Research progress of knee-salvage treatment for knee osteoarthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUO Baofeng ¹ ,  QIN Sihe ^1,2 , HUANG Ye ³

1. Department of Orthopaedics, ChuiYangLiu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China;
2. Department of Orthopaedics, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China;
3. Department of Orthopaedics, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China;

Corresponding?author：

QIN Sihe, Email: qinsihe@163.com

Keywords：

Knee joint; osteoarthritis; knee-salvage treatment; research progress

DOI：

10.7507/1002-1892.201807027

Video：

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Objective To review the progress of knee-salvage treatment based on the step therapy idea for knee osteoarthritis (KOA). Methods The domestic and foreign literature in recent years was searched, and the treatments of KOA at different stages were summarized and analyzed. Results The treatment of KOA is aimed at alleviating symptoms, delaying structural changes of joints, maintaining joint function, and improving quality of life. So the conservative treatment is still the first choice for KOA at early stage. Arthroscopic surgery can assist in the diagnosis and classification, simultaneously remove the intra-articular irritants, and limitedly repair the cartilage. Osteotomy is suitable for the KOA with abnormal lower extremity weight bearing line and articular line. And it can effectively balance the weight bearing stress of knee joint, improve the clinical symptom, and alleviate the progression of disease. Joint distraction can improve the mechanical environment of knee joint and repair the defect cartilage partly. With the technical development, unicompartmental knee arthroplasty (UKA) is back in fashion in recent years. It is a kind of real joint surface replacement, which is an important means of knee preservation method in patients with anterior medial KOA. Conclusion At present, there are many knee-salvage treatments based on the severity of the disease. Osteotomy and UKA are the most widely used and successful surgical techniques for knee preservation. However, the indications should be properly selected, and the surgeon should accumulate enough clinical experience. Otherwise, it is difficult to achieve good results.

Citation： GUO Baofeng, QIN Sihe, HUANG Ye. Research progress of knee-salvage treatment for knee osteoarthritis. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(10): 1292-1296. doi: 10.7507/1002-1892.201807027 Copy

1.	Riddle DL, Perera RA, Jiranek WA, et al. Using surgical appropriateness criteria to examine outcomes of total knee arthroplasty in a United States sample. Arthritis Care Res (Hoboken), 2015, 67(3): 349-357.
2.	中華醫學會風濕病學會. 骨關節炎診斷及治療指南. 中華風濕病學雜志, 2010, 14(6): 416-419.
3.	Brown GA. AAOS clinical practice guideline: treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg, 2013, 21(9): 577-579.
4.	Hutt JR, Craik J, Phadnis J, et al. Arthroscopy for mechanical symptoms in osteoarthritis: a cost-effective procedure. Knee Surg Sports Traumatol Arthrosc, 2015, 23(12): 3545-3549.
5.	Spahn G, Hofmann GO, Klinger M. The effects of arthroscopic joint debridement in the knee osteoarthritis: results of a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2013, 21(7): 1553-1561.
6.	Marder RA, Hopkins G Jr, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy, 2005, 21(2): 152-158.
7.	Freitag J, Ford J, Bates D, et al. Adipose derived mesenchymal stem cell therapy in the treatment of isolated knee chondral lesions: design of a randomised controlled pilot study comparing arthroscopic microfracture versus arthroscopic microfracture combined with postoperative mesenchymal stem cell injections. BMJ Open, 2015, 5(12): e009332.
8.	Mancò A, Goderecci R, Rughetti A, et al. Microfracture versus microfracture and platelet-rich plasma: arthroscopic treatment of knee chondral lesions. A two-year follow-up study. Joints, 2016, 4(3): 142-147.
9.	Lee DC, Byun SJ. High tibial osteotomy. Knee Surg, 2012, 24(2): 61-69.
10.	白玉明, 張海森, 劉暢, 等. 脛骨高位截骨術治療單純內側間室膝骨關節炎術后炎性細胞因子水平變化研究. 中國修復重建外科雜志, 2017, 31(4): 422-426.
11.	Howells NR, Salmon L, Waller A, et al. The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J, 2014, 96-B(11): 1491-1497.
12.	黃野. 脛骨高位截骨術治療膝關節骨關節炎的現狀. 中華關節外科雜志 (電子版), 2016, 10(5): 1-4.
13.	秦泗河, 鄭學建, 夏和桃, 等. 遠端半針 Ilizarov 外固定器結合微創截骨術治療膝內翻畸形. 中華骨科雜志, 2012, 32(3): 199-204.
14.	王潔穎, 秦泗河, 任龍喜, 等. 脛骨結節下閉合截骨與 Ilizarov 技術治療膝關節骨性關節炎合并膝內翻臨床療效分析. 中國骨與關節損傷雜志, 2013, 28(7): 692-693.
15.	劉鋒衛, 劉禮初, 秦泗河, 等. Ilizarov 技術治療中老年膝骨關節炎內側間室疼痛的臨床觀察. 中國骨質疏松雜志, 2017, 23(2): 216-220.
16.	秦泗河, 臧建成, 焦紹鋒, 等. Ilizarov 技術聯合脛腓骨上段微創截骨治療膝內翻骨關節炎. 中國矯形外科雜志, 2017, 25(4): 292-296.
17.	張英澤, 李存祥, 李冀東, 等. 不均勻沉降在膝關節退變及內翻過程中機制的研究. 河北醫科大學學報, 2014, 35(2): 218-219.
18.	楊延江, 鄭占樂, 李坤, 等. 腓骨高位截骨治療膝關節骨性關節炎的解剖學研究. 河北醫科大學學報, 2014, 35(6): 724-725.
19.	鄭占樂, 孫英彩, 張曉然, 等. 膝關節骨性關節炎發病機制的臨床影像學研究. 河北醫科大學學報, 2014, 35(5): 599-600.
20.	Morse KR, Flemister AS, Baumhauer JF, et al. Distraction arthroplasty. Foot Ankle Clin, 2007, 12(1): 29-39.
21.	秦泗河, 蔡剛, 葛建忠. 關節牽伸術在下肢骨關節炎中的治療作用. 中華外科雜志, 2010, 48(2): 146-148.
22.	Buckwalter JA, Anderson DD, Brown TD, et al. The roles of mechanical stresses in the pathogenesis of osteoarthritis: implications for treatment of joint injuries. Cartilage, 2013, 4(4): 286-294.
23.	Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg (Br), 2009, 91(1): 52-57.
24.	Thompson SA, Liabaud B, Nellans KW, et al. Factors associated with poor outcomes following unicompartmental knee arthroplasty: redefining the " classic” indications for surgery. J Arthroplasty, 2013, 28(9): 1561-1564.
25.	Song EK, Park JK, Park CH, et al. No difference in anterior knee pain after medial unicompartmental knee arthroplasty in patients with or without patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc, 2016, 24(1): 208-213.
26.	Pandit H, Van Duren BH, Gallagher JA, et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: in vivo kinematics. Knee, 2008, 15(2): 101-106.

1. Riddle DL, Perera RA, Jiranek WA, et al. Using surgical appropriateness criteria to examine outcomes of total knee arthroplasty in a United States sample. Arthritis Care Res (Hoboken), 2015, 67(3): 349-357.
2. 中華醫學會風濕病學會. 骨關節炎診斷及治療指南. 中華風濕病學雜志, 2010, 14(6): 416-419.
3. Brown GA. AAOS clinical practice guideline: treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg, 2013, 21(9): 577-579.
4. Hutt JR, Craik J, Phadnis J, et al. Arthroscopy for mechanical symptoms in osteoarthritis: a cost-effective procedure. Knee Surg Sports Traumatol Arthrosc, 2015, 23(12): 3545-3549.
5. Spahn G, Hofmann GO, Klinger M. The effects of arthroscopic joint debridement in the knee osteoarthritis: results of a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2013, 21(7): 1553-1561.
6. Marder RA, Hopkins G Jr, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy, 2005, 21(2): 152-158.
7. Freitag J, Ford J, Bates D, et al. Adipose derived mesenchymal stem cell therapy in the treatment of isolated knee chondral lesions: design of a randomised controlled pilot study comparing arthroscopic microfracture versus arthroscopic microfracture combined with postoperative mesenchymal stem cell injections. BMJ Open, 2015, 5(12): e009332.
8. Mancò A, Goderecci R, Rughetti A, et al. Microfracture versus microfracture and platelet-rich plasma: arthroscopic treatment of knee chondral lesions. A two-year follow-up study. Joints, 2016, 4(3): 142-147.
9. Lee DC, Byun SJ. High tibial osteotomy. Knee Surg, 2012, 24(2): 61-69.
10. 白玉明, 張海森, 劉暢, 等. 脛骨高位截骨術治療單純內側間室膝骨關節炎術后炎性細胞因子水平變化研究. 中國修復重建外科雜志, 2017, 31(4): 422-426.
11. Howells NR, Salmon L, Waller A, et al. The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J, 2014, 96-B(11): 1491-1497.
12. 黃野. 脛骨高位截骨術治療膝關節骨關節炎的現狀. 中華關節外科雜志 (電子版), 2016, 10(5): 1-4.
13. 秦泗河, 鄭學建, 夏和桃, 等. 遠端半針 Ilizarov 外固定器結合微創截骨術治療膝內翻畸形. 中華骨科雜志, 2012, 32(3): 199-204.
14. 王潔穎, 秦泗河, 任龍喜, 等. 脛骨結節下閉合截骨與 Ilizarov 技術治療膝關節骨性關節炎合并膝內翻臨床療效分析. 中國骨與關節損傷雜志, 2013, 28(7): 692-693.
15. 劉鋒衛, 劉禮初, 秦泗河, 等. Ilizarov 技術治療中老年膝骨關節炎內側間室疼痛的臨床觀察. 中國骨質疏松雜志, 2017, 23(2): 216-220.
16. 秦泗河, 臧建成, 焦紹鋒, 等. Ilizarov 技術聯合脛腓骨上段微創截骨治療膝內翻骨關節炎. 中國矯形外科雜志, 2017, 25(4): 292-296.
17. 張英澤, 李存祥, 李冀東, 等. 不均勻沉降在膝關節退變及內翻過程中機制的研究. 河北醫科大學學報, 2014, 35(2): 218-219.
18. 楊延江, 鄭占樂, 李坤, 等. 腓骨高位截骨治療膝關節骨性關節炎的解剖學研究. 河北醫科大學學報, 2014, 35(6): 724-725.
19. 鄭占樂, 孫英彩, 張曉然, 等. 膝關節骨性關節炎發病機制的臨床影像學研究. 河北醫科大學學報, 2014, 35(5): 599-600.
20. Morse KR, Flemister AS, Baumhauer JF, et al. Distraction arthroplasty. Foot Ankle Clin, 2007, 12(1): 29-39.
21. 秦泗河, 蔡剛, 葛建忠. 關節牽伸術在下肢骨關節炎中的治療作用. 中華外科雜志, 2010, 48(2): 146-148.
22. Buckwalter JA, Anderson DD, Brown TD, et al. The roles of mechanical stresses in the pathogenesis of osteoarthritis: implications for treatment of joint injuries. Cartilage, 2013, 4(4): 286-294.
23. Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg (Br), 2009, 91(1): 52-57.
24. Thompson SA, Liabaud B, Nellans KW, et al. Factors associated with poor outcomes following unicompartmental knee arthroplasty: redefining the " classic” indications for surgery. J Arthroplasty, 2013, 28(9): 1561-1564.
25. Song EK, Park JK, Park CH, et al. No difference in anterior knee pain after medial unicompartmental knee arthroplasty in patients with or without patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc, 2016, 24(1): 208-213.
26. Pandit H, Van Duren BH, Gallagher JA, et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: in vivo kinematics. Knee, 2008, 15(2): 101-106.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress of knee-salvage treatment for knee osteoarthritis

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