Old Wang, who has difficulty in walking, suffers from severe pain in his knees and has more difficulty in walking up and down stairs. After running to many major hospitals, he was diagnosed with “osteoarthritis of the knee” (referred to as knee OA), and the doctor’s recommendation was to do a total knee replacement. However, after several family meetings, Wang and his family could not make up their minds. “Surgery, in case of failure, not to mention the tens of thousands of dollars in treatment costs, the worse thing is that their original joints were cut off, the fake joints are not installed, how to live in the future. Do not do the surgery, the pain symptoms are very serious, taking Chinese and Western medicine, physical therapy, external ointment, massage, acupuncture and so on have tried, the effect is still very poor, really affecting the normal life. Artificial joint surgery in the end to do or not to do?”. This is the current situation of many severe knee osteoarthritis. This is the current problem faced by many patients with severe osteoarthritis of the knee, knee replacement surgery is currently a very good way to treat end-stage osteoarthritis, but is not just this one option? Total knee replacement is great, but not enough Osteoarthritis of the knee is a condition in which the cartilage wears down and degenerates leading to pain, fluid buildup, joint instability, bone spurs and other symptoms. Because human beings walk upright, freeing their hands also turns four-legged walking into two-legged walking, and the burden on the knee joints increases, which is why the incidence of osteoarthritis of the knee is so high in human beings. the incidence of people over 60 years of age is as high as 50%, and there are more than 100 million people with OA in our country. Total knee arthroplasty (TKA) is a procedure in which the damaged joint surface is cut off and replaced with a joint surface made of metal, polyethylene, etc. This method eliminates the phenomenon of bone rubbing on bone, and the symptoms of joint pain can be significantly relieved, which is what the people call “replacement of joints”. Generally speaking, patients over 65 years of age with significant and persistent pain in their daily lives, extensive and obvious osteoarthritis on X-ray, especially obvious degeneration of all three compartments of the knee joint, limited extension or flexion of the knee joint, and bone defects are more suitable for the TKA procedure. In Changhai Hospital, with the promotion and implementation of rapid rehabilitation surgery and clinical pathway for artificial joint replacement, this type of surgery has become increasingly safe and precise, with increasing patient satisfaction. Most patients are able to go down to the ground and perform functional exercises within 1~2 days after surgery, and resume daily exercise 1 month after surgery. But even so, only 80% of patients are satisfied with their surgery, and 20% are still dissatisfied with their results. Total knee replacement surgery removes the cruciate ligaments and nearly all of the cartilage from the knee joint, replacing the original physiological structure with an artificial joint mechanism. Although most patients experience significant pain relief after surgery, much of the ability to perform fine and strenuous knee movements is lost, and although it is quite satisfactory for older people who are not very active and do not have high athletic demands, it is not the best choice for younger patients with higher levels of athleticism. Moreover, because the patients are young and have a life expectancy that is longer than that of the artificial joint prosthesis, they also face the risk of the prosthesis wearing out and loosening, and the need to undergo revision increased risk of surgery. For this reason, our close neighbor South Korea introduced a health insurance policy in 2014 that advocates knee-preserving treatment for patients under the age of 65, with no reimbursement from the health insurance for knee replacement. Is total knee replacement the only option? In fact, not all patients with knee disease need to have their entire knee replaced. The human knee joint has three compartments: medial, lateral, anterior compartment, in the knee osteoarthritis patients, about nearly half of the patients, knee pain and degeneration is mainly limited to one side of the knee joint compartment, especially in the medial compartment is more common to this type of patients with a specialized medical diagnosis: anteromedial osteoarthritis. There are more surgical options for this group of patients, which brings us to the “big two” for the treatment of medial unicompartmental osteoarthritis, namely unicondylar arthroplasty (UKA) and high tibial osteotomy (HTO) What is unicondylar arthroplasty? Orthopaedic surgeons have been exploring the possibility of treating unicompartmental osteoarthritis by replacing only the diseased portion of the articular surface and preserving the still-healthy tissue in order to minimize trauma to the patient. Unicondylar knee arthroplasty (UKA) was developed from this concept, and this technique has been developed in Europe and North America for nearly 30 years. The procedure is to replace the cartilage of the diseased medial or lateral compartment, which is about one-third of the cartilage of the entire knee joint, and is described by the general public as a procedure that replaces only half of the joint, and has the advantages of small trauma, low risk, reduced hospitalization, and preservation of normal cruciate ligament and joint cartilage and other advantages. Studies in recent years have shown that, based on correct mastery of the indications and good surgical operation, unicondylar knee replacement can achieve satisfactory results, with 90% of the patients still functioning well at the 20-year post-operative follow-up, and the treatment results are satisfactory. Not all patients with osteoarthritis can use unicondylar replacement to solve their problems, and the decision needs to be made by a specialized doctor based on the patient’s actual situation. Usually, patients who meet these conditions are the best candidates for unicondylar knee replacement: age greater than 55 years old; pain in the knee joint is confined to one side, pain when standing or walking a short distance, and the effect of conservative treatment is not good; X-ray shows narrowing of the joint space in the medial compartment (bone rubbing bone), and the lateral compartment is intact; there is only intra-articular wear and tear, and the bony deformity is not serious; the function of the cruciate ligament is intact, and the mobility is close to normal; bending the knee is close to normal; and the knee is not worn out, and the bone deformity is not severe. The tibial tuberosity and mobility are close to normal; the inversion deformity is correctable at 20° of knee flexion; and there is no inflammatory arthropathy. What is High Tibial Osteotomy (HTO) This procedure was first reported by Dr. Jackson in 1958. Through high tibial osteotomy, the line of force of the lower limb is corrected, and the line of force is shifted from the worn-out medial compartment to the relatively normal lateral compartment, slowing down the destruction of the medial compartment, thus prolonging the service life of the knee joint, and postponing or avoiding knee arthroplasty. Early osteotomies were not as effective as TKA because the indications were not strictly selected, the surgical technique was crude, and there was no secure fixation to ensure the healing of the osteotomy, and it was often used as a palliative surgery only. In recent years, it has been found that as long as the indications are strictly controlled, combined with precise surgical techniques and reliable locking plate fixation for the osteotomy, the surgery can be comparable to total knee replacement in both the immediate and long term, and the recovery of the athletic level is even better than that of the arthroplasty, and a lot of young patients are even able to go for long-distance running and play ball after the surgery. So what kind of patients are eligible for a high tibial osteotomy? Usually patients younger than 65 years of age (there is no lower age limit, as long as the epiphysis is closed), with congenital inversion deformity of the tibial metaphysis combined with osteoarthritis of the medial compartment, with intact lateral compartments, with normal function of the lateral cartilage and meniscus, with near-normal knee motion (flexion greater than 90°, extension less than 20°), with relatively low ligament requirements (anterior or posterior cruciate ligament defects can be present), can be prioritized for HTO. patients can be prioritized for the HTO procedure. If you are a patient with knee osteoarthritis or a family member who is suffering from knee pain, you may wish to learn more about some of the treatment options: from total knee replacement in the context of the Rapid Rehabilitation Surgical Procedure (RRSP), to unicondylar replacement of only part of the joint, to high tibial osteotomies in the context of the “knee-preserving treatment”, you may be pleasantly surprised by the variety of options available to you!