Evidence map›Paper›PMID 40763924›Full record

ArticleBone & joint open2025

Knee arthroplasty compared with joint distraction for osteoarthritis: a phase III randomized controlled trial.

Thomas W Hamilton, Beth Lineham, Deborah D Stocken, Hemant Pandit, KARDS Study Group, A Muli, R Kelly, H Collier, R Mujica-Mota, A Metcalfe and 8 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Bone & joint open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Thomas W HamiltonNuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Beth LinehamLeeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Deborah D StockenClinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK.
Hemant PanditLeeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
KARDS Study Group
A MuliClinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK.
R KellyClinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK.
H CollierClinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK.
R Mujica-MotaAcademic Health Economics Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
A MetcalfeWarwick Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK.
H SimpsonDepartment of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK.
D W MurrayNuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
H SharmaDepartment of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Kingston upon Hull, UK.
D McGonagleChapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
D R EllardWarwick Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK.
J CroftClinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK.
J StokesClinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK.
P HarwoodLeeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Aims: Knee joint distraction (KJD) has been proposed as a joint-preserving alternative to arthroplasty. The objective of this study was to evaluate the clinical and cost-effectiveness of KJD compared to arthroplasty for knee osteoarthritis. Methods: This phase III multicentre, pragmatic, randomized controlled non-inferiority trial recruited adults aged ≤ 65 years with symptomatic osteoarthritis refractory to non-surgical treatment and suitable for knee arthroplasty. Patients were randomized to static, linear, KJD of 5 mm, produced with an external fixator construct for six-week duration, or total knee arthroplasty. The primary outcome measure was the Knee injury and Osteoarthritis Outcomes Score (KOOS) pain subscale 12 months post-surgery. The trial was terminated early due to failure to recruit following cessation of elective orthopaedic surgery during the COVID-19 pandemic. Results: A total of 24 participants were randomized with baseline characteristics balanced between groups. Improved median KOOS pain scores at 12 months postoperatively were observed in both treatment groups. The median KOOS pain score in the KJD group improved from 38.9 (IQR 30.6 to 41.7) at baseline to 55.6 (IQR 41.7 to 94.4) at 12 months, while corresponding scores in the arthroplasty group improved from 30.6 (IQR 11.1 to 36.1) to 75.0 (IQR 66.7 to 88.9). Similar improvements following KJD were seen across other KOOS subdomains and pain VAS, range of motion, or timed up-and-go test. The small sample size does not provide sufficient information to make meaningful comparisons between treatment groups. Pin site infection was seen in two patients, and a fracture through a pin site after frame removal following trauma in one patient. Conclusion: KJD appears to be associated with improved pain and function compared to baseline. The clinical and cost-effectiveness of KJD compared to arthroplasty remains uncertain.

Identifiers

PMID40763924
PMCPMC12324894

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.