Knee Joint Medial Compartment Osteoarthritis Treatment with High Tibial Opening Wedge Osteotomy and Arthroscopic Chondroplasty

Abstract

Background : Osteoarthritis is a pathological condition that affects movable joints, marked by cellular stress and the breakdown of the extracellular matrix. It is triggered by both micro and macro injuries, which initiate maladaptive repair mechanisms, including pro-inflammatory pathways associated with innate immunity. The disease initially presents as a molecular disturbance, involving abnormal metabolism of joint tissue. This is subsequently followed by anatomical and/or physiological disruptions, marked by cartilage breakdown, bone remodeling, osteophyte development, joint inflammation, and impaired joint function. These progressive changes can ultimately lead to illness. As of 2010, around 250 million people worldwide, or 3.6% of the population, were affected by knee osteoarthritis. Hip osteoarthritis, on the other hand, impacted approximately 0.85% of the global population. Both conditions held the 11th position among 291 disease-related causes of disability assessed globally. In the United States alone, there were roughly 964,000 hospitalizations due to osteoarthritis in 2011, equating to a rate of 31 stays per 10,000 individuals. These hospitalizations incurred a total cost of $14.8 billion, with an average expense of $15,400 per stay. This made osteoarthritis the second most expensive condition treated in U.S. hospitals that year. When categorized by payer, it was also the second-costliest condition billed to both private insurance and Medicare. Objectives : Our approach emphasizes preserving the knee joint and postponing knee arthroplasty in older individuals. The objective of our work is to demonstrate the effectiveness of simultaneously performing high tibial osteotomy (HTO) and arthroscopic chondroplasty in patients with medial compartment osteoarthritis of the knee. The correction of varus deformity in knee osteoarthritis is guided by the patient’s knee morphology, range of motion (ROM), findings from X-rays and MRI, as well as the patient’s symptoms, their duration, expectations, and recovery time. M ethods : Patients presenting with knee joint osteoarthritis have been systematically evaluated through a detailed collection of medical history (anamnesis), clinical examinations of both the knee and hip joints. Preoperative instrumental diagnostic procedures involve standard anteroposterior (AP, standing position) and lateral-medial (LM) radiographic imaging of the knee joint, a topographic scan of the entire lower extremities, and magnetic resonance imaging (MRI) of the knee joint. To assess and quantify the clinical condition of the knee, two validated outcome measures have been utilized: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the Knee Injury and Osteoarthritis Outcome Score (KOOS). Surgical management of this condition involved arthroscopic chondroplasty combined with high tibial osteotomy. During the high tibial osteotomy, Puddu and T shaped LCP (Locking Compression Plate) titanium implants were used to achieve stable fixation. The chondroplasty procedures include microfracture techniques, autologous mosaic chondroplasty interventions, and contemporary single-stage minced cartilage procedures. These methods were implemented with the goal of optimizing cartilage restoration and enhancing joint functionality. R esults : We have performed 50 high tibial osteotomy in combination with knee joint arthroscopy chondroplasty. We have reached functional improvement in 85% of clinical cases. C onclusions : Preliminary results showed Roentgenological and Functional improvement. We can conclude that combination of these two procedures improve knee joint osteoarthritis treatment outcome and delay or prevent knee joint replacement surgery with artificial joint. The single staged chondroplasty method, which had good preliminary result was used in our work, however long-term observation is required to make final positive conclusion.