Subchondral bone changes after joint distraction treatment for end stage knee osteoarthritis

S. C. Mastbergen, A. Ooms, T. D. Turmezei, J. W. MacKay, R. J. van Heerwaarden, S. Spruijt, F. P. J. G. Lafeber, M. P. Jansen

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Objective: Increased subchondral cortical bone plate thickness and trabecular bone density are characteristic of knee osteoarthritis (OA). Knee joint distraction (KJD) is a joint-preserving knee OA treatment where the joint is temporarily unloaded. It has previously shown clinical improvement and cartilage regeneration, indicating reversal of OA-related changes. The purpose of this research was to explore 3D subchondral bone changes after KJD treatment using CT imaging.

Design: Twenty patients were treated with KJD and included to undergo knee CT imaging before, one, and two years after treatment. Tibia and femur segmentation and registration to canonical surfaces were performed semi-automatically. Cortical bone thickness and trabecular bone density were determined using an automated algorithm. Statistical parametric mapping (SPM) with two-tailed F-tests was used to analyze whole-joint changes.

Results: Data was available of 16 patients. Subchondral cortical bone plate thickness and trabecular bone density were higher in the weight-bearing region of the most affected compartment (MAC; mostly medial). Especially the MAC showed a decrease in thickness and density in the first year after treatment, which was sustained towards the second year.

Conclusions: KJD treatment results in bone changes that include thinning of the subchondral cortical bone plate and decrease of subchondral trabecular bone density in the first two years after treatment, potentially indicating a partial normalization of subchondral bone.
Original languageEnglish
Pages (from-to)965-972
Number of pages8
JournalOsteoarthritis and Cartilage
Issue number7
Early online date7 Feb 2022
Publication statusPublished - Jul 2022


  • Computed tomography
  • Cortical
  • Knee joint distraction
  • Osteoarthritis
  • Subchondral bone
  • Trabecular

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