Clinical Effect And Gait Analysis For Medial Open Wedge High Tibial Osteotomy In The Treatment Of Medial Unicompartment Osteoarthritis Of Knee

Part Ⅰ Short-term clinical effect of medial open wedge high tibial osteotomy in the treatment of medial unicompartment osteoarthritis of the kneeObjective:To evaluate the short-term clinical effect of Medial Open Wedge High Tibial Osteotomy(MOWHTO)in the treatment of medial unicompartment osteoarthritis of the knee.Methods:84 cases of medial open wedge high tibial osteotomy were included in our study.All MOWHTO were finished in the Affiliated Zhongshan Hospital of Dalian University between Mar.2016 and Oct.2017.The patients were followed up 3 months,6 months and 12 months after operation.Visual Analogue Score(VAS)、American Knee Society knee score(AKS)、Femoral Tibial Angle(FTA)、MPTA、Insall-Salvati index、Tibial Posterior Slope Angle and Medial Proximal Tibial Angle(MPTA)were used to evaluate the postoperative effect.All data were analyzed by SPSS 22.0 statistical software.Results:84 patients were followed up for 12 months.The average time of bone healing was 13.5±2.9 weeks.During the follow-up period,no complications such as wound infection,screw breakage and bone nonunion occurred in 84 patients.The average score of VAS was 5.34±1.24 before operation and 0.83±0.21 twelve months after operation(P<0.05).The average score of AKS before operation was 68.9±5.8° and 12 months after operation was 88.1±4.8°(p<0.05).The average score of FTA before operation was 187.2±2.5° and 12 months after operation was 171.9±2.20(p<0.05).MPTA was 80.4±3.5 before operation vs MPTA was 88.3±1.5 twelve months after operation(p<0.05);Insall-Salvati and Tibial Posterior Slope Angle(p>0.05).Conclusion:MOWHTO and TomoFix plate used for medial compartment osteoarthritis of knee with varus deformity can retain the bone around knee joint,which can achieve bone healing in a short time.And arthroscopy was also used to treat intra-articular diseases at the same time.It significantly reduce the pain after operation,and enhance the quality of life for patients by correct the FT A.Through observation and follow-up,the clinical effect is satisfactory and MOWHTO can effectively improve the clinical symptoms of patients.Part Ⅱ Gait analysis of medial open wedge high tibial osteotomy for medial unicompartment osteoarthritis of the kneeObjective:To analyze the gait of patients who have been done medial open wedge high tibial osteotomy(MOWHTO),and to evaluate the change regulation of kinematics of knee joint after MOWHTO.Methods:From Mar.2016 to Oct.2017,in the Affiliated Zhongshan Hospital of Dalian University,64 cases of medial open wedge high tibial osteotomy were selected as experimental group,and 10 healthy adult were selected as the control group.The gait of the patients before operation,3 months,6 months and 12 months after operation were compared with that of the healthy adults.The gait of the patients were analyzed by comparing the flexion-extension angle,internal-external rotation angle and adduction-abduction angle.All data were analyzed by SPSS 22.0 statistical software.Results:In a gait circle,at the midterm of stance phase,the healthy knee flexion-extension angle was 2.5±1.3°,the adduction-abduction angle was 3.1±1.6°,the internal-external rotation angle was 6.3±2.4°,the MOWHTO knee,the flexion-extension angle was 1.5±2.1°(pre-)and 2.4±1.3°(post-*),the adduction-abduction angle was 7.1±2.6°(pre-)and 3.1±1.7°(post-*)and the internal-external rotation angle was 13.1±1.2°(pre-)and 7.1±2.0°(post-*);at the of swing phase,the healthy knee flexion-extension angle was 61.3±3.2°,the adduction-abduction angle was 5.1±3.9°,the internal-external rotation angle was 3.2±2.0°;the KOA knee,the flexion-extension angle was 49.1±2.2°(pre-)and 60.1±3.1°(post-*),the adduction-abduction angle was 6.9±2.4°(pre-)and 5.1±1.6°(post-*)and the internal-external rotation angle was 8.1±0.3°(pre-)and 3.2±1.5°(post-*),the coefficient of correlation between flexion-extension angle and AKS score was 0.657,adduction-abduction angle and AKS score was-0.905,internal-external rotation angle and AKS score was-0.929;The gait of 12 months after operation has statistical difference compared with that before operation(p<0.05),but has no statistical difference with healthy adults(p>0.05).(*12 months postoperation)Conclusion:Gait analysis is an objective and effective method for evaluating the effect of MOWHTO operation.It can reflect the variation of knee joint gait kinematics.Gait analysis has certain correlation with AKS score.Compared with healthy control group,it can further understand the recovery after MOWHTO operation.We believe that gait analysis has certain clinical value in short-term evaluation after MOWHTO operation.