Comparison Of The Short And Medium Term Effects Of Open-wedge High Tibial Osteotomy And Mobile-bearing Unicompartmental Knee Arthroplasty

Objective:Both open-wedge high tibial osteotomy(OWHTO)and mobile-bearing unicompartmental knee arthroplasty(MB-UKA)are commonly used treatment methods for patients with knee medial compartment disease,but the choice of surgical procedures for patients who are suitable for both types of surgery is still unclear,which need further exploration.This research explores the short and medium term effects comparison between open tibial high osteotomy and mobile-bearing unicompartmental knee arthroplasty in the mountainous area represented by Chengde,which can provide a reference for the surgical selection of clinical patients of this type.Methods:We selected patients with medial compartment osteoarthritis who underwent surgical treatment in the Joint Surgery Ward of the Affiliated Hospital of Chengde Medical College from December 2015 to December2019.50 cases were finally enrolled according to the inclusion and exclusion criteria,they were divided into open-wedge high tibial osteotomy group(OWHTO group,n=18)and mobile-bearing unicompartmental knee arthroplasty group(MB-UKA group,n=32).All patients gave informed consent to the surgical treatment plan and signed a consent form before surgery.This study has been approved by the hospital ethics committee.We observe and compare the basic data,operation time,intraoperative blood loss,changes of hemoglobin and hematocrit,perioperative complications in the two groups,preoperative and postoperative tibiofemoral angle(FTA),lysholm score,kujala score,hospital for special surgery score(HSS score),daily and stairs visual analogue scale score(VAS score)and joint range of motion(ROM)at last follow-up.Results:1 There was no significant difference in age,gender,body mass index(BMI),Kellgren-Lawrence grading of surgical side and surgical side joints,and comparison of underlying diseases between OWHTO group and MB-UKA group was not statistically significant(P>0.05).OWHTO group and MB-UKA group were comparable.2 The operation time,blood loss,perioperative hemoglobin perioperative hemoglobin,hematocrit and perioperative complications between the OWHTO group and MB-UKA group were not statistically significant(P>0.05)(Table 2).There was no difference in perioperative blood loss,operation time and perioperative complications between the two groups.3 The average follow-up time was 25.7 months in OWHTO group and21.3 months in MB-UKA group.Comparison of preoperative and postoperative tibiofemoral angles,the last follow-up lysholm score,HSS score,kujala score,daily and staircase pain visual analog score between OWHTO group and MB-UKA group was not statistically significant(P>0.05)(tables3,4),so there was no difference between the two surgical corrections and postoperative function.4 In the last follow-up,the range of motion in the OWHTO group was better than that in the MB-UKA group(P<0.05)(Table 4),indicating that open high tibial osteotomy had better range of motion than mobile-bearing unicompartmental knee arthroplasty.5 No postoperative complications occurred in the OWHTO group during the last follow-up,and 1 case of bearing dislocation occurred in the MB-UKA group,with the incidence of 3.1%.The comparison between the two groups was not statistically significant(P> 0.05)(Table 4).There was no difference in postoperative complications between the two groups.Conclusion:Both open-wedge high tibial osteotomy and mobile-bearing unicompartmental knee arthroplasty is an effective method for medial compartment osteoarthritis,and they have obtained satisfactory short and medium term effects in mountainous patients,but the former has the advantage of greater mobility than the latter.