As the name implies, this procedure involves distracting the stress on a joint by creating a metal frame outside the skin around the joint and anchoring the frame surgically to the bones above and below. The frame absorbs the weight, but the real benefit comes from the bones' separating. The ends of the bones become softer, enhancing blood flow and stimulating the growth of cartilage. A study published last year in Osteoarthritis and Cartilage showed that 15 of 23 European patients with advanced osteoarthritis had substantial reduction in pain and improvement in function for two years following knee distraction.
Distraction does have drawbacks. Knee distraction is not widely available in the U.S. (most patients opt for full knee replacement). The frames stay on for months. Rehabilitation is long. And the cartilage produced may be less durable than natural cartilage. Nevertheless, Annunziato Amendola, M.D., director of the University of Iowa Sports Medicine Center, says most of his ankle-distraction patients are "doing very well."
4. Cartilage Replacement
Because it's the loss of cartilage that makes osteoarthritis so painful, researchers have focused on finding ways to replace this connective tissue. Autologous chondrocyte implantation, or ACI, involves doctors' taking a small amount of cartilage from the patient's joint, cultivating the cells, sealing the affected area and injecting the cultivated cells under the seal. For all its promise, though, ACI works only when the arthritis is contained in a relatively small area.
That's why doctors are excited about recent research published in theProceedings of the National Academy of Sciences, in which scientists were able to prod bone marrow stem cells to act like cartilage. "Come up with something that regenerates cartilage and you have the Holy Grail," says Eric Ruderman, M.D., professor in medicine-rheumatology at Northwestern University in Chicago.
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