Collection of general information
A total of 160 patients with knee osteoarthritis who were treated in Chinese hospital from January 2017 to December 2018 were selected as the research subjects. They were divided into experimental group and control group according to their willingness of treatment. There were 80 cases in each group. The study protocol was approved by the hospital medical ethics committee and written informed consent was obtained from all patients before treatment. Diagnostic criteria for knee osteoarthritis in need of surgery was based on the 2007 edition of Guidelines for the Diagnosis and Treatment of Osteoarthritis : (i) there was obvious repeated knee pain within 1 month before admission; (ii) X-ray examination revealed that the joint space was narrow, the subchondral bone was hardened or cystic, and osteophytes formed at the joint edges; (iii) the joint fluid is clear and the white blood cell (WBC) level is lower than 2000 cells/ml; (iv) patients at age more than 40 years old; (v) morning stiffness time ≤ 30min; and (vi) bone rubbing feeling during activities. Those who met the above criteria (i) and (ii), or (i), (iii), (v) and (vi), or(i), (iv), (v) and (vi) can be diagnosed as osteoarthritis.
Inclusion and exclusion criteria
Inclusion criteria were: (i) all patients met the above diagnostic criteria; (ii) age of more than or equal to 45 years old; (iii) those who did not receive any related treatment before study admission; and (iv) patients with complete clinical and medical records. Exclusion criteria were: (i) patients with severe dysfunction of heart, liver, kidney and other organs; (ii) persons with severe infectious disease or immune disease; (iii) patients with rheumatoid arthritis, joint tuberculosis, gout and bone tumor disease; (iv) persons with neurological diseases or communication difficulties; and (v) person who is participating in other studies.
Patients treated with knee arthroscopic surgery were categorized as control group. Under epidural block anesthesia, patient was on supine position and the knee-eye approach was performed. During arthroscopy, the joints were lavaged and the proliferated synovial membrane, cuff, cartilage and debris were removed. The meniscus was trimmed, the cartilage was polished, and the free body was removed according to surgeon’s judgment. Then the joints are rinsed, and the incision is sutured after completion of the aspiration, and the bandage is compressed. After surgery, patient’s joint was compressed with ice for 12 hours and the drainage tube was removed 48 hours postoperatively. Patients were treated with conventional antibiotics and anticoagulants to prevent infection and thrombosis after the arthroscopic knee surgery.
Patients treated with total knee arthroplasty were categorized as experimental group. All patients were also under epidural block anesthesia for surgery. Incision was made at the anterior median part of the knee joint and the joint capsule was then incised in the superficial layer to the patella to determine the joint disease. Osteophytes, meniscus, cruciate ligament and submental fat pad were excised, and the soft tissue around the knee joint was then removed according to the specific conditions of the patient, and tibia and femur osteotomy were performed at the same time. The distal femoral joint was kept valgus of 5 to 7 degrees and externally rotated 3 degrees. After completion of prosthesis test, the corresponding knee prosthesis was implanted with the use of bone cement. After the total knee replacement operation, a negative pressure drainage tube was placed in the wound, and the incision area was closed with sutures. After the ice was applied for 48 to 72 hours, the drainage tube was removed and patients were treated with antibiotics and anticoagulants. All patients were followed for a period of 6 months.
Changes in HSS, VAS and SAS scores, treatment efficacy, and quality of life of patients were compared between two groups before and after surgery. Among them, HSS is mainly used to evaluate the functions of patients' knee joints, mainly including joint stability, joint muscle strength, range of motion, joint function, joint pain, and degree of joint flexion deformity . The total score is 100 points. A higher score indicates better knee function. VAS is mainly used to assess the pain intensity of patients, with a total score of 0 to 10 points, and the higher the score, the more severe the patient's pain . SAS is mainly used to assess the psychological anxiety of patients. It contains 20 items, of which SAS scores 1 to 4 points. The higher the score, the more severe the patient's anxiety . The curative effect is mainly judged based on the HSS score: an HSS score of ≥84 is excellent; an HSS score of 80-83 is good; an HSS score of 60-69 is acceptable; an HSS score of <60 is poor. Excellent rate = (excellent number + good number) / total number of cases × 100%. The Short Form-36 (SF-36) scale was used to evaluate and analyze the quality of life of patients, including eight aspects such as physiological function, physical function, physical pain, general health, social function, vitality, emotional function and mental health. There are 100 points for each aspect. A higher score indicates a better quality of life.
Data analysis was performed using SPSS 21.0 statistical software. Measurement data were expressed as mean ± standard deviation (M ± SD), and comparison was performed using t-test. Counting data were expressed by examples and percentage, and comparison was made by χ2 test. P-value of less than 0.05 was considered statistically significant.