The Short-term Clinical Efficacy And Imaging Observation Of Uniplanar High Tibial Osteotomy In The Treatment Of Knee Osteoarthritis

Objective:To investigate the short-term clinical effect of single-plane opening-wedge high tibial osteotomy in the treatment of knee osteoarthritis and the effect of operation on the correection of lower extremity varus deformity;to investigate the change and significance of single-plane opening-wedge high tibial osteotomy on the knee joint structure of patients;to incestigate the safety of single-plane opening-wedge high tibial osteotomy.Methods:There are 18 patients,who were suffering from knee osteoarthritis,treated by single-plane opening-wedge high tibial osteotomy in the Second Department of Orthopaedics of Dongzhimen Hospital from January 2018 to December 2019.Among them,there were 3 males and 15 females.Their age range from 50 to 76 years old,with an average age of(65.7±7.2)year old,and follow-up period fange from 4 to 12 months,with an average of(9.1±2.6)months.Clinical efficacy evalution indexes of both preoperative and final follow-up and imaging data of both preoperative and postoperative were collected.The VAS score(Walking knee),Lequesne index and JKOM score were used to evaluate the short-term clinical efficacy of patients.Measure the femoral tibal angle,weight bearing line ratio,joint line convergence angle,posterior tibal slope and Insall-Salvatti index before and after operation,and record the distance between medial tibial plateau and fibular head.Observe whether there were complications such as the lateral hinge fracture occured.Results:(1)clinical efficacy:The VAS score(Walking knee)were lower than preoperation[(1.78±0.85)scores vs(8.05±0.91)scores],the Lequesne index were lower than preoperation[(3.53±1.84)vs(11.79±3.22)],and the JKOM score were lower than preoperation[(10.53±7.53)scores vs(50.79±14.18)scores].At the final follow-up,both the VAS score,Lequesne index and JKOM score of patients were significantly improved compared with the preoperation(P<0.05).(2)imaging index:After operation,the femoral tibal angle[(170.79±2.01)° vs(180.66±3.64)°],joint line convergence angle[(2.64±0.88)°vs(3.63±1.17)°]and posterior tibal slope[(10.85±2.41)° vs(13.07±2.36)°]were smaller,the weight bearing line ratio was increased[(63.58±2.84)%vs(25.77±14.07)%].Both the femoral tibal angle,weight bearing line ratio,joint line convergence angle and posterior tibal slope of patient's knee were significantly changed compared with the preoperation(P<0.05).There were no significantly change in the Insall-Salvatti index before and after operation(P=0.679).After operation,the measurement of distance between medial tibial plateau and fibular head is(0.76±0.14)mm.(3)Complications:There were only one case presented with the lateral hinge fracture,and cured nicely by symptomatic treatment.There were no complications such as infection,hematoma,thrombus or nerve injury happened during the perioperative period,and no loosening or fracture of the internal fixation system appered after operation.Conclusion:The clinical efficacy of single-plane opening-wedge high tibial osteotomy is satisfactory in short-term follow-up.The imaging results showed that the weight bearing line and varus deformity of patients has been effectively corrected.And it has little effect on the structure of knee joint,the bone mass of proximal tibia will be reserved for the knee arthroplasty in the future.The complications such as fracture of lateral tibial hinge,increased exudation of incision and so on are easy to occur during the perioperative period of single-plane opening-wedge high tibial osteotomy.