Huang Nengteng, Xu Binbin, Wu Ziguang, Ye Xiuye, He Junyuan, Li Chun, Tang Jianbang
Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Guangdong, China.
J Orthop Surg Res. 2025 Aug 6;20(1):732. doi: 10.1186/s13018-025-06161-9.
Unicompartmental knee arthroplasty (UKA), high tibial osteotomy (HTO), and distal femoral osteotomy (DFO) are common knee-preserving surgeries for knee osteoarthritis (KOA), yet systematic comparisons of their effects on lower limb biomechanical parameters remain limited.
To retrospectively evaluate and compare the impacts of UKA, HTO, and DFO on hip-knee-ankle alignment in KOA patients, providing evidence for personalized surgical strategy formulation. We hypothesized that these procedures would exert differential effects on specific alignment parameters.
A total of 256 patients with knee osteoarthritis were initially screened. After applying the inclusion and exclusion criteria, 150 patients were enrolled and assigned to the UKA, HTO, or DFO group (50 patients per group). Preoperative and postoperative changes in seven alignment parameters were measured: medial proximal tibial angle (MPTA), mechanical greater trochanter angle (MGTA), femorotibial anatomic angle (FTA), distal tibial femoral angle (DTTA), talar dome mechanical axis angle (TDMA), talar tilt angle (TTA), and the mechanical axis percentage (%MA). Intergroup differences in these parameters were analyzed statistically.
(1) Baseline demographics and preoperative lower limb alignment parameters were comparable across groups. (2) UKA significantly changed MPTA, FTA, DTTA, TDMA, and %MA, but not MGTA or TTA. (3) DFO significantly changed MPTA, MGTA, FTA, and %MA, but not DTTA, TDMA, or TTA. (4) HTO significantly modified MPTA, MGTA, FTA, DTTA, TDMA and %MA, except for TTA. (5) UKA vs. HTO: No differences in FTA or DTTA, but significant differences in MPTA, MGTA, TDMA, TTA, and %MA. (6) UKA vs. DFO: No differences in MPTA or DTTA, but significant disparities in MGTA, FTA, TDMA, TTA and %MA.
UKA, HTO, and DFO each influence lower limb biomechanics in KOA patients, with distinct effects on specific alignment parameters. Surgical selection should prioritize individual anatomical and pathological characteristics to achieve personalized care.
单髁膝关节置换术（UKA）、高位胫骨截骨术（HTO）和股骨远端截骨术（DFO）是治疗膝关节骨关节炎（KOA）常见的保膝手术，但它们对下肢生物力学参数影响的系统比较仍然有限。
回顾性评估和比较UKA、HTO和DFO对KOA患者髋-膝-踝对线的影响，为制定个性化手术策略提供依据。我们假设这些手术对特定对线参数会产生不同的影响。
初步筛查了256例膝关节骨关节炎患者。应用纳入和排除标准后，纳入150例患者并分为UKA组、HTO组或DFO组（每组50例患者）。测量了七个对线参数术前和术后的变化：胫骨近端内侧角（MPTA）、大转子机械角（MGTA）、股胫解剖角（FTA）、胫股远端角（DTTA）、距骨穹顶机械轴角（TDMA）、距骨倾斜角（TTA）和机械轴百分比（%MA）。对这些参数的组间差异进行统计学分析。
（1）各组间基线人口统计学和术前下肢对线参数具有可比性。（2）UKA显著改变了MPTA、FTA、DTTA、TDMA和%MA，但未改变MGTA或TTA。（3）DFO显著改变了MPTA、MGTA、FTA和%MA，但未改变DTTA、TDMA或TTA。（4）HTO显著改变了MPTA、MGTA、FTA、DTTA、TDMA和%MA，但TTA除外。（5）UKA与HTO比较：FTA或DTTA无差异，但MPTA、MGTA、TDMA、TTA和%MA有显著差异。（6）UKA与DFO比较：MPTA或DTTA无差异，但MGTA、FTA、TDMA、TTA和%MA有显著差异。
UKA、HTO和DFO均影响KOA患者的下肢生物力学，对特定对线参数有不同影响。手术选择应优先考虑个体解剖和病理特征以实现个性化治疗。
