Comparison Of Short-term Clinical Outcomes Between Unicompartmental Knee Arthroplasty And Medial Open Wedge High Tibial Osteotomy Combined With Arthroscopy In The Treatment Of Medial Unicompartmental Knee Osteoarthritis

BackgroundUnicompartmental knee arthroplasty(UKA)has become one of the effective strategies for unicompartmental knee osteoarthritis.It replaces the worn cartilage of the knee joint with a prosthesis through partial replacement surgery and remains the anterior cruciate ligament.Compared with total knee arthroplasty,it appeared less trauma,less blood loss,faster postoperative recovery and better proprioceptive function.It has been applied for the treatment of knee osteoarthritis since the 1960s,but its early results were unsatisfactory due to the limitations of prosthesis design,surgical technique,and material technology.However,with the continuous improvement of the design of the prosthesis,the clear definition for the indications of patient selection,the continuous improvement of the surgical technique and the rapid progress of the material technology,UKA has achieved satisfactory results in the treatment of knee osteoarthritis.Arthroscopy,as a minimally invasive surgical tool,has been widely used in the diagnosis and treatment of joint diseases and sports medicine injuries.arthroscopic exploration,synovectomy,and free body extraction can relieve the symptoms of early stage knee osteoarthritis and improve the patient’s Quality of Life.High tibial osteotomy(HTO)is one of the effective strategies for unicompartmental knee osteoarthritis caused by extra-articular deformity factors.Since Jackson firstly reported the use of HTO in the treatment of knee osteoarthritis in 1961,with the development of material science,the advancement of internal fixation technology,and changes in the patient indications,the incidence of complications has been continuously reduced,and the surgical effect has improved.It has been widely used in treatment of knee arthritis.The main two surgical methods of HTO currently included medial open wedge high tibial osteotomy(MOWHTO)and lateral closed wedge high tibial osteotomy(LCWHTO).Although LCWHTO could heal faster,however,in order to achieve the ideal correction angle during the operation,the technique of osteotomy is more difficulty and complicated.Furthermore,at the same time,the fibula will be cut off,which can result in potential complications such as bone loss and shortening of the lower extremity and the peroneal nerve injury.The concept of enhanced recovery after surgery(ERAS)has been fully recognized and applied in the field of joint surgery.Resolving the factors that affect the early postoperative recovery of patients with joint surgery can reduce the patient’s hospitalization days and hospitalization expenses,and make the surgery safely and ultimately achieve better knee joint function and quality of life.There have been comparative studies on the efficacy of UKA and HTO in the treatment of medial compartmental knee osteoarthritis,but the results are still controversial.Some studies have shown that arthroscopy combined with HTO can achieve a more satisfactory early clinical effect than HTO alone.However,there are few comparative studies on the early clinical effect of UKA and MOWHTO combined with arthroscopy in the treatment of medial compartment knee osteoarthritis.We want to analyze the short-term clinical outcomes between the two operations in order to provide some suggestion for the surgery selection in treatment of medial compartmental knee osteoarthritis.Objective1.To find whether there are differences in perioperative clinical indicators between UKA and MOWHTO combined with arthroscopy in the treatment of medial unicompartmental knee osteoarthritis.2.To find whether there is a difference in the short-term clinical outcome between the two types of surgery,and to find the factors that affect the patients’ postoperative recovery and return to activities of daily living.MethodsRetrospectively analyzing the patients who underwent UKA or MOWHTO with arthroscopy for medial compartmental knee osteoarthritis in our department from June 2019 to December 2020,the patients were followed up for one year.We collect demographic characteristics,classification of osteoarthritis,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),perioperative indicators including the preoperative and first postoperative day hemoglobin value,the preoperative and first postoperative day hematocrit value on the first postoperative day,operation time,postoperative length of hospital stay,case of blood transfusion and blood transfusion volume,first postoperative day visual analogue score(VAS)score of the two groups of patients.The incidence of complications such as incision infection,delayed incision healing,implant loosening,implant fracture,and infection around implants were compared between the two groups.Using the preoperative,six weeks、three months、six months and one year postoperative follow-up score including VAS score and Hospital for special surgery osteoarthritis index(HSS)and the Western Ontario and McMaster universities osteoarthritis index(WOMAC)for clinical efficacy analysis.ResultAmong the 60 patients who were followed up for one year,there were no complications such as incision infection,delayed healing of incision,loosening of implants,fracture of implants,or implants infection occurred.There were no significant differences in demographic characteristics,preoperative knee scores(WOMAC,HSS,VAS)between the two group(P>0.05).In the perioperative indicators:no blood transfusion case occurred in the two groups after operation.There were no early incision complications and implant-related complications in both groups.The hemoglobin value and mean hematocrit of the first postoperative day in MOWHTO combined with arthroscopy group were lower than those in UKA group,and the difference between the two groups was statistically significant(P<0.05).The blood loss volume of the MOWHTO combined with arthroscopy group was greater,and there was a statistically significant difference between the two groups(P<0.05).There was no significant difference between the postoperative ESR of the two groups(P>0.05).The postoperative serum CRP value of the MOWHTO combined with arthroscopy group was higher,and there was a statistical difference between the two groups(P<0.05).There was no statistical difference between the postoperative length of hospital stay of the two groups(P>0.05);the operation time of MOWHTO combined with arthroscopy group was longer than that of UKA group,and there was a statistical difference between the two groups(P<0.05).Comparison of knee joint function scores between the two groups:the WOMAC and HSS scores of the two groups were significantly improved at six weeks,three months,six months,and one year postoperatively compared with those before operation(P<0.05);The WOMAC score of the patients in the MOWHTO combined with arthroscopy group was higher than that in the UKA group at six weeks after surgery,and the difference was statistically significant(P<0.05).The WOMAC score improvement value of UKA group was greater than the MOWHTO combined with arthroscopy group,but it was lower from 6 weeks after operation to three months after operation,the difference between the two groups was statistically significant(P<0.05);there was statistical difference in the six months postoperative follow up HSS score between the two groups(P<0.05).In terms of VAS score:MOWHTO combined with arthroscopy group had higher VAS scores than UKA group on the first postoperative day and six weeks after operation,and the difference between the two groups was statistically significant(P<0.05).In terms of VAS score improvement value,the VAS score improvement value of UKA group was higher than that of MOWHTO combined with arthroscopy group at the six weeks follow-up after operation,but it was lower from six weeks to three months after operation,the difference was statistically significant(P<0.05).Factors such as patient BMI,preoperative knee function level,and VAS score of the first postoperative day were correlated with patients’early-stage postoperative recovery(P<0.05).ConclusionWith clear indications,both MOWHTO combined with arthroscopy and UKA can achieve good short-term clinical efficacy in the treatment of medial unicompartment knee osteoarthritis,which can relieve pain,improve knee function and quality of life of patients significantly.we need further follow-up research to identify the long-term clinical outcomes.Factors such as patient BMI,preoperative knee function status,and pain level of the first postoperative day have an impact on postoperative knee function rehabilitation.Strengthen the health education and individualized treatment of patients in preoperative joint function exercise,weight management,postoperative pain management and appropriate tele-rehabilitation exercise guidance after discharge can help patients recover quickly.