Abstract:Objective To analyze and investigate the optimal hip knee ankle(HKA) angle correction rate in the treatment of knee osteoarthritis(KOA) by high tibial osteotomy(HTO) for clinical treatment.Methods A total of 89 patients with KOA treated with HTO who met the inclusion criteria were analyzed,including 35 males and 54 females.The patients age ranged from 38 to 68 years,with an average of (55.10±6.54)years.The Oxford knee score(OKS) was used to score the patients before surgery,3 months after surgery and 1 year after surgery,and the patients’ preoperative and postoperative HKA angles were measured.The ratio of the correction of HKA angle in HTO (the absolute value of the difference between the postoperative HKA angle and the preoperative HKA angle,the amount of change in the HKA angle caused by the surgery) to the preoperative HKA angle was defined as the correction rate of the HKA angle (hereinafter referred to as the correction rate).The relationship between the correction rate and the surgical outcome (measured as the difference between the preoperative OKS score and the postoperative score) was investigated by presetting a number of hypothetical ideal correction rates and analyzing them in comparison with the actual postoperative correction rates achieved by each patient.Results The deviation of a patient’s actual postoperative correction rate from some preset values of the presumed hypothetical ideal correction rate (the absolute value of the difference between the two) was negatively correlated with surgical outcome.This was reflected in the fact that the ideal correction rate (corresponding to the smallest P value) was about 1.1 to 1.2 at 3 months postoperatively and 1.2 at 1 year postoperatively,which mean that a reasonable amount of surgical correction should be about 1.2 times the preoperative knee HKA varus angle to achieve a mildly valgus knee HKA angle after surgery.Conclusion Using 1.2 as the target value of HTO correction rate,which means the amount of intraoperative correction of HTO is 1.2 times of the patient’s preoperative HKA varus angle value,a better surgical result can be achieved,and this conclusion can provide a reference for the preoperative planning of HTO.
[1]Heller MO,Matziolis G,Knig C,et al.Musculoskeletal biomechanics of the knee joint.Principles of preopera tive planning for osteotomy and joint replacement[J].Orthopade,36(7):628-634.
[2]Sharma L,Song J,Felson DT,et al.The role of knee alignment in disease progression and functional decli ne in knee osteoarthritis[J].JAMA,286(2):188-195.
[3]Agneskirchner JD,Hurschler C,Wrann CD,et al.The effects of valgus medial opening wedge high tibial osteotomy on ar ticular cartilage pressure of the knee:A biomechanical study[J].Arthroscopy,23(8):852-861.
[4]Hernigou P,Medevielle D,Debeyre J,et al.Proximal tibial osteotomy for osteoarthritis with varus deformity.A ten to thirteenyear followup study[J].J Bone Joint Surg (Am),69(3):332-354.
[5]Fujisawa Y,Masuhara K,Shiomi S.The effect of high tibial osteotomy on osteoarthritis of the knee.An arthroscopic study of 54 knee joints[J].Orthop Clin North Am,10(3):585-608.
[6]Martay JL,Palmer A Jr,Bangerter NK,et al.A preli minary modeling investigation into the safe correction zone for high tibial osteotomy[J].The Knee,25(2):286-295.
[7]Smith JO,Wilson AJ,Thomas NP.Osteotomy around the knee:evolution,principles and results[J].Knee Surg Sports Traumatol Arthrosc,2013,21(1):3-22.
[8]Feucht MJ,Minzlaff P,Saier T,et al.Degree of axis correction in valgus high tibial osteotomy:Proposal of an individualised approach[J].Int Orthop,38(11):2273-2280.
[9]Collins NJ,Misra D,Felson DT,et al.Measures of knee function:International knee documentation committee (IKDC)subjective knee vevaluation form,knee injury and osteoarthritis outcome score (KOOS),knee injury and osteoarthritis outcome score ph ysical function short form (KOOS-PS),knee outcome survey activities of daily living scale (KOS-ADL),lysholm knee scoring scale,Oxford kne e score (OKS),western ontario and m cmaster universities osteoarthriti s index (WOMAC),activity rating scale (ARS),and tegner activity score (TAS)[J].Arthritis Care Res,63 (Suppl 11):208-228.
[10]Brinkman JM,Luites JW,Wymenga AB,et al.Early full weight bearing is safe in openwedge high tibial osteotomy[J].Acta Orthop,2010,81(2):193198.
[11]Takeuchi R,Ishikawa H,Aratake M,et al.Medial opening wedge high tibial osteotomy with early full weight bearing[J].Arthroscopy,2009,25(1):46-53.
[12]Paley D.Principles of deformity correction[M].Berlin:Springer,2003:1-268.
[13]Liu X,Chen Z,Gao Y,et al.High tibial osteotomy:Review of techniques and biomechanics[J].J Healthc Eng,2019(2019):8363128.
[14]Lee S-S,Lee HI,Cho ST,et al.Comparison of the outcomes between two different target points after o pen wedge high tibial osteotomy:The Fujisawa point versus the lateral tibial spine[J].Knee,27(3):915-922.
[15]Jiang X,Xie K,Han X,et al.HKA Angle-A Reliable planning parameter for high tibial osteotomy:A Theoretical analysis using standing wholeleg radiographs[J].J Knee Surg,35(1):54-60.
[16]李一凡,李立,符东林,等.胫骨高位截骨术治疗膝内侧骨关节炎短期疗效的影响因素分析[J].实用骨科杂志,2021,27(10):891-894.