Comparison of high tibial osteotomy and fibula osteotomy in treatment of knee osteoarthritis

Abstract

Objective To compare the clinical efficacy of high tibial osteotomy (HTO) and fibular osteotomy in the treatment of knee osteoarthritis (KOA). Methods A retrospective analysis was made on the patients with KOA who underwent HTO or fibular osteotomy from January 2015 to December 2016 in the 9th Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine. There were 37 cases in HTO group, 11 males and 26 females, with an average age of (59±3) 26 cases in fibular osteotomy group, nine males and 17 females, with an average age of (59±3). The operation time, intraoperative blood loss, total hospitalization cost, postoperative complications and knee arthroplasty were analyzed between the two groups. The Lysholm score and the University of Western Ontario and Manchester arthritis index (WOMAC) were used to assess the knee function before surgery, six months after surgery and 12 months after surgery. Data were analyzed by SPSS13.0 statistical software. The operation time, intraoperative blood loss, total cost of hospitalization, Lysholm score and WOMAC score were examined by independent sample t-test, and chi-square test was used to compare the incidence of postoperative knee arthroplasty and postoperative complications during follow-up period. Results The median follow-up time of group HTO was 15.7 months, and the fibula osteotomy group had a median follow-up of 14.9 months. The operation time (t=21.094, P<0.05), intraoperative blood loss (t= 9.91, P<0.05), total hospitalization cost (t=65.471, P<0.05) in HTO group were significantly lower than those in fibular osteotomy group. There was one complication case in HTO group (2.7%) and two complication cases in fibular osteotomy group (7.7%) and no significant difference was found between the two groups by Fisher′s exact probability analysis (P=0.785). There was no significant difference in Lysholm score and WOMAC score between the two groups before operation. The Lysholm score in HTO group was significantly better than that in fibular osteotomy group (t=2.426, P<0.05). WOMAC score in HTO group was significantly lower than that in fibular osteotomy group (t=3.997, P<0.01). The Lysholm score (t=2.979, P<0.01), WOMAC score (t=-2.472, P<0.05) in HTO group were significantly better than those in fibular osteotomy group 12 months after operation. Conclusion High tibial osteotomy for osteoarthritis of the knee is more time-consuming, more bleeding and more hospital costs than fibular osteotomy; 12 months follow-up shows that high tibial osteotomy can achieve better knee function than fibular osteotomy. Key words: Osteotomy; Tibia; Fibula; Osteoarthritis, knee