| Objective:To evaluate the recent efficacy of medial open wedge tibial high osteotomy for medial compartment osteoarthritis of the knee and to assess the pattern of kinematic and kinetic changes in patients before and after surgery by three-dimensional gait analysis.Methods:Arthroscopic exploration and clearance combined with medial open wedge high tibial osteotomy were selected from December 2016 to December 2020(Zhongshan Hospital Affiliated to Dalian University).Twenty-one patients with Knee osteoarthritis(KOA)were treated by OWHTO,the mean age was 53±5.2 years old,the BMI was25-30 kg/m~2,the mean BMI was(28±3.4)kg/m~2,11 patients with left knee and 10 patients with the right knee.All patients were followed up for 26.0±1.2 months.We compared the posterior inclination of the tibial plateau,Femorotibial angle(FTA,Femorotibial angle),and proximal medial tibial Angle(MPTA,)for the patient’s knee joint at various time points before surgery and 6,12,and 24 months after surgery.Medial proximal tibial angle),Caton-Deschamps(CD),and Keen Society Score(KSS)for knee function.Eighteen healthy volunteers with an average age of 46±7.3 years and BMI of 23-29 kg/m~2(27±3.6)kg/m~2 were selected as the control group.Jibuen (?)Gait detection evaluation and training system developed by Dalian Qianhan Technology Company was used to detect and analyze the mechanical changes and motion Angle changes of the knee joint.The kinematic and dynamic changes of the knee joint in the control group,before surgery and at different time points of 6 months,12 months,and24 months after surgery were compared.Results:According to imaging measurements,the medial Angle of the proximal tibia was improved from preoperative 80.3±2.0° to 88.3±1.0°,the difference was statistically significant(p<0.05),and the posterior Angle of the tibial plateau before surgery was12.2±1.7°.The postoperative posterior inclination of the tibial plateau was 12.4±1.8°and the preoperative CD was(1.10±0.14),while the postoperative CD was(1.09±0.07),the difference was not statistically significant(p>0.05).The functional Score of KSS(Keen Society Score)was improved from 51.42±2.7 to 93.4±2.3 before the operation,and the difference was statistically significant(p<0.05).In one gait cycle,the knee internal and external varus angles(varus +)were 12.1±1.4°(before surgery),4.6±0.8°(6 months after surgery),3.3±1.0°(12 months after surgery),and 3.3±0.9°(24months after surgery)in patients with mid-standing phase.Internal and external rotation Angle(in +)13.0 ± 0.7 °(before),7.8 ± 0.6 °(6 months)after operation,6.2 ± 1.3 °(12months)after operation,6.1 ±1.2 °(24 months postoperatively);Stretch the knee Angle is 1.4 ±0.6 °(before),2.1 ± 0.8 °(6 months)after operation,2.4 ± 0.7 °(12 months)after operation,2.5 ± 0.4 °(24 months postoperatively).The maximum knee flexion angles in oscillating phase patients were 61.5±1.8° before surgery,52.7±0.9° after 6months,61.5±1.8° after 12 months,and 61.5±1.9° after 24 months.In the control group,the valgus Angle of the standing phase was 3.5±1.6°,the pronation Angle was 5.5±1.8°,and the knee extension Angle was 2.4±0.7°.The maximum knee flexion Angle in the oscillating phase is 61.3±1.8°.Six months after surgery,the maximum knee flexion Angle of the swing phase,knee extension Angle of the standing phase,internal and external varus,and internal and external rotation Angle were statistically significant compared with the control group(p < 0.05).Six months after surgery,the maximum knee flexion Angle of the swing phase,the knee extension,and the internal and external rotation Angle of the standing phase was smaller,and the internal and external rotation Angles had statistical significance compared with that before surgery(p < 0.05).The maximum knee flexion Angle of the swing phase,knee extension Angle of the standing phase,internal and external varus,and internal and external rotation Angle were significantly different 6 months after surgery compared with 12 and 24 months after surgery(p < 0.05).12 and 24 months after surgery,there were no significant differences in the maximum knee flexion Angle of the swing phase,knee extension in the standing phase,internal and external varus,and internal and external rotation Angle compared with the control group(p > 0.05).12 and 24 months after surgery,there were statistically significant differences in knee extension Angle,internal and external varus Angle,and internal and external rotation Angle in the standing phase compared with those before surgery(p < 0.05),but there was no statistically significant difference in maximum knee flexion Angle in swinging phase(p > 0.05).There was no significant difference in gait parameters between 12 months and 24 months after surgery(p > 0.05).Compared with the control group,there were statistically significant differences in knee extension Angle,internal and external varus Angle,and internal and external rotation Angle in the standing phase before surgery(p < 0.05),but there was no statistically significant difference in the maximum knee flexion Angle in the swinging phase(p >0.05).In the dynamics,the two peaks of coronal attractive torque of patients before surgery(2.7±1.2 Nm/Kg,1.9±0.7 Nm/Kg)increased compared with that of the control group(0.3±1.4Nm/Kg,0.9±3.2 Nm/Kg),the difference was statistically significant(p <0.05),and the two peak values of coronal adduction torque each time point after surgery(0.6±0.6 Nm/Kg,1±1.8 Nm/Kg)(6 months after surgery)(0.4±0.6 Nm/Kg,0.8±1.5Nm/Kg)(12 months after surgery)(0.3±1.2 Nm/Kg,0.7±1.0 Nm/Kg)(24 months after surgery)were significantly lower than before surgery(2.7±1.2 Nm/Kg,1.9±0.7 Nm/Kg).The difference was statistically significant(p < 0.05),and there was no statistical difference between patients and the healthy control group at each time point after surgery(p > 0.05).Conclusion:OWHTO can significantly improve the motor function and force of the knee joint after the operation,which is an effective treatment for KOA.At the same time,three-dimensional gait as an objective evaluation index can better understand the change rule of OWHTO postoperative movement,which is worthy of clinical application. |
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