Comparison Of The Effect Of Distal And Proximal Tuberosity Osteotomy In Open Wedge High Tibial Osteotomy In Treatment Of Knee Osteoarthritis With Knee Varus

Objective To compare and analyze the effect of distal and proximal tuberosity osteotomy in open wedge high tibial osteotomy in treatment of knee osteoarthritis with knee varus and the influence to patellar height.And to explore the ability of intraoperative control of the ratio of anterior and posterior osteotomy gap to maintain the posterior tibial slope.Methods Patients underwent high tibial osteotomy from November 2017 to June2019 in our hospital were retrospectively studied.According to inclusion and exclusion criteria,35 patients were included in this study.15 patients underwent distal tuberosity osteotomy(DTO)while 20 patients underwent proximal tuberosity osteotomy(PTO).The ratio of anterior and posterior osteotomy gap was controlled to be about 2/3intraoperatively.The femoro-tibial angle(FTA),medial proximal tibia angle(MPTA),Caton-Deschamps index(CDI)and posterior tibial slope angle(PTSA)were measured.Complications were recorded and statistically analyses were performed.Results The follow-up time of PTO group was 15.10±2.49 months and DTO group was 16.20±2.00 months.There were no significant differences in follow-up time,preoperative characteristics and complications between the two groups(p>0.05).At the last follow-up,Lysholm score and HSS score were improved and varus deformity was improved in both groups,the difference was statistically significant(p<0.01),but there was no significant difference between groups(p>0.05).CDI in PTO group was significantly decreased compared with pre operation(p<0.01),while CDI in DTO group was not significantly changed(p>0.05).The difference in PTSA has no statistical significance in both groups(p>0.05).Conclusion Both DTO and PTO can improve the function of knee and correct varus deformity significantly,and the early effect is same.DTO has no influence on the patellar height while PTO will decrease it.The PTSA could be maintained through controlling the ratio of anterior and posterior osteotomy gap in operation.