Comparison of the Curative Efficacy of Three Kinds of Osteotomy to Protect the Knee on the Treatment of Medial Knee Osteoarthritis
Objective:To compare the efficacy of three knee-preserving schemes:open wedge high tibial osteotomy,arthro-scopic debridement combined with open wedge high tibial osteotomy,and arthroscopic debridement combined with proxi-mal fibular osteotomy on medial knee osteoarthritis.Methods:82 patients(82 knees)with medial knee osteoarthritis re-ceived knee-preserving surgery from January 2016 to August 2022,which were divided into three groups according to the different treatment options:group A was open wedge high tibial osteotomy(23 cases),group B underwent arthroscopic debridement combined with open wedge high tibial osteotomy(30 cases),group C underwent arthroscopic debridement combined with proximal fibular osteotomy(29 cases).The operation time,perioperative blood loss,Hospital of Special Surgery(HSS)scores and visual analogue scale(VAS)scores during preoperative and postoperative follow-up in the three groups were recorded,and the efficacy was evaluated.Results:All cases were followed up with an average time of(20.4±8.5)months.There was no statistically significant difference in operation time between groups A and C(P＞0.05),and both were shorter than group B,and the differ-ence was statistically significant(P＜0.05).There was no significant difference in perioperative blood loss between groups A and B(P＞0.05),which were more than those in group C,and the difference was statistically significant(P＜0.05).The HSS scores and VAS scores of the three groups were improved at 12 months after surgery compared with those before the operation,and the difference was statistically significant(P＜0.05),comparison among the three groups showed that:the difference between group A and group B was not statistically significant(P＞0.05),and both improved more significantly than group C,and the difference was statistically significant(P＜0.05).Conclusion:The three knee-preserving schemes have good efficacy on medial knee osteoarthritis.Combined arthroscopy can treat meniscus injuries and cartilage injuries,but it does not significantly improve the efficacy of high tibial osteotomy.Opening wedge high tibial oste-otomy(OWHTO)can achieve satisfactory results.Proximal fibula osteotomy is inferior to high tibial osteotomy in long-term efficacy,but its advantages are less trauma,less cost,and full weight bearing early after surgery.
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