To make the young patients with osteoarthritis and genu varum of knee delay total knee arthroplasty, to observe the clinical effect of mosaicplasty of femoral medial condyle, patellar-plasty and high tibial osteotomy in the treatment of osteoarthritis of knee with varum.
From June 2004 to February 2006, 8 patients with osteoarthritis of knee with varum (10 knees) were treated with combined operation such as mosaicplasty of femoral medial condyle, patellar-plasty and hightibial osteotomy. There were 2 males with3 knees, and 6 females with7 knees,withan average age of 50 years (42-56 years). The left knees and right knees were involved in 3 cases respectively and bilateral knees in 2 cases. All patients had knee ache after walk or long-time standing. The X-ray showed hyperosteogeny at peri-patella and circum ferential femur-tibial joint, especially in the medial. The gap between patella and femur narrowed or disappeared, especially in the medial femurtibial joint. The femoral tibial angel (FTA) was 185-200 degrees (mean 190 degrees). The HSS score of knee was 55-75 (mean 60). The history of knee ache was 1-12 years (mean 5 years).
All patients were followed up for 7-24 months (mean 15 months). All the incisions healed by first intention,no early complication occurred. The clinical bone healing time was 8-11 weeks (mean 9 weeks). Rectification of FTA was 15-30 degrees (mean 20 degrees). Normal weight-loading alignment was recovered. The valgus angle of knee was 10 degrees. The range of motion of knee was 100-120 degrees after operation, increasing by 5-20 degrees (mean 10 degrees) when compared with preoperation. The X-ray of postoperation showed that genu varum was corrected obviously and that no displacement, loosening and breakage occurred. The mean score of HSS was 80 (75-88), increasing by 20 when compared with preoperation.
Mosaic-plasty of femoral medial condyle can make articular cartilage repair in certain degrees, patellar-plasty can relieve ache of fore region of knee effectively, and high tibial osteotomy can recover normal weight-loading alignment. The curative effect is good with the combined methods.