Therapeutic effect of different surgical procedures on medial compartment knee osteoarthritis

doi:10.3877/ cma.j.issn.1674-134X.2024.06.004

Abstract

Abstract:

Objective

To explore the curative effect of different surgical procedures on medial compartment osteoarthritis of knee joint and the effect of improving knee joint function.

Methods

A total of 106 patients with medial compartment osteoarthritis of knee joint treated in Hengshui Hospital of Traditional Chinese Medicine from January 2021 to April 2023 were selected as the research object. Inclusion criteria were as follows： the first surgical treatment of osteoarthritis in the medial compartment of the knee joint， with indications for surgery， etc. Patients with infectious diseases， traumatic fractures， osteoporosis and the history of bone and joint surgery were excluded. According to the final treatment， the patients were divided into two groups： the high tibial osteotomy group （the HTO group， 51 cases） and the single condyle replacement group（the SCR group，55 cases）. Four cases in the HTO group were lost to follow-up， and 47 cases were eventually included. Six cases in the SCR group were lost during follow-up， and 49 cases were finally included. Both groups were observed until discharge and were followed up for 12 months. The clinical efficacy （one week after operation）， peri-operative indices， knee joint range of motion （before operation and one month after operation），sitting pain， knee joint function （at different time points）， complications （during follow-up） and observation value of knee joint （before and 12 months after operation） were compared between the two groups by t test，repeated measurement analysis of variance and chi square test.

Results

One week after operation， compared with the HTO group， the total clinical effective rate in the SCR group was higher ， the difference was statistically significant（χ²=5.752， P＜0.05）. Compared with the HTO group， the time of getting out of bed and length of hospital stay in the SCR group was shorter （t=14.461， 10.619， both P＜0.05）. Compared with the data before operation， the flexion， extension， abduction and adduction activities of the two groups all increased one month after operation （t =130.125， 113.624， 70.859， 69.402， 53.584， 51.447， 26.909， 27.901， all P＜0.05）； the difference between the two groups were not statistically significant （all P＞0.05）. There was no statistically significant difference in the sitting pain score before surgery and 12 months after the surgery in the HTO group（F=1.308， P＞0.05） nor in the SCR group （F=0.382， P＞0.05）. There was no significant difference between the two groups in the variance of repeated measurement of sitting pain score from preoperative to postoperative 12 months （F=1.556， 0.951， 1.381， 0.472， all P＞0.05）.There was no statistical significance in the University of Western Ontario and McMaster osteoarthritis index （WOMAC） in the HTO group at each time point from before operation to 12 months after operation （F=1.162， P＞0.05）， and there was no statistical significance in comparing the variance of repeated measurement of WOMAC in the SCR group at each time point from before operation to 12 months after operation （F=0.663， P＞0.05）. There was no significant difference in the variance of repeated measurement of WOMAC score between the two groups at each time point from preoperative to postoperative 12 months （F=1.442， 0.975， 0.794， 1.941， all P＞0.05）. During the follow-up period， the total incidence of complications in the SCR group was lower than that in the HTO group， the difference was statistically significant（P＜0.05）. Compared with the data before operation， the varus angle of tibial plateau decreased in both groups at 12 months after operation （t=5.457、12.047）， especially in the SCR group （t=20.602）； the ratio of internal and external space increased in both groups at 12 months after operation （t=4.060、9.726）， especially in the SCR group （t=6.196）， the differences were statistically significant（all P＜0.05）.

Conclusion

Compared with high tibial osteotomy， the postoperative recovery time of patients with medial compartment osteoarthritis of the knee joint treated by single condyle replacement is relatively shorter， and the line and angle of knee joint can be adjusted. The incidence of complications is lower and the curative effect is more obvious， but it has the same effect on improving postoperative pain， knee joint function and knee joint mobility.

Key words: Knee joint, Osteoarthritis, Osteotomy

Yungang Xie, Changhai Fan, Rongshun Liu, Ruichen Deng. Therapeutic effect of different surgical procedures on medial compartment knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(06): 720-728.

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Figures/Tables 10

Table 1 Ggeneral information of the two groups before operation

组别 Groups	例数 Number of cases	膝手术侧别（左/右） Side of knee（left/right）	性别（男/女） Gender（male/female）	BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］
胫骨高位截骨组 High tibial osteotomy group	47	23/24	21/26	22.5±0.4
单髁置换组 Single condyle replacement group	49	21/28	19/30	22.5±0.5
统计值 Statistical value		χ²=0.357	χ²=0.344	t=0.460
P值		＞0.05	＞0.05	＞0.05
组别 Groups	例数 Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］ Age（year）	病程［年，（ $\overset{ˉ}{x}$ ±s）］ course of disease （year）	膝关节软骨Recht-MRI分级（Ⅲ级/Ⅳ级） Recht-MRI classification of knee cartilage
胫骨高位截骨组 High tibial osteotomy group	47	55.8±5.6	4.9±0.3	18/29
单髁置换组 Single condyle replacement group	49	55.8±5.6	4.9±0.4	17/32
统计值 Statistical value		t=0.035	t=0.576	χ²=0.135
P值		＞0.05	＞0.05	＞0.05

Table 1 Ggeneral information of the two groups before operation

组别 Groups	例数 Number of cases	膝手术侧别（左/右） Side of knee（left/right）	性别（男/女） Gender（male/female）	BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］
胫骨高位截骨组 High tibial osteotomy group	47	23/24	21/26	22.5±0.4
单髁置换组 Single condyle replacement group	49	21/28	19/30	22.5±0.5
统计值 Statistical value		χ²=0.357	χ²=0.344	t=0.460
P值		＞0.05	＞0.05	＞0.05
组别 Groups	例数 Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］ Age（year）	病程［年，（ $\overset{ˉ}{x}$ ±s）］ course of disease （year）	膝关节软骨Recht-MRI分级（Ⅲ级/Ⅳ级） Recht-MRI classification of knee cartilage
胫骨高位截骨组 High tibial osteotomy group	47	55.8±5.6	4.9±0.3	18/29
单髁置换组 Single condyle replacement group	49	55.8±5.6	4.9±0.4	17/32
统计值 Statistical value		t=0.035	t=0.576	χ²=0.135
P值		＞0.05	＞0.05	＞0.05

Table 2 Comparison of clinical efficacy between the two groups

组别 Groups	例数 Number of cases	治愈 Cure	显效 Obvious effect	有效 Effective	无效 No eff ect	总有效率 Total eff ective rate
胫骨高位截骨组 High tibial osteotomy	47	20（42.5）	12（25.5）	4（8.5）	11（23.4）	36（76.6）
单髁置换组 Single condyle replacement group	49	21（42.9）	15（30.6）	10（20.4）	3（6.1）	46（93.9）
χ²值						5.752
P值						0.016

Table 3 Comparison of perioperative indicators between the two groups

组别 Groups	例数 Number of cases	手术时间（min） Operation time	术后下床时间（d） Time to be ambulant after operation	住院时间（d） Length of hospital stay	出血量（ml） Blood loss
胫骨高位截骨组 High tibial osteotomy	47	69.8±6.6	6.9±0.7	12.4±1.3	182.4±15.9
单髁置换组 Single condyle replacement group	49	68.8±6.6	5.1±0.5	9.4±1.4	178.8±13.0
t值		0.742	14.544	10.868	1.217
P值		＞0.05	＜0.001	＜0.001	＞0.05

Table 4 Comparison of knee joint range of motion between two groups

组别 Groups	例数 Number of cases	屈曲Flexion		t值	P值	后伸Extension		t值	P值
组别 Groups	例数 Number of cases	术前 Before operation	术后1个月 One month after operation	t值	P值	术前 Before operation	术后1个月 One month after operation	t值	P值
胫骨高位截骨组High tibial osteotomy group	47	58.39±2.50	120.11±2.14	130.125	＜0.001	2.18±0.15	9.17±0.66	70.859	＜0.001
单髁置换组Single condyle replacement group	49	58.56±2.44	119.32±2.78	113.624	＜0.001	2.21±0.16	8.98±0.65	69.402	＜0.001
t值		0.337	1.556			0.947	1.421
P值		＞0.05	＞0.05			＞0.05	＞0.05
组别 Groups	例数 Number of cases	外展Abduction		t值	P值	内收Adduction		t值	P值
组别 Groups	例数 Number of cases	术前 Before operation	术后1个月 One month after operation	t值	P值	术前 Before operation	术后1个月 One month after operation	t值	P值
胫骨高位截骨组High tibial osteotomy group	47	16.88±2.19	37.07±1.44	53.584	＜0.001	11.81±1.60	20.11±1.42	26.909	＜0.001
单髁置换组Single condyle replacement group	49	16.91±2.25	36.54±1.41	51.447	＜0.001	11.76±1.62	19.98±1.25	27.901	＜0.001
t值		0.066	1.822			0.152	0.477
P值		＞0.05	＞0.05			＞0.05	＞0.05

Table 5 Comparison of sitting pain between the two groups

组别 Groups	例数 Number of cases	术前 Before operation	术后3个月 Three months after operation	术后6个月 Six months after operation	术后12个月 12 months after operation	F值	P值
胫骨高位截骨组High tibial osteotomy group	47	7.11±0.81	4.06±0.25	3.40±0.54	1.83±0.38	1.308	＞0.05
单髁置换组Single condyle replacement group	49	7.06±0.80	3.27±0.45	2.57±0.50	1.78±0.55	0.382	＞0.05
F值		1.556	0.951	1.381	0.472
P值		＞0.05	＞0.05	＞0.05	＞0.05

Table 6 Comparison of knee joint function between two groups

组别 Groups	例数 Number of cases	术前 Before operation	术后3个月 Three months after operation	术后6个月 Six months after operation	术后12个月 12 months after operation	F值	P值
胫骨高位截骨组 High tibial osteotomy group	47	65.2±7.2	42.8±4.5	27.4±3.9	20.1±2.6	1.162	＞0.05
单髁置换组 Single condyle replacement group	49	64.1±7.5	34.5±3.7	20.7±2.2	19.4±2.5	0.663	＞0.05
F值		1.442	0.975	0.794	1.941
P值		＞0.05	＞0.05	＞0.05	＞0.05

Table 7 Comparison of complications between the two groups

组别 Groups	例数 Number of cases	切口感染Incision infection	愈合不良Poor healing	下肢静脉血栓 Venous thrombosis of lower extremity	深静脉炎 Deep phlebitis	总发生率 Total occurrence
胫骨高位截骨组 High tibial osteotomy group	47	4（8.5）	2（4.3）	3（6.4）	2（4.3）	11（23.4）
单髁置换组 Single condyle replacement group	49	2（4.1）	1（2.0）	1（2.0）	0	4（8.2）
χ²值		-	-	-	-	4.227
P值		-	-	-	-	0.040

Table 8 Comparison of observation values of knee joint between two groups

组别 Groups	例数 Number of cases	胫骨平台内翻角Tibial plateau varus angle		t值	P值
组别 Groups	例数 Number of cases	术前Before operation	术后12个月 12 months after operation	t值	P值
胫骨高位截骨组High tibial osteotomy group	47	5.12±0.57	4.66±0.15	5.457	＜0.001
单髁置换组Single condyle replacement group	49	5.11±0.58	4.09±0.12	12.047	＜0.001
t值		0.085	20.602
P值		＞0.05	＜0.001
组别 Groups	例数 Number of cases	内外间隙比Internal and external clearance ratio		t值	P值
组别 Groups	例数 Number of cases	术前Before operation	术后12个月 12 months after operation	t值	P值
胫骨高位截骨组High tibial osteotomy group	47	0.75±0.09	0.81±0.05	4.060	＜0.001
单髁置换组Single condyle replacement group	49	0.74±0.08	0.88±0.06	9.726	＜0.001
t值		0.576	6.196
P值		＞0.05	＜0.001

Figure 1 X ray images of knees of typical case one before and after high tibial osteotomy. A is image of bilateral knees at anteroposterior position before surgery， showing obviously narrowing of the medial space of the right knee and slightly varus； B is lateral image of the right knee before surgery， showing hyperplasia and osteoarthritis； C is anteroposterior image of lower limbs， showing bilateral knee osteoarthritis and the medial compartments were severe with slightly varus of right knee； D is image of right knee at anteroposterior and lateral positions after surgery， showing good internal fixation and well recovered force line and the medial joint space

Figure 2 X-ray images before and after single condyle replacement of left knee in typical case two. A is image of left knee at anteroposterior and lateral positions before surgery， showing the obviously narrowed medial space of knee joint with hyperplasia and osteoarthritis ； B is full length image of lower limbs before surgery， showing unequal width of bilateral knee joint spaces with narrower medial space， and more severe in the left knee； C is image of left knee at anteroposterior and lateral positions after surgery， showing good and stabilized prosthesis position

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