1. 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)

2. 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

3. Osteoarthritis Degenerative joint disease characterized by destruction of articular cartilage Cartilage cushion causes friction between bones, causing pain and stiffness of the joint

4. Causes osteoarthritis Veroudering Aangeboren standafwijking Trauma like sportblessures Chronic overbelasting obesitas Ontstekingsreacties van het lichaam

5. Prevalence & incidence osteoarthritis in the Netherlands (2007) Incidence (per 1.000) Male Female Age (years) Prevalence (per 1.000) MaleFemale Age (years) Nationaal Kompas Volksgezondheid, versie 4.3, 6 april 2011, © RIVM, Bilthoven Expected growth 2000 – 2020: 38%

6. Current treatments osteoarthritis Physical therapy Medication Lifestyle modification Churgical treatment Knee replacement Cartilage transplantation

7. 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

8. 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.

9. 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

10. 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 ProblemsGoals and wishes

11. 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

12. Follow-up 2011 Further development of prototype 2012 Testing treatment on 10 patients

13. This is why we are doing this! Thank you for your attention!