Tibial osteotomy combined with arthroscopic condylar notch plasty to treat flexion deformity of knee varus osteoarthri-tis

Abstract

Objective To explore the medial open wedge high tibial osteotomy (OWHTO) combined with arthroscopic condyle plasty with clinical flexion deformity in patients with osteoarthritis of knee varus. Methods From January 2014 to July 2015, 11 cases (11 knees) of varus knee joint flexion deformity were applied the procedure of OWHTO combined with arthroscopic condyle plasty, including 4 male and 7 female; the average age was 52.1 years old (ranged from 48 to 58 years). OWHTO could ad-just the line of force of the lower limbs in coronal plane (the connection line between femoral head center point and the center point of ankle joint) through lateral tibial plateau 62.5% position, and implant allogeneic bone to support posterior inclination an-gle, underwent arthroscopic condyle plasty to improve flexion deformity at the same time. Results 11 patients in this group were all followed up, and the follow-up time was 1-2.5 years, average 1.5 years. No case of fracture nonunion or delayed healing was found. Imaging data was measured to evaluate the mechanical axis of lower extremity by the relative position of tibial plateau, femo-ral tibial angle,femoral notch width index, tibial plateau posterior angle before operation and one year after the operation. The rela-tive position of the mechanical axis of the lower limb through the tibial plateau was 17.4% ± 4.9% preoperatively, and 58.9% ± 3.1% after operation, femoral tibial angle changed from 181.6°±1.2° to 170.3°±1.3°, tibial plateau posterior inclination angle: pre-operative 7.7°±2.2°, postoperative 7.9°±1.9°, femoral notch width index was increased from 0.221±0.007 to 0.272±0.009 after op-eration, flexion deformity angle of preoperative was 11.1°±3.1°, and 1.4°±1.5° one years after operation, VAS score was (6.5±1.1) points before surgery, and (2.5±0.8) points of postoperative, Lysholm score was (50.72±6.57) points before operation, and (75.72±7.41) points one year after operation, and the differences were all statistically significant. Conclusion OWHTO combined with arthroscopic condyle plasty can significantly improve the lower limb line and flexion deformity, and also maintain the posterior in-clination angle of tibial plateau,and can get a good short-term efficacy. Key words: Osteoarthritis, knee; Osteotomy; Genu varum; Treatment outcome