Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea.
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnamsi 13620, Republic of Korea.
Medicina (Kaunas). 2023 Apr 17;59(4):779. doi: 10.3390/medicina59040779.
: Clinically, it is beneficial to determine the knee osteoarthritis (OA) subtype that responds well to conservative treatments. Therefore, this study aimed to determine the differences between varus and valgus arthritic knees in the response to conservative treatment. We hypothesized that valgus arthritic knees would respond better to conservative treatment than varus arthritic knees. : Medical records of 834 patients who received knee OA treatment were retrospectively reviewed. Patients with Kellgren-Lawrence grades III and IV were divided into two groups according to knee alignment (varus arthritic knee, hip-knee-ankle angle [HKA] > 0° or valgus arthritic knee, HKA < 0°). The Kaplan-Meier curve with total knee arthroplasty (TKA) as an endpoint was used to compare the survival probability between varus and valgus arthritic knees at one, two, three, four, and five years after the first visit. A receiver operating characteristic (ROC) curve was used to compare the HKA thresholds for TKA between varus and valgus arthritic knees. : Valgus arthritic knees responded better to conservative treatment than varus arthritic knees. With TKA as an endpoint, the survival probabilities for varus and valgus arthritic knees were 24.2% and 61.4%, respectively, at the 5-year follow-up ( < 0.001). The thresholds of HKA for varus and valgus arthritic knees for TKA were 4.9° and -8.1°, respectively (varus: area under the ROC curve [AUC] = 0.704, 95% confidence interval [CI] 0.666-0.741, < 0.001, sensitivity = 0.870, specificity = 0.524; valgus: AUC = 0.753, 95% CI 0.693-0.807, < 0.001, sensitivity = 0.753, specificity = 0.786). : Conservative treatment is more effective for valgus than for varus arthritic knees. This should be considered when explaining the prognosis of conservative treatment for knees with varus and valgus arthritis.
临床上，确定对保守治疗反应良好的膝骨关节炎（OA）亚型是有益的。因此，本研究旨在确定内翻和外翻关节炎膝关节对保守治疗反应的差异。我们假设外翻关节炎膝关节对保守治疗的反应会优于内翻关节炎膝关节。
回顾性分析了 834 例接受膝骨关节炎治疗的患者的病历。根据膝关节对线（内翻关节炎膝关节，髋膝踝角 [HKA] > 0°或外翻关节炎膝关节，HKA < 0°）将 K-L 分级为 III 级和 IV 级的患者分为两组。使用以全膝关节置换术（TKA）为终点的 Kaplan-Meier 曲线比较初次就诊后 1、2、3、4 和 5 年时内翻和外翻关节炎膝关节的 TKA 生存概率。使用受试者工作特征（ROC）曲线比较 TKA 时内翻和外翻关节炎膝关节的 HKA 阈值。
外翻关节炎膝关节对保守治疗的反应优于内翻关节炎膝关节。以 TKA 为终点，5 年随访时内翻和外翻关节炎膝关节的生存率分别为 24.2%和 61.4%（ < 0.001）。TKA 时内翻和外翻关节炎膝关节的 HKA 阈值分别为 4.9°和-8.1°（内翻：ROC 曲线下面积 [AUC] = 0.704，95%置信区间 [CI] 0.666-0.741， < 0.001，敏感度 = 0.870，特异性 = 0.524；外翻：AUC = 0.753，95%CI 0.693-0.807， < 0.001，敏感度 = 0.753，特异性 = 0.786）。
保守治疗对内翻关节炎膝关节的疗效优于外翻关节炎膝关节。在解释内翻和外翻关节炎膝关节保守治疗的预后时应考虑这一点。
