Changes in kinematic parameters after unicompartmental knee arthroplasty and high tibial osteotomy

doi:10.12307/2022.064

Abstract

Abstract: BACKGROUND: Unicompartmental knee arthroplasty and high tibial osteotomy are two effective methods for the treatment of medial compartment osteoarthritis of the knee. However, there is still a lack of medium and long-term efficacy observation, and there is no study to analyze and compare the postoperative kinematic parameters of the two.
OBJECTIVE: To investigate the clinical efficacy and kinematic parameters of unicompartmental knee arthroplasty and high tibial osteotomy in the treatment of medial compartment osteoarthritis of the knee.
METHODS: Clinical data of 97 patients with osteoarthritis in the medial compartment of the knee who were admitted to the Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine from January 2016 to June 2017 and met the inclusion criteria were retrospectively collected. According to different surgical methods, they were divided into two groups, including 49 cases in unicompartmental knee arthroplasty group and 48 cases in high tibial osteotomy group. The range of motion, Lysholm knee score, Tegner knee motion score and tibiofemoral angle of the two groups were recorded and compared before operation and 1, 2, 3 years after operation. Simultaneously, Opti-Knee three-dimensional motion analysis system was used to record the three-dimensional six degree of freedom range of motion of knee joint during gait before and 1, 2, 3 years after operation.
RESULTS AND CONCLUSION: (1) Both groups of patients healed by first intention and had no complications related to endophytes. All patients were followed up. (2) The range of motion, Tegner knee score, Lysholm knee score, tibiofemoral angle and knee kinematics parameters of the two groups were significantly improved 3 years after operation (P < 0.05). However, there was no significant difference in above indexes between the two groups (P > 0.05). (3) It is suggested that both unicompartmental knee arthroplasty and high tibial osteotomy can effectively improve knee joint function and correct deformity, and can effectively improve gait parameters for patients with medial compartment osteoarthritis of knee joint. The curative effect of the two methods is similar, but the long-term efficacy needs further study.

Key words: knee joint, medial compartment, osteoarthritis, unicompartmental knee arthroplasty, high tibial osteotomy, efficacy, kinematic parameter

CLC Number:

Liu Shaohua, Zhou Guanming, Chen Xicong, Xiao Keming, Cai Jian, Liu Xiaofang. Changes in kinematic parameters after unicompartmental knee arthroplasty and high tibial osteotomy[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(3): 390-396.

Figures/Tables 10

References

[1] PALAZZO C, NGUYEN C, LEFEVRE-COLAU MM, et al. Risk factors and burden of osteoarthritis. Ann Phys Rehabil Med. 2016;59(3):134-138.
[2] LAWRENCE RC, FELSON DT, HELMICK CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26-35.
[3] EGLOFF C, HÜGLE T, VALDERRABANO V. Biomechanics and pathomechanisms of osteoarthritis. Swiss Med Wkly. 2012;142: w13583.
[4] VIGNON E, BRANDT KD, MERCIER C, et al. Alignment of the medial tibial plateau affects the rate of joint space narrowing in the osteoarthritic knee. Osteoarthritis Cartilage. 2010;18(11):1436-1440.
[5] WALKER T, GOTTERBARM T, BRUCKNER T, et al. Total versus unicompartmental knee replacement for isolated lateral osteoarthritis: a matched-pairs study. Int Orthop. 2014;38(11):2259-2264.
[6] RYU SM, PARK JW, NA HD, et al. High Tibial Osteotomy versus Unicompartmental Knee Arthroplasty for Medial Compartment Arthrosis with Kissing Lesions in Relatively Young Patients. Knee Surg Relat Res. 2018;30(1):17-22.
[7] HAN SB, KYUNG HS, SEO IW, et al. Better clinical outcomes after unicompartmental knee arthroplasty when comparing with high tibial osteotomy. Medicine (Baltimore). 2017;96(50):e9268.
[8] DETTONI F, BONASIA DE, CASTOLDI F, et al. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J. 2010;30:131-140.
[9] KIM YJ, KIM BH, YOO SH, et al. Mid-Term Results of Oxford Medial Unicompartmental Knee Arthroplasty in Young Asian Patients Less than 60 Years of Age: A Minimum 5-Year Follow-up. Knee Surg Relat Res. 2017;29(2):122-128.
[10] 陈锐鸿,葛鸿庆,陈文治.单髁置换与胫骨高位截骨治疗膝关节内侧间室骨关节炎:1年随访比较[J].中国组织工程研究,2019, 23(20):3143-3147.
[11] 郝朋,杨柳,何锐,等.人工单髁关节置换术后步态及临床疗效分析[J].中国修复重建外科杂志,2020,8(9):1-7.
[12] WHATLING GM, BIGGS PR, ELSON DW, et al. High tibial osteotomy results in improved frontal plane knee moments, gait patterns and patient-reported outcomes. Knee Surg Sports Traumatol Arthrosc. 2020;28(9):2872-2882.
[13] DUNN AS, PETTERSON SC, PLANCHER KD. Unicondylar knee arthroplasty: intramedullary technique. Clin Sports Med. 2014;33(1): 87-104.
[14] LIM JW, COUSINS GR, CLIFT BA, et al. Oxford unicompartmental knee arthroplasty versus age and gender matched total knee arthroplasty - functional outcome and survivorship analysis. J Arthroplasty. 2014; 29(9):1779-1783.
[15] 邓汝林,胡鸣舞,张虹俊,等.UKA与关节镜联合HTO治疗膝关节内侧间室骨性关节炎的疗效比较[J].南昌大学学报(医学版),2019, 59(3):74-78.
[16] ZUIDERBAAN HA, VAN DER LIST JP, KLEEBLAD LJ, et al. Modern Indications, Results, and Global Trends in the Use of Unicompartmental Knee Arthroplasty and High Tibial Osteotomy in the Treatment of Isolated Medial Compartment Osteoarthritis. Am J Orthop (Belle Mead NJ). 2016;45(6):E355-E361.
[17] 刘晓东,蔡珉巍,凃意辉.微创单髁置换术治疗膝关节内侧间室骨性关节炎的初步临床报告[J].中国矫形外科杂志,2010,18(7): 548-552.
[18] LOBENHOFFER P. Indication for Unicompartmental Knee Replacement versus Osteotomy around the Knee. J Knee Surg. 2017;30(8):769-773.
[19] BORUS T, THORNHILL T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg. 2008;16(1):9-18.
[20] KOZINN SC, SCOTT R. Unicondylar knee arthroplasty. J Bone Joint Surg Am. 1989;71(1):145-150.
[21] WONG T, WANG CJ, WANG JW, et al. Functional outcomes of uni-knee arthroplasty for medial compartment knee arthropathy in asian patients. Biomed J. 2014;37(6):406-410.
[22] NWACHUKWU BU, MCCORMICK FM, SCHAIRER WW, et al. Unicompartmental knee arthroplasty versus high tibial osteotomy: United States practice patterns for the surgical treatment of unicompartmental arthritis. J Arthroplasty. 2014;29(8):1586-1589.
[23] WILLIS-OWEN CA, BRUST K, ALSOP H, et al. Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee. 2009;16(6):473-478.
[24] ARGENSON JN, BLANC G, AUBANIAC JM, et al. Modern unicompartmental knee arthroplasty with cement: a concise follow-up, at a mean of twenty years, of a previous report. J Bone Joint Surg Am. 2013;95(10):905-909.
[25] NIINIMÄKI T, ESKELINEN A, MÄKELÄ K, et al. Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year Finnish registry study. Clin Orthop Relat Res. 2014;472(5):1496-1501.
[26] JACKSON JP, WAUGH W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br. 1961;43-B:746-751.
[27] SONG SJ, BAE DK, KIM KI, et al. Long-term survival is similar between closed-wedge high tibial osteotomy and unicompartmental knee arthroplasty in patients with similar demographics. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1310-1319.
[28] SCHUSTER P, GEßLEIN M, SCHLUMBERGER M, et al. Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment. Am J Sports Med. 2018;46(6):1362-1370.
[29] 黄野.胫骨高位截骨术治疗膝关节骨关节炎的现状[J].中华关节外科杂志(电子版),2016,10(5):470-473.
[30] PORNRATTANAMANEEWONG C, NUMKANISORN S, CHAREANCHOLVANICH K, et al. A retrospective analysis of medial opening wedge high tibial osteotomy for varus osteoarthritic knee. Indian J Orthop. 2012;46(4):455-461.
[31] STUKENBORG-COLSMAN C, WIRTH CJ, LAZOVIC D, et al. High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7-10-year follow-up prospective randomised study. Knee. 2001;8(3):187-194.
[32] 宋伟,朱振国,徐进,等.单髁置换术与胫骨高位截骨术治疗膝关节骨性关节炎的荟萃分析[J].中国矫形外科杂志,2018,26(21): 1962-1968.
[33] MACFARLANE LA, YANG H, COLLINS JE, et al. Association of Changes in Effusion-Synovitis With Progression of Cartilage Damage Over Eighteen Months in Patients With Osteoarthritis and Meniscal Tear. Arthritis Rheumatol. 2019;71(1):73-81.
[34] PRIMEAU CA, BIRMINGHAM TB, LEITCH KM, et al. Degenerative Meniscal Tears and High Tibial Osteotomy: Do Current Treatment Algorithms Need to Be Realigned? Clin Sports Med. 2019;38(3):471-482.
[35] PRAKASH J, SONG EK, LIM HA, et al. High tibial osteotomy accelerates lateral compartment osteoarthritis in discoid meniscus patients. Knee Surg Sports Traumatol Arthrosc. 2018;26(6):1845-1850.
[36] 罗旺林,殷德雄,彭超,等.胫骨高位截骨与单髁置换治疗单室膝骨性关节炎的荟萃分析[J].中国矫形外科杂志,2018,26(9):814-820.
[37] 白浩,孙海飚,韩晓强,等.胫骨高位截骨与单髁置换治疗膝关节内侧间室骨关节炎的Meta分析[J].中国组织工程研究,2020,24(30): 4905-4913.
[38] 杨波,姜鑫.单髁置换术与胫骨高位截骨术治疗膝关节内侧间室骨关节炎的近期疗效比较[J].中国修复重建外科杂志,2015,29(5): 548-552.
[39] MOCHIZUKI T, SATO T, TANIFUJI O, et al. Unicompartmental knee arthroplasty cannot restore the functional flexion axis of a living knee to normal. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3736-3742.
[40] 何利雷,赵立连,卢明峰,等.第四代Oxford单髁置换术对膝关节内侧间室骨关节炎患者的疗效评估及步态分析[J].生物骨科材料与临床研究,2020,17(4):21-25.
[41] FU YC, SIMPSON KJ, KINSEY TL, et al. Does interlimb knee symmetry exist after unicompartmental knee arthroplasty? Clin Orthop Relat Res. 2013;471(1):142-149.
[42] JUNG WH, TAKEUCHI R, CHUN CW, et al. Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy. 2014;30(1):72-79.
[43] KIM KT, LEE S, LEE JS, et al. Long-Term Clinical Results of Unicompartmental Knee Arthroplasty in Patients Younger than 60 Years of Age: Minimum 10-Year Follow-up. Knee Surg Relat Res. 2018; 30(1):28-33.
[44] SPAHN G, HOFMANN GO, VON ENGELHARDT LV, et al. The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):96-112.
[45] FU D, LI G, CHEN K, et al. Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis: a meta-analysis. J Arthroplasty. 2013;28(5):759-765.
[46] SCHINDLER OS, SCOTT WN, SCUDERI GR. The practice of unicompartmental knee arthroplasty in the United Kingdom. J Orthop Surg (Hong Kong). 2010;18(3):312-319.