Transcript Dia 1 - Imdi SPRINT

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
Trauma like sportblessures
Chronic overbelasting obesitas
Veroudering
Ontstekingsreacties van het
lichaam
Aangeboren standafwijking
Prevalence & incidence osteoarthritis in the
Netherlands (2007)
Nationaal Kompas Volksgezondheid, versie 4.3, 6 april 2011, © RIVM, Bilthoven
Prevalence (per 1.000)
Male
Female
Incidence (per 1.000)
Age (years)
Prevalence
Per 1000
Total numbers
Female
Male
Incidence
Male
14,3
Female
23,8
Male
1,6
Female
3,1
115.000
197.000
13.300
25.700
Expected growth 2000 – 2020: 38%
Age (years)
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 cartilage
repair 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 knee
A. 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 a
Randomized Controlled Study
Anne C. A. Marijnissen,1 Peter M. van Roermund,1 Jan van Melkebeek,2 Willem Schenk,3
Abraham J. Verbout,1 Johannes W. J. Bijlsma,1 and Floris P. J. G. Lafeber; Utrecht/NL
Prolonged clinical benefit from joint distraction in the treatment
of ankle osteoarthritis
J. 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
Problems
Goals and wishes
- Patient can not use it for daily
 Patient can use it for daily
activities
activities
- Very uncomfortable
 Comfortable
- Possible inflammation/infection
 No inflammation/infection
(non-invasisve treatement)
- Expensive treatment
 Considerable cost reduction
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!