Comparison Of Efficacy Of Treatment For Medial Isolated Compartment Knee Osteoarthritis By High Tibial Osteotomy And Unicompartmental Knee Replacement

Objective:Knee osteoarthritis(KOA)is an chronic joint disease characterized by the degeneration and damage of cartilage and hyperostosis.The most common symptom are joint swelling,pain,hyperostosis and limitation,which has a serious impact on the life and work of patients.Treatments for isolated compartmental knee osteoarthritis are still in controversy.The degeneration of cartilage in most patients are only in the medial compartment,while the other two compartments are normal.Treatments are high tibial osteotomy(HTO),unicompartmental knee replacement(UKA)and total knee arthroplasty(TKA).HTO and UKA can preserve most functions and constructions of the knee,so in this study,we analyzed the cases of patients undergone HTO or UKA to compare the efficacy for medial isolated compartment knee osteoarthritis and their respective indications and complications by retrospective analysis attempting to guide clinical work.Methods:From March 2010 to November 2015,72 patients(4 lost,68 in total)undergone HTO or UKA in the department of orthopaedics of Tangdu hospital were selected.Of the 46HTO patients(64 knees),16 were male,30 were female and 30 were left knees,34 were right knees and 28 were for single knee,18 were for double knees.The mean follow-up time was 60(36~96)months.Of the 22 UKA patients(28 knees),6 were male,16 were female and 13 were left knees,15 were right knees and 16 were for single knee,6 were for double knees.The mean follow-up time was 54(28~72)months.At the last time of follow-up,score changes of HSS and VAS were evaluated.Meanwhile,lower limb alignment were evaluated by FTA and MPTA measured through the full-length X-ray of the lower limb.Results:HTO cases:The HSS score of the selected patients was increased from preoperative56.17±3.01)to postoperative(79.08±2.57)(P<0.05),to(70.92±3.53)after 3-8years(P>0.05).The VAS score of the selected patients was reduced from preoperative(2.93±0.27)to postoperative(1.87±0.17)(P<0.05),to(1.66±0.154)after 3-8years(P>0.05).After surgery,FTA was corrected from preoperative(185.30~0±1.84~0)to(172.50~0±0.97~0)(P<0.05),and to(174.40~0±0.96~0)after 3-8 years(P>0.05).After surgery,MPTA was corrected from preoperative(82.33~0±0.77~0)to(91.08~0±0.76~0)(P<0.05),and to(89.42~0±0.45~0)after 3-8 years(P>0.05).All the above cases were free from infection,unhealed osteotomy,injured common peroneal nerve,lower quadriceps strength or lower extremity shortening.Two cases(4%)suffered from venous thrombosis in lower limb.One case(2%)suffered from delayed healing of osteotomy.All of the 4 evaluation indicators were superior to preoperative ones,P<0.05.UKA cases:The HSS score of the selected patients was increased from preoperative(58.29±1.33)to postoperative(79.50±1.41)(P<0.05),to(69.54±2.08)after 3-8 years(P<0.05).The VAS score of the selected patients was reduced from preoperative(4.75±0.33)to postoperative(1.00±0.17)(P<0.05),to(2.17±0.41)after 3-8 years(P<0.05).After surgery,FTA was corrected from preoperative(182.80~0±0.80~0)to(171.50~0±0.35~0)(P<0.05),and to(173.90~0±0.74~0)after 3-8 years(P<0.05).After surgery,MPTA was corrected from preoperative(80.74~0±0.64~0)to(91.45~0±0.37~0)(P<0.05),and to(88.84~0±0.55~0)after 3-8years(P<0.05).All the above cases were free from infection,injured ligaments,unhealed incisions or lower extremity shortening.All of the 4 evaluation indicators were superior to preoperative ones,P<0.05.Conclusion:Both HTO and UKA can achieve satisfactory medium-term clinical results in terms of pain relief,knee deformity correction,etc.Due to the limitation of patients'number and follow-up's time,the long-term clinical results has yet to be observed.