Effect analysis of high tibial osteotomy for treatment of knee medial compartment osteoarthritis

doi:10.3877/cma.j.issn.1674-134X.2021.01.006

Abstract

Abstract:

Objective

To investigate the clinical effect of open wedge high tibial osteotomy(OWHTO)in the treatment of medial compartment osteoarthritis (MCOA) of the knee.

Methods

A total of 56 patients (64 knees) with MCOA diagnosed in the Department of orthopedics, the First Affiliated Hospital of Jinan University were included in this study. All the cases underwent OWHTO, from January, 2016 to Febrary, 2019. Inclusion criteria: medial compartment osteoarthritis of knee joint; complicated with tibial varus deformity. Exclusion criteria: inflammatory and infectious arthritis, joint degeneration in multiple compartments, range of motion of knee joint<90°, flexion deformity>10°.The knee function and pain were evaluated by the visual analogue score (VAS) and Hospital for Special Surgery (HSS) score before and after surgery. The correction effect of postoperative knee varus was evaluated by femorotibial angle (FTA), medial proximal tibial angle (MPTA), knee varus angle (KVA), and weight-bearing line ratio of lower limbs (WBL). The scores and measured values were analyzed by repeated measurement analysis of variance, WSC test was used for comparison between each follow-up visit, and LSD test was used for pairwise comparison.

Results

All the incisions healed by first intention after operation. The lateral hinge undisplaced fracture occurred in five cases, which were healed by delayed weight bearing. Swelling and ecchymoses in leg occurred in 10 cases, which disappeared after symptomatic treatment. All the patients were followed up for an average of (15±3) months. During the follow-up, there was no failure of internal fixation, delayed union or nonunion of bone. At the follow-up of three, six and 12 months, the HSS scores of the patients were significantly higher than those before the operation(F=312.7, P<0.05). The VAS scores of the cases were significantly lower than those before the operation(F=185.6, P<0.05). Among the imaging indexes, FTA(t=3.2), MPTA(t=6.3), KVA(t=5.8)and WBL(t=2.7) were improved after operation. Compared with those before operation, varus deformity was corrected (all P<0.05).

Conclusion

OWHTO has a good effect in the treatment of medial compartment osteoarthritis of knee joint with varus deformity by correcting the mechanical alignment of lower extremities, alleviating pain and improving knee joint function.

Key words: Osteotomy, Osteoarthritis, Tibia, Knee joint, Treatment outcome

Songwei Huan, Simin Luo, Huantian Zhang, Guorong She, Wenrui Wu, Junyuan Chen, Tengfeng Zhuang, Hua Li, Zhengang Zha, Ning Liu. Effect analysis of high tibial osteotomy for treatment of knee medial compartment osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(01): 33-38.

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References 23

[1]	Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee[J]. J Bone Joint Surg Br, 1969, 51(1): 88-94.
[2]	Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis[J]. J Bone Joint Surg Am, 1973, 55(1): 23-48.
[3]	Miniaci A, Ballmer FT, Ballmer PM, et al. Proximal tibial osteotomy. A new fixation device[J]. Clin Orthop Relat Res, 1989, 246(246): 250-259.
[4]	Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints[J]. Orthop Clin North Am, 1979, 10(3): 585-608.
[5]	Webb M, Dewan V, Elson D. Functional results following high tibial osteotomy: a review of the literature[J]. Eur J Orthop Surg Traumatol, 2018, 28(4): 555-563.
[6]	Van Egmond N, Janssen D, Hannink G, et al. Biomechanical comparison of two different locking plates for open wedge high tibial osteotomy[J]. J Orthop Sci, 2018, 23(1): 105-111.
[7]	Stannard JT, Stannard JP. High tibial osteotomy following biologic replacement of the knee[J]. J Knee Surg, 2017, 30(8): 764-768.
[8]	赵学千，贾育松，孙旗，等．关节镜清理联合术后针刺与鸡尾酒疗法治疗膝骨关节炎[J/CD]．中华关节外科杂志(电子版)，2018，12(5)：681-686.
[9]	Shin YS, Sim HB, Yoon JR. Tibial nerve neuropathy following medial opening-wedge high tibial osteotomy-case report of a rare technical complication[J]. Eur J Orthop Surg Traumatol, 2017, 27(4): 563-567.
[10]	Sundararajan SR, Nagaraja HS, Rajasekaran S. Medial open wedge high tibial osteotomy for varus malunited tibial plateau fractures[J]. Arthroscopy, 2017, 33(3): 586-594.
[11]	Jung WH, Takeuchi R, Chun CW, et al. Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy[J]. Arthroscopy, 2014, 30(1): 72-79.
[12]	Meidinger G, Imhoff AB, Paul J, et al. May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(3): 333-339.
[13]	Koh YG, Son J, Kim HJ, et al. Multi-objective design optimization of high tibial osteotomy for improvement of biomechanical effect by using finite element analysis[J]. J Orthop Res, 2018, 36(11): 2956-2965.
[14]	Kuremsky MA, Schaller TM, Hall CC, et al. Comparison of autograft vs allograft in opening-wedge high tibial osteotomy[J]. J Arthroplasty, 2010, 25(6): 951-957.
[15]	林炯同，杨伟毅，潘建科，等．内侧开放楔形高位胫骨截骨术外侧合页骨折的处理[J]．中国矫形外科杂志，2019，27(10)：907-911.
[16]	Nakamura R, Komatsu N, Fujita K, et al. Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy[J]. Bone Joint J, 2017, 99-B(10): 1313-1318.
[17]	Hantes ME, Natsaridis P, Koutalos AA, et al. Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(11): 3199-3205.
[18]	Al-Ghandour AE. Management of medial compartment knee osteoarthritis with medial opening wedge tibial osteotomy[J]. RJPBCS, 2018, 9(5): 1063-1071.
[19]	张宽宽，吴敏．开放性楔形胫骨高位截骨术术中并发外侧铰链断裂的研究[J]．中国修复重建外科杂志，2019，33(1)：110-114.
[20]	Krause M, Drenck TC, Korthaus A, et al. Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(6): 1859-1866.
[21]	张军，张利勇，宗永刚，等.3D打印辅助胫骨截骨治疗膝内侧骨关节炎现状[J/CD]．中华关节外科杂志(电子版)，2019，13(6)：750-754.
[22]	Jacobi M, Villa V, Reischl N, et al. Factors influencing posterior tibial slope and tibial rotation in opening wedge high tibial osteotomy[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(9): 2762-2768.
[23]	Darees M, Putman S, Brosset T, et al. Opening-wedge high tibial osteotomy performed with locking plate fixation (TomoFix) and early weight-bearing but without filling the defect. A concise follow-up note of 48 cases at 10 years' follow-up [J]. Orthop Traumatol Surg Res, 2018, 104(4): 477-480.

时间	VAS评分	HSS评分
时间	VAS评分	疼痛	功能	活动度	肌力	屈曲畸形	稳定性	总分
术前	6.8±1.3^a	12.7±1.3^a	11.8±3.8^a	13.3±2.9^a	7.8±3.5^a	5.6±0.3^a	5.2±0.5^a	60.3±5.7^a
术后3月	3.5±2.4^b	20.1±2.9^b	16.3±3.1^b	15.5±4.3^b	8.6±1.3^b	8.6±0.5^b	7.8±0.7^b	81.7±4.9^b
术后6月	2.6±1.7^b	23.3±1.3^b	18.1±2.1^b	16.2±2.4^b	8.9±1.5^b	8.8±0.3^b	8.2±0.8^b	85.2±5.8^b
术后12月	1.8±1.1^b	23.9±1.2^b	18.4±1.5^b	16.6±1.1^b	8.8±1.1^b	8.9±0.9^b	8.1±0.3^b	85.4±3.2^b
F值	185.6	199.6	187.1	324.1	234.9	198.4	122.7	312.7
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

时间	VAS评分	HSS评分
时间	VAS评分	疼痛	功能	活动度	肌力	屈曲畸形	稳定性	总分
术前	6.8±1.3^a	12.7±1.3^a	11.8±3.8^a	13.3±2.9^a	7.8±3.5^a	5.6±0.3^a	5.2±0.5^a	60.3±5.7^a
术后3月	3.5±2.4^b	20.1±2.9^b	16.3±3.1^b	15.5±4.3^b	8.6±1.3^b	8.6±0.5^b	7.8±0.7^b	81.7±4.9^b
术后6月	2.6±1.7^b	23.3±1.3^b	18.1±2.1^b	16.2±2.4^b	8.9±1.5^b	8.8±0.3^b	8.2±0.8^b	85.2±5.8^b
术后12月	1.8±1.1^b	23.9±1.2^b	18.4±1.5^b	16.6±1.1^b	8.8±1.1^b	8.9±0.9^b	8.1±0.3^b	85.4±3.2^b
F值	185.6	199.6	187.1	324.1	234.9	198.4	122.7	312.7
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

时间	FTA(°)	MPTA(°)	KVA(°)	WBL(%)
术前	188.2±4.6^a	80.2±3.1^a	11.3±2.1^a	23.8±4.1^a
术后3月	170.9±4.5^b	95.5±2.1^b	1.9±2.6^b	62.3±5.7^b
术后6月	171.2±3.3^b	95.2±1.9^b	2.2±1.5^b	62.1±4.3^b
术后12月	171.4±2.1^b	94.5±1.1^b	2.5±1.4^b	61.9±4.2^b
F值	216.2	186.4	345.1	291.5
P值	<0.001	<0.001	<0.001	<0.001

时间	FTA(°)	MPTA(°)	KVA(°)	WBL(%)
术前	188.2±4.6^a	80.2±3.1^a	11.3±2.1^a	23.8±4.1^a
术后3月	170.9±4.5^b	95.5±2.1^b	1.9±2.6^b	62.3±5.7^b
术后6月	171.2±3.3^b	95.2±1.9^b	2.2±1.5^b	62.1±4.3^b
术后12月	171.4±2.1^b	94.5±1.1^b	2.5±1.4^b	61.9±4.2^b
F值	216.2	186.4	345.1	291.5
P值	<0.001	<0.001	<0.001	<0.001

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