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2022 Vol. 28, No. 10
Published: 2022-10-25
 
865 The Strategy of Double Level Osteotomy for Osteoarthritis Knees with Severe Varus Deformity And The Mid-Term Results
Liu Jian，Wang Xingshan，Liu Yuan，Huang Ye
Objective To retrospective evaluate the clinical and radiologic results of double level osteotomy(DLO) for osteoarthritis knees with severe varus deformity and mid-term results.Methods The patients in Beijing Jishuitan Hospital between 2016-2018 who underwent DLO for osteoarthritis knees with severe varus deformity were retrospectively studied.21 patients，including 5 males and 16 females were ultimately enrolled.The age ranged form 25 to 68，with an average age of (47.7±11.8)years.All patients underwent radiological assessment.In the radiological assessment，the following parameters were measured on fulllength weightbearing radiographs both pre and postoperatively：femorotibial angle(FTA)，lateral distal femoral angle(LDFA)，medial proximal tibial angle(MPTA)，and jointline convergence angle(JLCA).In addition，we shared the experience of preoperative planning using Miniacci methods and surgical strategy.We also analyzed the reasons and results of intro-operative and post-operative complications.Clinical results were evaluated using the Oxford knee score(OKS)e.Results The preoperative FTA，LDFA，MPTA，and JLCA values averaged (162.1±7.6)° varus，(79.5±6.2)°，(98.1±7.4)°，and (2.1±2.7)°，respectively.The postoperative FTA，LDFA，MPTA，and JLCA values averaged (178.2±5.6)° varus，(89.5±2.6)°，(90.8±5.2)°，and (1.5±1.3)°，respectively.All of the radiological parameters significantly improved and corrected to the values within normal range(P＜0.05).All osteotomy sites were fixed with Tomofix plate，and healed well even with hinge fracture.All patients were followed up for (5±1)years.The OKS was (44±3) in the last phone interview.Conclusion The DLO technique is a valuable surgical technique accomplishing restoration of physiologic knee joint alignment and orientation with significant improvement.The bone healing rate was 100% even with hinge fracture using single plate fixation because all osteotomy sites were fixed with Tomofix locking plate system which is a rigid fixation.
2022 Vol. 28 (10): 865- [Abstract] ( 294 ) HTML (1 KB)  PDF (2837 KB)  ( 579 )
870 Effect of Distal Tibial Tuberosity Open Wedge High Tibial Osteotomy on Patellofemoral Joint
Su Ke，Wang Qinghai，Sang Weihua
Objective To assess the radiographic and functional scores of patellofemoral joint following a distal tibial tuberosity open-wedge high tibial osteotomy (DTTOWHTO).Methods A total of 36 patients with varus knee osteoarthritis with patellofemoral arthritis were treated by DTT-OWHTO in our hospital，including 15 males and 21 females.The age range was (43~64) years，with an average age of (52.96±4.59)years.Changes in Iwano’s classification，medial angle of the proximal tibia (MPTA)，patellar height，lateral patellofemoral angle (LPFA)，tibial posterior slope (TPS)，the Lysholm score，Kujala score and the Western Ontario and McMaster Universities(WOMAC) were assessed.Results All patients were followed up for (23.69±4.22)months (range：15~33 months).The Iwano’s classification of patellofemoral joint was statistically significant before and after surgery (P＜0.05).The MPTA shifted from a mean (81.84±3.96)° before operation to a mean (90.57±2.53)° after operation (P＜0.05).No changes in patellar height，LPFA and TPS were observed.The Lysholm score and Kujala score increased significantly from (58.50±5.87) and (56.69±9.43) before operation to (86.39±2.14) and (72.69±5.79) after operation，respectively (P＜0.05).The WOMAC score decreased significantly from (65.19±6.48)preoperatively to (43.81±8.48)postoperatively (P＜0.05).Conclusion DTT-OWHTO maintains the preoperative patellar height，which could help prevent progression of cartilage degeneration in the patellofemoral joint after surgery，and the radiographic as well as the clinical results support the use of this technique to treat varus knee osteoarthritis with patellofemoral arthritis.
2022 Vol. 28 (10): 870- [Abstract] ( 207 ) HTML (1 KB)  PDF (3416 KB)  ( 287 )
875 The Effect of Body Mass Indexon the Outcome of Patients with Osteoarthritis After Open Wedge High Tibial Osteotomy
Wu Peng，Ji Zhenwei，Wang Zhixue，Feng Chongyang，Liu Yongming，Fang Huanming，Ding Yong
Objective To investigate the effect of body mass index (BMI) on high tibial open wedge osteotomy in patients with osteoarthritis (OA) of the medial compartment of the knee joint.Methods From January 2018 to January 2021，100 patients with OA of the medial compartment of the knee were enrolled in Tangdu Hospital.The patients with BMI≥24 kg/m2 were divided into group A (52 patients；30 male，22 female).The age was (50.28±4.27)years (range，40~60 years).The patients with BMI<24 kg/m2 were divided into group B (48 patients；19 male，29 female).The age was (50.39±4.11)years (range，40~58 years).All patients underwent open wedge high tibial osteotomy(OWHTO)，the changes of Tegner knee movement score，the Western Ontario and McMaster University(WOMAC) arthritis index score，knee function and quality of life were observed before and 3 months after operation.Results The scores of Tegner and WOMAC in group B were significantly higher than those in group A (P＜0.05).The level of pain，range of motion，limitation of movement and extension，varus and varus deformity，walking function and activities of daily living in group B were better than those in group A (P＜0.05).The quality of life in group B was significantly better than those in group A (P＜0.05).Conclusion OWHTO can improve the knee joint function and improve the knee joint motion function in patients with medial compartment osteoarthritis.But the BMI of the patients will affect the curative effect of the operation to some extent.Therefore，we should consider the influencing factors of the BMI of the patients when we treat the patients with OA，and choose a more suitable treatment method for them to maximize the effect of surgery.
2022 Vol. 28 (10): 875- [Abstract] ( 197 ) HTML (1 KB)  PDF (604 KB)  ( 430 )
879 Efficacy Analysis of Different Osteotomy Methods Combined with Arthroscopy in the Treatment of Medial Knee Osteoarthritis
Fu Kunpeng，Zhang Zhongbin，Zhu Kai，Zhang Yu，Li Hua
Objective To investigate the efficacy of different osteotomy methods combined with arthroscopy in the treatment of medial knee osteoarthritis.Methods A total of 124 patients with medial knee osteoarthritis in the Eighth People's Hospital of Hebei Province from January 2019 to January 2021 were selected and randomly divided into a double plane group (n＝62) and a single plane group (n＝62).Both groups underwent arthroscopy and high tibial osteotomy (HTO).The biplane group underwent biplane osteotomy，and the single plane group underwent single plane osteotomy.All patients were followed up for 6 months.The perioperative indicators，complications and the excellent and good rate of knee joint function recovery of the two groups were counted and compared the relevant indexes of lower limb force line，including knee varus angle (KVA)，femoral tibia angle (FTA)，medial proximal tibial angle (MPTA)，American hospital for special surgery knee score (HSS)，and visual analogue scale (VAS) before and 6 months after surgery.Results (1)Follow-up of 6 months showed that the bone healing time of the biplane group was shorter than that of the single plane group (P＜0.05).(2)The MPTA of the biplane group was higher than that of the single plane group，and the FTA and KVA of the biplane group were lower than those of the single plane group at 6 months after operation (P＜0.05).(3)The HSS score of the biplane group was higher than that of the single plane group at 6 months after operation，and the VAS score was lower than that of the single plane group (P＜0.05).(4)The complication rate of the biplane group was 1.61%，and the single plane group’s complication rate was 8.06%.The difference was not statistically significant (P＞0.05).(5)The excellent and good rate of knee function recovery in the biplane group(88.71%) was higher than that in the single plane group (74.20%) at 6 months after operation (P＜0.05).Conclusion Arthroscopic combined with biplane osteotomy is superior to arthroscopy combined with single plane osteotomy in improving knee joint function，pain score，lower limb force line and fracture healing.It can be used as one of the effective method to treat medial knee osteoarthritis.
2022 Vol. 28 (10): 879- [Abstract] ( 231 ) HTML (1 KB)  PDF (3653 KB)  ( 253 )
892 Comparison of Fixed-Bearing and Mobile-Bearing Unicompartmental Knee Arthroplasty in Short-term Outcome
Li Jinfeng，Lu Yufeng，Qiao Feng，Zhang Baogang，Jia Bin，He Jinlong，Xu Zhaochen，Zhong Haoliang，Ren Jing
Objective To compare mobile and fixed-bearing unicompartmental knee arthroplasty (UKA) for the treatment of medial osteoarthritis of the knee.Methods From January 2017 to December 2019，124 patients with medial knee osteoarthritis admitted to Department of Orthopaedics of Honghui Hospital Affiliated to Xi’an Jiaotong University were retrospectively analyzed.All patients were treated with UKA.A total of 64 patients (18 males and 46 females) used the second generation LINK fixed platform Sled prosthesis (fixed platform group).The average age was (66.2±7.7)years (range：50~83 years).Sixty patients (10 males and 50 females) used the 4th generation Oxford mobile platform prosthesis (mobile platform group).The average age was (63.4±7.1) years (range：53~82 years).The knee society score (KSS)，functional score，mechanical femorotibial angle (mFTA)，postoperative varus angle of tibia prosthesis and valgus angle of femoral prosthesis，and posterior inclination angle of tibial prosthesis were compared between the two groups before and after operation.Results The mean follow-up time was (36.0±7.3) months (range：28~44 months).There were no complications such as infection，pad dislocation，fracture，symptomatic deep vein thrombosis and aseptic loosening in both groups.Sled prosthesis had more varum than Oxford prosthesis after UKA，and the difference was statistically significant (P＝0.036).The KSS scores and functional scores of the two prostheses were significantly improved after operation compared with those before operation (P＜0.001).Although the KSS score and function score of Sled prosthesis after UKA were higher than those of Oxford prosthesis，there was no significant difference between them (P＞0.05).Conclusion Both fixed platform UKA and active platform UKA have good clinical and imaging results，and there is no significant difference in short-term efficacy between them.
2022 Vol. 28 (10): 892- [Abstract] ( 265 ) HTML (1 KB)  PDF (1865 KB)  ( 850 )
898 Study on the Short and Medium Term Efficacy of Single Condyle Replacement Combined with Autologous Osteochondral Graft in the Treatment of Bicompartment Osteoarthritis
Tang Jixiang，Jing Lin，Zhang Hongmei，Ai Qi，Yan Qi，Pan Li，Liu Siye，Li Yan
Objective To observe the short and medium term clinical efficacy of medial unicompartmental knee arthroplasty (UKA) combined with autologous osteochondral transplantation in the treatment of two-compartment osteoarthritis of knee joint.Methods A retrospective analysis has been performed on 22 patients from June 2018 to September 2019 in Orthopaedics Department of Wangjing Hospital of China Academy of Chinese Medical Sciences.6 male cases and 16 female cases were included.The age ranged from 53 to 64，with an average of 58.The patients with two-compartment osteoarthritis of the knee were treated with UKA combined with autologous osteochondral transplantation.Imaging data before and after surgery were collected，and visual analogue VAS scores，American knee society score(KSS) scores and complications were recorded before and 3，6 and 12 months after surgery.Results All patients have been followed up for 18 ~ 26 months.(1)Compared with the operation，intraarticular angulation，varus deformity Angle and knee posterior inclination Angle were significantly decreased after operation，and the differences were statistically significant (P＜0.05).(2)Knee pain and functional activity were significantly improved after surgery，and the final score was significantly increased，with statistical significance (P＜0.05).(3)In postoperative follow-up，only 1 patient had joint instability and recovered well after treatment.Conclusion UKA combined with autologous osteochondral transplantation has the best clinical efficacy in early and middle stage for patients with severe medial knee osteoarthritis complicated with mild patellofemoral joint.
2022 Vol. 28 (10): 898- [Abstract] ( 210 ) HTML (1 KB)  PDF (3036 KB)  ( 315 )
903 Effect of Patellar Denervation on Early Postoperative Anterior Knee Pain and Knee Function in Unicompartmental Knee Arthroplasty
Lyu Xin，Su Rina，Sun Zhiwen，Zhang Yibo，Chen Xiaowei，Zheng Hongmei
Objective To analyze the effect of patellar denervation in unicompartmental knee arthroplasty (UKA) on early postoperative anterior knee pain and knee function.Methods A retrospective study was conducted to analyze 80 patients with knee osteoarthritis (KOA) admitted to the Department of Osteoarthritis of Chifeng Municipal Hospital from December 2018 to April 2020.Forty patients with peripheral denervation treatment were included in the observation group，and 40 patients without peripheral denervation treatment of the patella during the same period were selected and included in the control group.Observation group included 10 males and 30 females average age was (62.13±7.78)years (range，46~77 years).The 20 cases of right knee and 20 cases of left knee.Control group had 8 males and 32 females.The average age was (62.23±7.14)years (range，47~76 years).There were 19 cases of right knee and 21 cases of left knee.Outpatient follow-up was performed at 3 months，6 months，12 months，and 24 months after operation.The last follow-up was used as the criterion.The Feller patella score，hospital for special surgery (HSS) knee score，the Western Ontario and McMaster Universities(WOMAC) osteoarthritis index and the incidence of anterior knee pain were collected.The resulting data analyzed the effect of peripatellar denervation in UKA on early postoperative anterior knee pain and knee function.Results All patients in this study were followed-up until 24 months after operation.At the last follow-up，the Feller patella score in the observation group was significantly higher than that in the control group，and the difference was statistically significant (P＜0.05).There was no significant difference in the scores，and the difference was not statistically significant (P＞0.05).The incidence of postoperative knee pain in the observation group was 10.0%(4/40)，which was lower than that in the control group，27.5%(11/40)，and the difference was statistically significant (P＜0.05).Conclusion Denervation around the patella in UKA can effectively reduce the incidence of anterior knee pain，improve quadriceps muscle strength，and improve knee function in the early postoperative period.
2022 Vol. 28 (10): 903- [Abstract] ( 228 ) HTML (1 KB)  PDF (1919 KB)  ( 405 )
944 A Study of the Effects of Bone Marrow Edema Area on Outcomes of Conservative Treatment of Spontaneous Osteonecrosis of the Knee
He Qiang，Huang Xiaoqiang，Sun Caihong
Objective The purpose of this study is to investigate whether bone marrow edema (BME) is a risk factor for the failure of conservative treatment of SONK.Methods A total of 90 consecutive cases of SONK in our hospital from May 2020 to October 2020 were retrospectively included.Those patients were divided into low BME group and high BME group according to the MRI grading standard of knee BME area at the first visit.The patients received conservative treatment with limited weight-bearing and non-steroidal anti-inflammatory drugs for one year.The patients were followed to confirm if they received surgical treatment due to knee pain.Surgical treatment means the failure of conservative treatment.The failure rate of conservative treatment was compared between low BME group and high BME group.The failure rate of conservative treatment was surgical treatment cases divided total of cases in high or low BME group.Results The failure rate of conservative treatment in high BME group (75%) was significantly higher than that in low BME group(19%).Conclusion Our study found that BME area had an effect on the conservativetreatment of SONK.The failure rate of conservative treatment of SONK patients with the larger BME area is much higher than ones with smaller BME area.
2022 Vol. 28 (10): 944- [Abstract] ( 210 ) HTML (1 KB)  PDF (1090 KB)  ( 201 )
948 Measurement of Lower Limb Force Line with Inertial Sensor Unit
Wang Jialin，Yan Junlan，Yang Pengfei，Zhao Jiaxin，Liu Tun，Wang Siyuan，Wang Wei
Objective To compare the force line data of lower limbs measured on the full-length piece with that measured by the portable force line measuring device based on the inertial sensor unit under different motion modes，to explore the appropriate posture for measuring the force line of lower limbs，and to evaluate its feasibility and accuracy.Methods 15 healthy adult volunteers weared portable power line measuring device based on the inertial sensing unit designed for this study.Hip flexion movement，abducent movement，rotation movement and supine knee straight downward hip flexion movement and outreach were performed when the patients standed with knee straight.Hip-knee-ankle angle (HKA) and mechanical axis deviation (MAD) mechanical lateral distal femur angle，mLDFA and the medial proximal tibia angle (MPTA) of the tibia were measured.Full-length X-ray films of lower limbs were taken for all 15 volunteers.The HKA angle，MAD value，mLDFA and MPTA of lower limbs were measured by three physicians respectively.The force lines and angle data measured by the two methods were compared and analyzed.Results There were no significant differences in HKA，MAD，mLDFA and MPTA values between volunteers in the sagittal plane of the lower extremity in supine position and those measured on the fulllength radiographs of the lower extremities (P＞0.05).The HKA，MAD，mLDFA and MPTA values measured in standing sagittal plane，standing coronal plane，standing rotatory motion and supine coronal plane were statistically different from those measured in full-length radiographs (P＜0.05).Further consistency analysis showed that the data obtained by the lower extremity force line measurement device in the supine sagittal plane were in good consistency with the data measured by the fulllength film of both lower extremities.Conclusion When the subjects are in supine position and performed hip flexion motion in sagittal plane，the portable lower limb force line measurement device based on inertial sensor unit can replace the full length of the lower limb to measure the HKA，MAD，mLDFA and MPTA of normal subjects.
2022 Vol. 28 (10): 948- [Abstract] ( 192 ) HTML (1 KB)  PDF (2621 KB)  ( 309 )
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