Long-term Efficacy Of Arthroscopic Clearance Combined With Closeing Wedge High Tibial Osteotomy In The Treatment Of Knee Osteoarthritis

Objective:To investigate the long-term efficacy of arthroscopic clea rance combined with closing wedge high tibial osteotomy in the treatme nt of medial interstitial osteoarthritis of the knee.Methods: From 2003 to 2007,14 patients(19 knees)underwent ar throscopic clearance combined with closing wedge high tibial osteotomy in the third hospital of hebei medical university,including 1 male and13 female,aged 38-58 years,with an average age of 48 ± 6 years.The surgical method was to make diagnosis and treatment under arthroscop y to treat the articular cavity lesions,then open the upper tibiofibular jo int,then perform lateral closed wedge high tibial osteotomy,and perfor m lateral 5?8°(mean 7°)osteotomy,followed by internal fixation.No se rious complications occurred after the operation.All patients were followe d up.The patients were evaluated with HSS score and lysholm score.Results: Among the 14 patients(19 knees),47%(9 knees)underw ent knee replacement later,with an interval of 13±4 years.Among them,1 patient(1 knee)underwent knee replacement 5 years after high wed ge tibial osteotomy,and the interval of the other 8 knees was 11?17 ye ars,with an average of 14 years.Fifty-three percent(10 knees)of the p atients did not receive knee replacement surgery,and they were still fun ctional and had no significant impact on their daily life.Preoperative HS S score was 55.7±7.0,lysholm score was 51.9±8.7,and 12 to 18 years after surgery,the HSS score was 82.4±9.2 and lysholm score was 85.4±7.0.There was a statistically significant difference between preoperative a nd postoperative knee scores(P<0.05).If the final patient underwent kne e replacement surgery was defined as a failure,the 5-year survival rate of the knee in closing wedge tibial high osteotomy was 100%,the 10-y ear survival rate was 95%,and the 15-year survival rate was 53%.Conclusions: Closing wedge high tibial osteotomy has a better lon g-term effect and can delay or avoid knee replacement surgery.It is sui table for younger patients with medial compartment osteoarthritis with hi gh activity requirements.