| [Objective]To compare the clinical outcomes between arthriscopic debridement(AD) and arthriscopic debridement combined with proximal fibular osteotomy(AD&PFO) in treatment of medial tibiofemoral joint osteoarthritis with varus. [Methods]From March 2010 to June 2012, 34 patients(34 knees) of medial tibiofemoral joint osteoarthritis with varus who needed to be treated by operations, were divided into observation group treated only by AD and control group treated by AD&PFO according to patients’ wishes. AD group had 15 patients, including 6 males and 9 females, with a mean age of 58.8±5.0 years. AD&PFO group had 19 patients, including 7 males and 12 females, with a mean age of 60.3±5.7 years. There was no significant difference between two groups at preoperation. Arthroscopic examinations of the knee joint were performed in each group to assess degeneration of tibiofemoral joint, patellofemoral joint, meniscus and cruciate ligaments. Cases would be excluded whether lateral tibiofemoral joint, patellofemoral joint and lateral meniscus were severely degenerated, or cartilage and subchondral bone of medial tibiofemoral joint destructed very severely. AD, including synovectomy, removal of osteophytes, part resection of meniscus, microfracture, removal of exfoliated cartilage and loose bodies, was performed at the same time. In AD&PFO group, proximal fibular osteotomy was performed following it. Segment of 15 to 20 millimeters in length and 55 millimeters away from fibular head, was cut off, with bone wax smeared on the cut end. The two groups were compared at preoperation and postoperation in terms of visual analogue scale(VAS), hospital for special surgery knee score(HSS), tibiofemoral joint space angle, femoro-tibial angle, postoperative complication rate. [Results]A case in AD&PFO group was excluded because of severe degeneration of lateral tibiofemoral joint and patellofemoral joint assessed by arthroscopic examination. 14 cases in AD group and 18 cases in AD&PFO group, were followed up for more than 24 months, with the mean follow-up time of 38.6±8.8 months and 38.4±8.6 months respectively. At preoperation, the mean VAS score, HSS score, tibiofemoral joint space angle and femoro-tibial angle in AD&PFO group, were 7.8±1.1 points, 58.33±5.46 points, 3.11±0.65°, 183.12±1.50° respectively. At 15 days postoperation, the mean VAS score, HSS score and tibiofemoral joint space angle in AD&PFO group improved to 3.1±1.4 points, 70.06±5.31 points, 1.81±0.37°. At 24 months postoperation, the mean VAS score, HSS score, tibiofemoral joint space angle and femoro-tibial angle in AD&PFO group improved to 1.8±1.1 points, 79.56±4.79 points, 1.21±0.43°, 180.60±1.77°. The observation indexes showed significant differences at different time points in AD&PFO group(P<0.05). There were also significant differences between AD group and AD&PFO group in the observation indexes of different time points(P<0.05). No cases of AD group suffered infections and neurovascular injuries. In AD&PFO group, there were 1 injury of the extensor hallucis longus muscle branch of the common peroneal nerve, superficial peroneal nerve injury, and chronic incision pain in 1 case respectively. There were no significant differences between the two groups in the postoperative complication rate(P>0.05). [Conclusion]AD&PFO which could make the indication clear, handle intra-articular lesions and improve the alignment of lower limb, led to satisfactory outcomes on treating medial tibiofemoral joint osteoarthritis with varus, to a certain extent, including postponing medial tibiofemoral joint osteoarthritis and protecting knee joint function. It has advantages of less invasion, less incision pain and quicker postoperative recovery, and is worth popularizing and applying. |
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