Clinical effect of double level osteotomy combined with arthroscopy in the treatment of severe varus deformity of knee joint.

Abstract

To report the radiological and functional results of a double-level osteotomy (distal femoral lateral closed wedge and proximal tibial medial open wedge) combined with arthroscopy in the treatment of patients with severe varus knee osteoarthritis. A retrospective analysis of 52 patients with severe varus knee osteoarthritis treated with double level osteotomy (DLO) combined with arthroscopy from January 2016 to December 2022, including 19 men and 33 women, with a mean age of 59.1 ± 4.3 years (range 48-67 years). All patients were followed up for at least 2 years. Radiological and clinical outcomes were evaluated at postoperative years 1 and 2. Preoperative and postoperative full-length standing radiographs of both lower limbs and frontal and lateral radiographs of the knee joint were measured and analyzed. The anatomical tibiofemoral angle (aFTA), hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and the joint line convergence angle (JLCA), posterior proximal tibial angle (PPTA) and medial tibial plateau depression (MTPD) were measured. In addition, VAS score, Lysholm score, Tegner Activity Scale (TAS), Knee Injury and Osteoarthritis Outcome score (KOOS), and International Knee Documentation Committee score (IKDC) were used to evaluate the clinical effects of patients during follow-up. In cases where patients required hardware removal, secondary arthroscopy was performed concurrently with the removal procedure. The assessment of cartilage regeneration was conducted in accordance with the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. All 52 patients were followed up for 29.2 ± 3.5 months (range 24-39 months). At 1 and 2 years after surgery, aFTA, HKA, mLDFA, mMPTA, JLCA and MTPD were significantly improved compared with the preoperative period (P < 0.001). The postoperative PPTA was 82.49° ± 1.61° at year 1 and 82.05° ± 1.57° at year 2, with no statistically significant difference from the preoperative value 82.51° ± 1.43° (p = 0.230). Patients' VAS, Lysholm, Tegner Activity Scale, KOOS, and IKDC scores were significantly improved at 1 and 2 years postoperatively compared to preoperative scores (P < 0.001). Arthroscopic evaluation was performed at the time of internal fixation removal in 27 patients, and cartilage regeneration was seen in the medial femoral condyle: 74 % of the knees; and in the medial tibial plateau: 81 % of the knees. There was a significant difference in the cartilage status or cartilage grading before and after surgery (P < 0.001). DLO combined with arthroscopy effectively corrects lower extremity varus deformity, maintain the joint line in a physiologic state, and allow the patient to return to normal daily activities quickly. DLO combined with arthroscopy can probably induce some cartilage regeneration in the articular surfaces of the medial tibia and femur of the knee and improve clinical symptoms. These findings suggest that DLO combined with arthroscopic techniques may reduce pain and improve knee function, and may delay or even prevent total knee arthroplasty to some extent.