Effect Of Different Lateral Hinge Positions Of HTO On KOA Medial Compartment Osteoarthritis

BackgroundKnee osteoarthritis(KOA)is the most common joint disease in the world.It is one of the most common causes of pain,loss of function and disability in adults,seriously affecting the quality of daily life of patients and causing great physical and mental pain to patients.Although TKA is the gold standard for the treatment of end-stage KOA,the option of TKA for patients with early KOA is aggressive.With the increasing call of the majority of scholars and KOA patients for knee preservation,more and more choose high tibial osteotomy to treat knee arthritis.High tibia osteotomy(HTO),as one of the surgical options for the treatment of KOA,was first reported by Jacksn in 1960,and a variety of modifications have been developed on this basis.For medial compartment osteoarthritis of the knee,medial wedge high tibial osteotomy(MOWHTO)can be used to treat medial compartment osteoarthritis of the knee and prolong the service life of the knee by adjusting the knee joint force line from the worn medial compartment to the relatively normal lateral compartment and slowing down the destruction of the medial compartment.The disadvantages ofMO WHTO are complications such as delayed union of the cut surface,nonunion,malunion,and internal fixation failure due to fractures in the hinge position.Nakamura et al.found that the probability and type of lateral hinge fracture were different in different positions,and divided the lateral hinge position into five regions:AM area,AL area,WM area,WL area,and B area.However,there is still no clear conclusion on where MOWHTO specifically selects the hinge position to effectively reduce the complications caused by fractures in the hinge position of HTO.PurposeTo investigate the advantages and disadvantages of MOWHTO in reducing the fracture of hinge position by selecting the lateral hinge position in zone B and WL,and to provide a better hinge position selection for MOWHTO and reduce the complications caused by the fracture of hinge position.MethodA total of 61 patients with medial compartment bone and joint of knee joint treated in the First Affiliated Hospital of Zhengzhou University from September 2016 to October 2018 were analyzed retrospectively,and medial wedge distraction osteotomy was used.According to different groups of hinge position,the experimental group:29 cases(43 knees)of tibiofibular syndesmosis,and the control group:32 cases(41 knees)of tibiofibular syndesmosis.The cross-sectional fracture rate,Hospital for Special Surgery Knee Score(HSS score),knee flexion range of motion,medial tibial angle,operation time,blood loss,and intraoperative fluoroscopy times were used as evaluation indicators of the effect after HTO.ResultsAll patients were followed up.The HSS score,knee flexion range of motion and medial angle of tibial shaft in the experimental group and the control group were significantly improved 1 year after operation.The operation time,blood loss and intraoperative fluoroscopy times of patients with lateral hinge position fracture were increased compared with those without fracture,and the differences had statistical significance.The difference between the two groups had no statistical significance.The HTO hinge fracture rate in the experimental group was less than that in the control group.CONCLUSIONThe medial high tibial osteotomy of the knee joint with area B as the hinge position has the advantages of less trauma and satisfactory results in the near future,which can effectively reduce the occurrence of fracture in the lateral hinge position after operation.