{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:15:25Z","timestamp":1791821725298,"version":"4.3.4"},"reference-count":45,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","thekneejournal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The Knee"],"published-print":{"date-parts":[[2025,10]]},"DOI":"10.1016\/j.knee.2025.07.008","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:55:55Z","timestamp":1753890955000},"page":"637-645","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"special_numbering":"C","title":["Joint distraction versus custom-made unloading orthosis for knee osteoarthritis \u2013 A clinical and radiological study"],"prefix":"10.1016","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3357-6650","authenticated-orcid":false,"given":"M.R.","family":"Huizinga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.J.","family":"de Vries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.P.","family":"Jansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.C.","family":"Mastbergen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.C.","family":"Jutte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.W.","family":"Brouwer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.knee.2025.07.008_b0005","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1002\/1529-0131(199808)41:8<1343::AID-ART3>3.0.CO;2-9","article-title":"An update on the epidemiology of knee and hip osteoarthritis with a view to prevention","volume":"41","author":"Felson","year":"1998","journal-title":"Arthritis Rheum"},{"key":"10.1016\/j.knee.2025.07.008_b0010","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1016\/j.joca.2019.06.011","article-title":"OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis","volume":"27","author":"Bannuru","year":"2019","journal-title":"Osteoarthritis Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0015","doi-asserted-by":"crossref","first-page":"256","DOI":"10.3928\/01477447-20180828-08","article-title":"The conservative treatment of osteoarthritis of the knee","volume":"41","author":"Bert","year":"2018","journal-title":"Orthopedics"},{"key":"10.1016\/j.knee.2025.07.008_b0020","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1001\/jama.286.2.188","article-title":"The role of knee alignment in disease progression and functional decline in knee osteoarthritis","volume":"286","author":"Sharma","year":"2001","journal-title":"J Am Med Assoc"},{"key":"10.1016\/j.knee.2025.07.008_b0025","doi-asserted-by":"crossref","first-page":"169","DOI":"10.26502\/josm.511500192","article-title":"Surgical interventions in severe osteoarthritis: pros and cons","volume":"7","author":"Aabedi","year":"2025","journal-title":"J Orthop Sports Med"},{"key":"10.1016\/j.knee.2025.07.008_b0030","doi-asserted-by":"crossref","DOI":"10.1155\/aort\/6274196","article-title":"Improvement in quality of life, pain and function after total and unicompartmental knee replacement: a secondary analysis of 12-month post-operative outcomes","volume":"2025","author":"Snell","year":"2025","journal-title":"Adv Orthop"},{"key":"10.1016\/j.knee.2025.07.008_b0035","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1055\/s-0037-1605557","article-title":"Impact of age on patient-reported outcome measures in total knee arthroplasty","volume":"31","author":"Townsend","year":"2018","journal-title":"J Knee Surg"},{"key":"10.1016\/j.knee.2025.07.008_b0040","doi-asserted-by":"crossref","DOI":"10.5435\/JAAOS-D-25-00299","article-title":"Value in knee arthroplasty: a comparative patient-level value analysis of cost and cost-effectiveness for unicompartmental knee arthroplasty and primary total knee arthroplasty in the United States","author":"Sauder","year":"2025","journal-title":"J Am Acad Orthop Surg"},{"key":"10.1016\/j.knee.2025.07.008_b0045","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1177\/19476035231196524","article-title":"Moderate to severe osteoarthritis: what is the economic burden for patients and the health care system? Insights from the \u201cPONOS\u201d study","volume":"15","author":"Savvari","year":"2024","journal-title":"Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0050","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1016\/S0140-6736(17)30059-4","article-title":"The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study","volume":"389","author":"Bayliss","year":"2017","journal-title":"Lancet"},{"key":"10.1016\/j.knee.2025.07.008_b0055","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1177\/19476035231164733","article-title":"Total knee arthroplasty (TKA): when do the risks of TKA overcome the benefits? Double risk of failure in patients up to 65 years old","volume":"14","author":"Perdisa","year":"2023","journal-title":"Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0060","doi-asserted-by":"crossref","first-page":"2606","DOI":"10.1007\/s11999-009-0834-6","article-title":"Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030","volume":"467","author":"Kurtz","year":"2009","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.knee.2025.07.008_b0065","doi-asserted-by":"crossref","first-page":"3679","DOI":"10.1007\/s00167-016-4232-9","article-title":"Progression of medial compartmental osteoarthritis 2-8 years after lateral closing-wedge high tibial osteotomy","volume":"25","author":"Huizinga","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"10.1016\/j.knee.2025.07.008_b0070","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1177\/1947603519828432","article-title":"Knee joint distraction compared with high tibial osteotomy and total knee arthroplasty: two-year clinical, radiographic, and biochemical marker outcomes of two randomized controlled trials","volume":"12","author":"Jansen","year":"2021","journal-title":"Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0075","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2023-003074","article-title":"Joint distraction using a purpose-built device for knee osteoarthritis: a prospective 2-year follow-up","volume":"9","author":"Struik","year":"2023","journal-title":"RMD Open"},{"key":"10.1016\/j.knee.2025.07.008_b0080","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1097\/01.bor.0000240366.54960.a1","article-title":"Unloading joints to treat osteoarthritis, including joint distraction","volume":"18","author":"Lafeber","year":"2006","journal-title":"Curr Opin Rheumatol"},{"key":"10.1016\/j.knee.2025.07.008_b0085","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/j.joca.2011.02.005","article-title":"Subchondral bone remodeling is related to clinical improvement after joint distraction in the treatment of ankle osteoarthritis","volume":"19","author":"Intema","year":"2011","journal-title":"Osteoarthritis Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0090","doi-asserted-by":"crossref","first-page":"1113S","DOI":"10.1177\/1947603520942945","article-title":"Knee joint distraction as treatment for osteoarthritis results in clinical and structural benefit: a systematic review and meta-analysis of the limited number of studies and patients available","volume":"13","author":"Jansen","year":"2021","journal-title":"Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0095","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1016\/j.joca.2013.08.006","article-title":"Sustained clinical and structural benefit after joint distraction in the treatment of severe knee osteoarthritis","volume":"21","author":"Wiegant","year":"2013","journal-title":"Osteoarthritis Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0100","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1093\/rheumatology\/keab456","article-title":"Knee joint distraction results in MRI cartilage thickness increase up to 10 years after treatment","volume":"61","author":"Jansen","year":"2022","journal-title":"Rheumatology (Oxford)"},{"key":"10.1016\/j.knee.2025.07.008_b0105","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1016\/j.joca.2018.08.004","article-title":"Initial tissue repair predicts long-term clinical success of knee joint distraction as treatment for knee osteoarthritis","volume":"26","author":"Jansen","year":"2018","journal-title":"Osteoarthritis Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0110","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1093\/rheumatology\/31.7.437","article-title":"Intermittent hydrostatic compressive force stimulates exclusively the proteoglycan synthesis of osteoarthritic human cartilage","volume":"31","author":"Lafeber","year":"1992","journal-title":"Br J Rheumatol"},{"key":"10.1016\/j.knee.2025.07.008_b0115","article-title":"Joint distraction for the treatment of knee osteoarthritis","author":"Itthipanichpong","year":"2023","journal-title":"J Cartilage Joint Pres"},{"key":"10.1016\/j.knee.2025.07.008_b0120","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.joca.2019.12.005","article-title":"The molecular profile of synovial fluid changes upon joint distraction and is associated with clinical response in knee osteoarthritis","volume":"28","author":"Watt","year":"2020","journal-title":"Osteoarthr Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0125","doi-asserted-by":"crossref","DOI":"10.3389\/fbioe.2020.579751","article-title":"Gene expression signatures of synovial fluid multipotent stromal cells in advanced knee osteoarthritis and following knee joint distraction","volume":"8","author":"Sanjurjo-Rodriguez","year":"2020","journal-title":"Front Bioeng Biotechnol"},{"key":"10.1016\/j.knee.2025.07.008_b0130","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1136\/annrheumdis-2014-206847","article-title":"Synovial fluid hyaluronan mediates MSC attachment to cartilage, a potential novel mechanism contributing to cartilage repair in osteoarthritis using knee joint distraction","volume":"75","author":"Baboolal","year":"2016","journal-title":"Ann Rheum Dis"},{"key":"10.1016\/j.knee.2025.07.008_b0135","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1055\/s-0038-1669447","article-title":"Is knee joint distraction a viable treatment option for knee OA?-A literature review and meta-analysis","volume":"32","author":"Takahashi","year":"2019","journal-title":"J Knee Surg"},{"key":"10.1016\/j.knee.2025.07.008_b0140","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1177\/19476035231226418","article-title":"Comparison of clinical efficacy and mechanical characteristics of two knee distraction devices with relevance for clinical practice","volume":"15","author":"Struik","year":"2024","journal-title":"Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0145","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-083069","article-title":"'The unexpected journey': a qualitative interview study exploring patient and health professionals experiences of participating in the knee arthroplasty versus joint distraction study (KARDS)","volume":"14","author":"Arnold","year":"2024","journal-title":"BMJ Open"},{"key":"10.1016\/j.knee.2025.07.008_b0150","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.3233\/THC-230953","article-title":"New concept of orthosis treatment for knee osteoarthritis: clinical and radiological outcomes","volume":"32","author":"Huizinga","year":"2024","journal-title":"Technol Health Care"},{"key":"10.1016\/j.knee.2025.07.008_b0155","doi-asserted-by":"crossref","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"key":"10.1016\/j.knee.2025.07.008_b0160","first-page":"1833","article-title":"Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee","volume":"15","author":"Bellamy","year":"1988","journal-title":"J Rheumatol"},{"key":"10.1016\/j.knee.2025.07.008_b0165","doi-asserted-by":"crossref","first-page":"851","DOI":"10.2147\/JPR.S158847","article-title":"Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain","volume":"11","author":"Alghadir","year":"2018","journal-title":"J Pain Res"},{"key":"10.1016\/j.knee.2025.07.008_b0170","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.joca.2007.06.009","article-title":"Knee images digital analysis (KIDA): a novel method to quantify individual radiographic features of knee osteoarthritis in detail","volume":"16","author":"Marijnissen","year":"2008","journal-title":"Osteoarthr Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0175","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1016\/j.joca.2021.07.013","article-title":"Performance of knee image digital analysis of radiographs of patients with end-stage knee osteoarthritis","volume":"29","author":"Jansen","year":"2021","journal-title":"Osteoarthr Cartilage"},{"key":"10.1016\/j.knee.2025.07.008_b0180","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"10.1016\/j.knee.2025.07.008_b0185","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1037\/0033-2909.112.1.155","article-title":"A power primer","volume":"112","author":"Cohen","year":"1992","journal-title":"Psychol Bull"},{"key":"10.1016\/j.knee.2025.07.008_b0190","series-title":"Statistical power analysis for the behavioral sciences","author":"Cohen","year":"2013"},{"key":"10.1016\/j.knee.2025.07.008_b0195","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/s00167-014-3305-x","article-title":"Current state of unloading braces for knee osteoarthritis","volume":"24","author":"Steadman","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"10.1016\/j.knee.2025.07.008_b0200","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0227975","article-title":"Knee joint distraction in regular care for treatment of knee osteoarthritis: a comparison with clinical trial data","volume":"15","author":"Jansen","year":"2020","journal-title":"PLoS One"},{"key":"10.1016\/j.knee.2025.07.008_b0205","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1302\/0301-620X.99B1.BJJ-2016-0099.R3","article-title":"Knee joint distraction compared with total knee arthroplasty: a randomised controlled trial","volume":"99-B","author":"van der Woude","year":"2017","journal-title":"Bone Joint J"},{"key":"10.1016\/j.knee.2025.07.008_b0210","doi-asserted-by":"crossref","first-page":"88-y","DOI":"10.1186\/s40634-020-00305-y","article-title":"Reduction of pin tract infections during external fixation using cadexomer iodine","volume":"7","author":"Jansen","year":"2020","journal-title":"J Exp Orthop"},{"issue":"3","key":"10.1016\/j.knee.2025.07.008_b0215","doi-asserted-by":"crossref","first-page":"066","DOI":"10.17352\/2455-2968.000016","article-title":"Total knee prosthesis after knee joint distraction treatment","volume":"1","author":"Wiegant","year":"2015","journal-title":"J Surg Surgical Res"},{"key":"10.1016\/j.knee.2025.07.008_b0220","doi-asserted-by":"crossref","first-page":"368","DOI":"10.3390\/jcm10020368","article-title":"Changes in cartilage thickness and denuded bone area after knee joint distraction and high tibial osteotomy-post-hoc analyses of two randomized controlled trials","volume":"10","author":"Jansen","year":"2021","journal-title":"J Clin Med"},{"key":"10.1016\/j.knee.2025.07.008_b0225","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-062721","article-title":"Clinical and cost-effectiveness of knee arthroplasty versus joint distraction for osteoarthritis (KARDS): protocol for a multicentre, phase III, randomised control trial","volume":"12","author":"Tassinari","year":"2022","journal-title":"BMJ Open"}],"container-title":["The Knee"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0968016025001875?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0968016025001875?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T12:24:53Z","timestamp":1761395093000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0968016025001875"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":45,"alternative-id":["S0968016025001875"],"URL":"https:\/\/doi.org\/10.1016\/j.knee.2025.07.008","relation":{},"ISSN":["0968-0160"],"issn-type":[{"value":"0968-0160","type":"print"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Joint distraction versus custom-made unloading orthosis for knee osteoarthritis \u2013 A clinical and radiological study","name":"articletitle","label":"Article Title"},{"value":"The Knee","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.knee.2025.07.008","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}