Scoring System For The Selection Of HTO And UKA In The Treatment Of Knee Osteoarthritis

Background:In the treatment of medial compartment knee osteoarthritis(OA),an appropriate indication selection may be the key to achieving good therapeutic results with medial unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO).Clinically,there have been improvements in implants and surgical techniques,promotion of the concept of knee protection,and an increase in postoperative expectations.Consequently,there have been expansion and changes in some indications for medial UKA and HTO.However,clinicians have not yet reached a clear consensus,with slight differences in the focus of attention,and thus with a certain intersection of indications.Gender,age,BMI,degree of varus deformity of the osteoarthritic knee,degree of cartilage injury,patellofemoral joint condition,and postoperative activity are all influential factors for the selection of surgical procedures,leading to a complex,difficult and confused decision-making for individualized treatment.Objective:This study was performed to creatively design a new scoring scale for the selection of medial UKA and HTO in the surgical treatment of patients with knee OA,with preliminary clinical validation simultaneously.Method:The subjects of the study were 69 patients with medial compartment knee OA undergoing surgical treatment in our hospital,with an average age of(58.64±7.52)years.Six indicators that affected the selection of surgical procedures,such as patients’ age,activity level,anterior cruciate ligament condition,Kellgren-Lawrence(K-L)classification of the knee joint,degree of varus deformity of the osteoarthritic knee,and degree of cartilage damage,were quantified and assigned for comprehensive scoring.Meanwhile,SPSS25.0 software was employed to determine the potential correlations with surgical procedures.Prism 8 software was used to draw receiver operating characteristic(ROC)curves and determine the optimal cutoff values for constructing a scoring scale for indication selection of HTO or UKA.Further verification among multiple hospitals was conducted to identify the two surgeries in patients with medial compartment knee OA.Results:The results showed that there was a positive correlation between the two surgical procedures and the total score of the indication selection scale(r=0.850,p<0.001),and there was statistical significance between the two surgeries and the total score of the indication selection scale(p<0.001).According to the ROC curve analysis of the indication selection scale scores,the optimal cutoff value was 12.5 points,and corresponding Youden index was 0.914(sensitivity:94.3%,specificity:97.2%,and area under the curve:99.1%;p<0.001).Meanwhile,it was verified that the patient data and surgical selection from multiple hospitals were consistent with the prediction results of the scoring scale designed in our study.Conclusion:The present study has successfully constructed a scoring system that can be used for indication selection of HTO or UKA,with an optimal cut-off value of 12.5 points.It is recommended to perform UKA for patients with scores of>12.5 points,and to receive HTO for patients with scores of<12.5 points.Moreover,this study also preliminarily verifies the reliability,repeatability,and clinical guidance of this scale.Collectively,the scoring scale constructed in our study can assist the clinical decision-making of HTO and UKA.