Treatment of varus knee osteoarthritis secondary to tibial fracture malunion by high tibial osteotomy assisted by digital orthopedic techniques
10.3760/cma.j.cn115530-20241223-00498
- VernacularTitle:数字骨科技术辅助胫骨高位截骨治疗胫骨骨折畸形愈合继发内翻型膝骨关节炎的疗效分析
- Author:
Bin ZHAO
1
;
Wei LUO
1
;
Songqing YE
1
;
Haohao BAI
1
;
Zijian LIAN
1
;
Xuan JIANG
1
;
Zhihu ZHAO
1
;
Xinlong MA
1
Author Information
1. 天津市天津医院数字骨科技术临床应用中心，天津 300211
- Publication Type:Journal Article
- Keywords:
Tibial fractures;
Osteoarthritis, knee;
Genu varum;
Osteotomy;
Computer-aided design;
Printing, three-dimensional
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(2):117-124
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical effectiveness of high tibial osteotomy (HTO) assisted by digital orthopedic techniques in the treatment of varus knee osteoarthritis secondary to tibial fracture malunion.Methods:The clinical data were retrospectively analyzed of the 16 patients who had been admitted to Clinical Application Center of Digital Orthopedic Technology, Tianjin Hospital for varus knee osteoarthritis secondary to tibial fracture malunion from April 2022 to October 2023. There were 6 men and 10 women, with an age of (56.3±1.6) years and a mean body mass index of (23.8±0.9) kg/m 2. HTO was performed for all the patients using patient-specific instrumentation integrated osteotomy and orthopedic guide which was designed and printed with digital orthopedic techniques. If preoperative imaging indicated symptomatic meniscus injury (tear), intraarticular free body, or intercondylar fossa stenosis in a patient, arthroscopic clearance was first conducted before subsequent performance of HTO at one stage. Clinical effectiveness was evaluated by measuring and comparing hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), posterior tibial slope (PTS), lower limb weight-bearing line (WBL) ratio, Western Ontario and McMaster University (WOMAC) osteoarthritis index, visual analogue scale (VAS) pain score and knee range of motion (ROM) before surgery and 12 months after surgery. Results:The operative time was (41.3±2.1) min and intraoperative fluoroscopy was performed only once in all the patients. All the wounds healed by the first stage with no such complications as hinge point fracture, wound infection, vascular injury, nerve injury, delayed union or nonunion of fracture, lower limb deep venous thrombosis, loosening of internal fixation, or plate rupture. The follow-up time for the 16 patients was (16.3±0.7) months. At 12 months after surgery, the HKA (179.5°±0.5°), MPTA (91.7°±0.5°), WBL ratio (61.2%±0.4%), WOMAC osteoarthritis index [(12.8±0.8) points], VAS pain score [(1.8±0.3) points] and knee ROM (121.8°±1.8°) were significantly better than those before surgery [166.6°±1.3°, 81.8°±0.4°, 29.6%±1.0%, (38.4±2.1) points, (4.8±0.3) points, and 110.5°±2.1°] ( P < 0.05). There was no significant difference in PTS between pre-surgery and 12 months after surgery ( P > 0.05). Conclusions:When HTO is used to treat varus knee osteoarthritis secondary to tibial fracture malunion, assistance of digital orthopedic techniques can improve HKA, MPTA, lower limb alignment, and knee ROM to reduce and recover knee function for the patients.
