Identify risk factors for knee degenerative arthritis after orthodontic osteotomy
Nov 21, 2024
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The study is expected to contribute to establishing a safer and more effective surgical plan for patients by finding that JLCA has an important effect on the prognosis of both knees.
The number of patients visiting hospitals for knee degenerative arthritis in Korea continued to increase, reaching about 3.2 million last year. This is an increase of more than 25% from more than a decade ago, and is expected to continue to increase in the future as the population ages. Degenerative arthritis is accompanied by symptoms such as pain, movement limitation, and swelling caused by cartilage damage, and the shape of the leg is sometimes deformed into an O-shape. As a result, some patients who have not been sufficiently effective with conservative treatment consider surgical treatment such as orthodontic osteotomy.
Orthodontic osteotomy is a surgery that reduces pain and improves joint function by correcting the curved shape of the leg so that the weight is transferred from the inside to the outside of the knee. However, excessive or insufficient opening of the medial joint (the degree to which the space in the inner joint of the knee opens) can put abnormal pressure on the knee joint, increasing the risk of degenerative arthritis not only in the operated knee but also in the other knee.
Professor Han Hyuk-soo's team at Seoul National University Hospital (Dr. Kim Geun-woo at Seoul National University Medical School) announced on the 21st that it will follow up 197 patients who underwent orthodontic osteotomy at Seoul National University Hospital from 2007 to 2020 for about six years and analyze radiological factors affecting the prognosis of both knees after surgery.
The research team analyzed various radiologic indicators such as joint line convergence angle (JLCA), center-of-gravity ratio (WBLR), and joint line oblique angle (Joint Line Obliquity Angle) through X-ray images before and after surgery.
Analysis showed that when the change in the joint line convergence angle (ΔJLCA) before and after surgery (JJLCA) was between 1.7 and 5.6 degrees, the progression of degenerative arthritis in both knees decreased and the prognosis improved. In addition, when the postoperative JLCA was in the range of 1.5 to 3.9 degrees, the risk of progression of degenerative arthritis and further surgery was lowest in both the operated and non-operatively opposite knees. On the other hand, out of this range, the prognosis of both knees could worsen.
In particular, when the JLCA was overcorrected (with large internal arthroplasty open, ΔJLCA greater than 5.6 degrees), arthritis progressed more rapidly and was more likely to require surgery in the nonoperative opposite knee (P = .027, P = .006). Conversely, when the JLCA was under-corrected (with a small opening of the medial joint line, and ΔJLCA less than 1.7 degrees), the arthritis was more severe in the operated knee and was more likely to switch to artificial joint replacement (P = .014, P = .027).
These results suggest that maintaining proper correction of the joint line convergence angle after surgery is essential for long-term preservation of knee health.
The study was the first to determine that orthodontic osteotomy has a long-term effect not only on the operated knee but also on the opposite knee, providing important clinical guidance that patients' both knees should be considered in a wider field of view when planning surgery. These studies provide evidence for improving long-term outcomes after surgery for patients and medical staff considering orthodontic osteotomy, and are expected to be used as important basic data for maximizing the effectiveness of surgery.
Professor Han Hyuk-soo (Orthopedic Surgery) stated that "Maintaining an appropriate JCLA range after orthodontic osteotomy is an important factor in improving the prognosis of both knees after surgery"This can slow the progression of degenerative arthritis and reduce the risk of reoperation"Kim Geun-woo, a Ph.D. researcher, added, `This study shows that a more comprehensive approach is needed when establishing a surgical plan by examining the effects not only on the knee operated after orthodontic osteotomy but also on the other knee.'
The findings were published in the recent issue of the prestigious international journal 'AJSM (American Journal of Sports Medicine)'.
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bellho@sportschosun.com
