Mylène Jansen

KJD in regular care 113 6 a distraction distance of 2 mm was provided intra-operatively. All this was performed under general or spinal anesthesia, depending on the surgeon’s and patient’s preference. Figure 1 : Representative radiograph of the external distraction frame in use. In regular care In regular care, the average intervention time (the time between the first incision and the surgeon being finished) was 53 (range 31–79) minutes. Blood loss during surgery was in all cases negligible. After surgery, patients generally stayed in the hospital for another 2 to 3 days, during which the tubes were gradually distracted until 5 mm distraction was reached. At completion, the distraction distance was checked on weight-bearing radiographs and adapted if needed. During the distraction period weight-bearing, supported with crutches if needed, was allowed and encouraged. This provides intra-articular fluid pressure changes, considered relevant for nutrition of the cartilage, because of 3 mm axial displacement under 80 kg of weight-bearing of the internal springs. 18,19 Patients received low molecular weight heparin for 6 weeks and a standard prescription for 7 days of oral antibiotics (flucloxacillin). If patients suspected a pin tract infection, based on consulting their physician, a course of flucloxacillin was started. During the distraction period, patients visited the outpatient clinic once for a general evaluation. After 6 weeks, the distraction frame was removed and knee manipulation (flexion-extension) was performed under general or spinal anesthesia at day-treatment. The total frame removal time in regular care was 16 minutes (range 7–36) and patients were discharged the same day.