Canapp Jr SO. External fracture fixation. Clin Tech Small Anim Pract 2004; 19 (03) 114-119
    CrossrefPubMedGoogle Scholar
  • 22 Beever LJ, Giles K, Meeson RL. Postoperative complications associated with external skeletal fixators in dogs. Vet Comp Orthop Traumatol 2018; 31 (02) 137-143
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Harari J. Complications of external skeletal fixation. Vet Clin North Am Small Anim Pract 1992; 22 (01) 99-107
    CrossrefPubMedGoogle Scholar
  • 24 Kazmers NH, Fragomen AT, Rozbruch SR. Prevention of pin site infection in external fixation: a review of the literature. Strateg Trauma Limb Reconstr 2016; 11 (02) 75-85
    CrossrefPubMedGoogle Scholar
  • 25 Moss DP, Tejwani NC. Biomechanics of external fixation: a review of the literature. Bull NYU Hosp Jt Dis 2007; 65 (04) 294-299
    PubMedGoogle Scholar
  • 26 Bible JE, Mir HR. External fixation: Principles and applications. J Am Acad Orthop Surg 2015; 23 (11) 683-690
    CrossrefPubMedGoogle Scholar
  • 27 Watt FE, Hamid B, Garriga C. et al. The molecular profile of synovial fluid changes upon joint distraction and is associated with clinical response in knee osteoarthritis. Osteoarthritis Cartilage 2020; 28 (03) 324-333
    CrossrefPubMedGoogle Scholar
  • 28 Sanjurjo-Rodriguez C, Altaie A, Mastbergen S. et al. Gene expression signatures of synovial fluid multipotent stromal cells in advanced knee osteoarthritis and following knee joint distraction. Front Bioeng Biotechnol 2020; 8: 579751
    CrossrefPubMedGoogle Scholar
  • 29 Kleine SA, Gogal RM, George C, Thaliath M, Budsberg SC. Elevated synovial fluid concentration of monocyte chemoattractant protein-1 and interleukin-8 in dogs with osteoarthritis of the stifle. Vet Comp Orthop Traumatol 2020; 33 (02) 147-150
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Allen PI, Conzemius MG, Evans RB, Kiefer K. Correlation between synovial fluid cytokine concentrations and limb function in normal dogs and in dogs with lameness from spontaneous osteoarthritis. Vet Surg 2019; 48 (05) 770-779
    CrossrefPubMedGoogle Scholar
  • 31 Syx D, Tran PB, Miller RE, Malfait AM. Peripheral mechanisms contributing to osteoarthritis pain. Curr Rheumatol Rep 2018; 20 (02) 9
    CrossrefPubMedGoogle Scholar
  • 32 Teunissen M, Miranda Bedate A, Coeleveld K. et al. Enhanced extracellular matrix breakdown characterizes the early distraction phase of canine knee joint distraction. Cartilage 2021. Doi: 19476035211014595
    PubMedGoogle Scholar