# Cost-Effectiveness Analysis Based on Intelligent Electronic Medical Arthroscopy for the Treatment of Varus Knee Osteoarthritis

Authors: Chunfeng Liu; Zhen Wang; Jinlian Liu; Yaozeng Xu
Journal: Journal of Healthcare Engineering
 (2021)

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## Abstract

The incidence of inverted knee osteoarthritis is slowly increasing, there are technical limitations in the treatment, and the operation is difficult. In this article, we will study the benefits and costs of arthroscopic cleaning treatments based on intelligent electronic medicine. This article focuses on knee osteoarthritis patients in the EL database. There are 12 male patients, accounting for 66.67%, and 6 female patients, accounting for 33.33%. The average body mass index (BMI) of the patients was 28.08, the average time from first knee discomfort to surgery was 28.44 months, and the average time of arthroscopic debridement treatment for patients with VKOH knee osteoarthritis was 143.11 minutes. One case of perioperative complication occurred within 35 days after operation, which was a soleus muscle intermuscular venous thrombosis. After immobilization and enhanced anticoagulation for 1 week, it was stable without risk of shedding. The average postoperative study time was 20.00 months. The electronic medical arthroscopy cleaning treatment plan in this article can greatly improve the quality of life of patients and can check the pathological state in time, with low cost. In the course of treatment, comprehensive treatment costs can be saved by 45%. Arthroscopic clean-up treatment can not only reduce knee pain and other uncomfortable symptoms, restore normal knee joint function, and improve the quality of life of patients, but also correct the unequal length of the lower limbs, thereby avoiding spinal degeneration caused by knee instability. Therefore, it is the first choice for the treatment of advanced knee osteoarthritis in patients with VKOH.


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## Body

## 1. Introduction

Knee osteoarthritis (VKOH) has a high incidence, usually only slight pain in the early stage, and it is generally difficult to be completely cured after inflammation. Its pathogenic mechanism and recovery mechanism have not been universally recognized. The treatment methods are also very limited and controversial. The research on VKOH in academia stays at the stage of biological tissue research, and further research is needed in treatment [1].Yoon found that the first peak of KAM is closely related to bone density, and the second peak of KAM and adduction impulse are also related to the ratio of medial-lateral bone density. When the KAM peak increases by 1% when the patient is walking fast after arthroscopic meniscus debridement, the risk of cartilage defect occurrence or aggravation increases by more than 2 times [2]. Tajima first studied the changes of KAM peak and related symptoms before, during, and after high tibial osteotomy and proposed that KAM is related to the prognosis of VKOH, and patients with high KAM peak have a higher recurrence rate of varus deformity [3]. Ohori further found that patients with knee varus deformity adjust their gait to produce a higher KAM peak and increase gait stability by increasing the medial knee load. The KAM peak has been proposed to be an important parameter that reflects medial knee load. Whether KAM can represent the medial load of the knee joint has always been controversial [4]. Jamsher implanted a pressure sensor into the knee joint to directly measure the load of the medial compartment of a patient under different walking conditions (normal pace, fast pace, slow pace, and deviated foot). The results showed that KAM and the medial knee have linear relationship. Contrary to the previous study, this study did not find a statistical correlation between KAM peak and medial load peak [5]. Fink increased the number of patients and increased the number of implanted sensors from 4 to 6. As a result, it was found that KAM peak and medial load peak had a good correlation in the early stage of the support phase but only a moderate correlation in the later stage. And there are high interindividual differences [6]. KAM is also affected by walking speed and footwear. The definition of the knee joint center during data processing, including the choice of musculoskeletal model, will also affect the measurement results.Peyrache uses gait biomechanics and processed EMG to calibrate and execute the EMG-driven model and calculate the load of muscles and tibia and femur, to observe the more violent walking, running, and lateral striding of healthy individuals. There is a correlation between KAM and the medial load of the knee joint under the gait task. The results show that the inner load during KAM running and outer stride is less predictable. This may be due to muscle load relative to medial load in more intense walking tasks. Contribution increases, while the impact of external load decreases [7]. Jackson found that muscles play a vital role in balancing the coronal load of the knee joint, and the level of muscle contraction may significantly increase the medial load [8]. De Padua uses arthroscopic technology to clean the radial wrist short extensor joint and at the same time decorticalizes the external epicondyle. The results show that the same treatment effect as open surgery can be achieved, but arthroscopic surgery has fewer complications and the movement can be earlier to restore life [9]. Niki reported that the arthroscopic radiofrequency cleaning of the joint capsule and the radial wrist short extensor joint can resume work in an average of 2.2 weeks after the operation, and the grip strength can reach 96% of the contralateral side [10]. Kambara proposed that arthroscopic surgery can directly observe the diseased tissues of the joints and loosen them under direct vision, making the operation more intuitive and accurate, avoiding the blindness of percutaneous release, and cleaning the degenerated tissues on the joint surface at the same time [11]. The above studies are mostly in the detection stage, and they are blind in treatment, and the cost is high and the recurrence rate is high. There are many meaningless tasks in actual implementation, and there is a risk of aggravating the disease.This article studies the arthroscopic clean-up treatment plan for varus knee osteoarthritis, compares the cost and effect of the treatment with the ordinary treatment plan, and reviews the characteristics of the current disease population and the research stage and the patient’s recovery and pain feeling in the evaluation and analysis.


## 2. Electronic Medicine and Varus Knee Osteoarthritis

### 2.1. Electronic Medical Arthroscopy and Its Clinical Application in the Treatment of Varus Knee Osteoarthritis

In knee arthroscopic surgery, a large amount of normal saline is used as lavage fluid to fill the surgical field and clean up free tissue during the operation [12]. Due to the destruction of normal joint tissue by knee arthroscopy and continuous lavage and expansion of the joint cavity, patients will experience knee joint pain and swelling after surgery, which affects postoperative rehabilitation training and resuming sports [13]. Clinically, preoperative preventive medication, intraoperative intervention, and postoperative pain medication are used to reduce the impact of knee arthroscopy [14]. It is pointed out in literature that the use of saline lavage at different temperatures during knee arthroscopy will not affect postoperative knee joint pain and swelling [15]. However, there is currently a question about whether continuous saline lavage during knee arthroscopy will affect early postoperative pain and swelling. The situation has not been reported yet [16]. At this stage, there are mainly two methods for the treatment of VKOH: surgical and nonsurgical [17]. Nonsurgical treatment mainly includes using crutches or walking aids to limit weight-bearing, movement correction, and physical therapy to reduce the pressure on the hip [18]. However, these methods have no effect in the treatment of advanced osteonecrosis and have limited effects in preventing disease progression, even in the early stage of VKOH (ARCO stages I and II) [19]. In terms of treatment, patients are encouraged to adopt methods such as weight control, quitting smoking and alcohol, and avoiding the use of hormones to delay the early progression of VKOH [20]. At present, the most common indications for arthroscopy in the treatment of knee joint diseases include femoral acetabular impingement, knee cleft labrum, and articular cartilage injury [21]. The earliest description of arthroscopic treatment of VKOH was to use arthroscopy to record the exact position of VKOH core decompression in the study. As more and more joint surgeons apply arthroscopy to the knee-saving treatment of early and midterm femoral head necrosis, they have obtained reliable midterm survival rates and acceptable total knee replacement rates.


### 2.2. Arthroscopy Is Used in the Diagnosis and Treatment of VKOH

The staging and treatment of varus knee osteoarthritis are closely related. Different stages of VKOH mean that the disease goes into different stages, needs to solve different problems, and faces different surgical methods. Therefore, accurate staging is very important for treatment guidance [22]. The clinical staging of femoral head necrosis mainly relies on the results of the patient’s imaging examination and estimates the location and extent of the necrosis based on the X-ray, CT, and MRI of the patient’s knee and evaluates the patient’s condition [23]. Although MRI is more sensitive to the diagnosis of VKOH than other tests, when MRI shows changes in the femoral head such as ischemia, there is already cartilage damage on the surface of the femoral head under arthroscopy [24]. Therefore, imaging examinations cannot confirm the diagnosis of injuries in the knee joint. The final diagnosis requires arthroscopic surgery to assist in the diagnosis [25]. Therefore, in terms of diagnostics, arthroscopic technology can accurately assess the articular surfaces of the femoral head and acetabulum for accurate staging [26]. Although there is no standard method to guide the hip-preserving treatment of VKOH, in order to reduce the intramedullary pressure that increases due to the process of osteonecrosis and inflammatory cell infiltration in the process of varus knee osteoarthritis, core decompression (CD) has been considered to be the most common treatment for early lesions [27]. In addition to the treatment of bone necrosis, the assistance of arthroscopy also plays a vital role in the accompanying pathological changes of soft tissue or cartilage and is less traumatic, which is conducive to rehabilitation. The report on the treatment of femoral head necrosis with core decompression and platelet-rich plasma (PRP) under arthroscopy describes the unique advantages of arthroscopy, which can accurately locate and drill the necrosis under direct vision of the arthroscopy and is effective in avoiding penetrating the articular surface and help guide the decompression of the core to the necrotic area [28]. Therefore, whether it is diagnosis or treatment, the assistance of arthroscopy will provide an important role for early VKOH. With clinical efficacy and complications core decompression (CD) is considered to be the most common treatment for the precollapse lesions of varus knee osteoarthritis. Although CD is the most common and basic method of femoral head preservation, it has been proven that successful results were achieved in the staged lesions before collapse. Excessive flushing pressure in the joint cavity will increase the pressure on the femoral head and easily aggravate ischemia; improper traction time and strength during lower limb traction may cause perineal soft tissue damage, compressed bruising of the foot, and perineal nerve and sciatic nerve damage [29].Knee joint bone and joint surgery has gradually become the focus of joint surgeons. Although various hip-preserving surgeries have not achieved breakthrough development, hip-preserving surgery assisted by arthroscopy is a new, evolving, and promising surgery method; in continuous follow-up observation and in-depth analysis, it is found that it has a significant clinical effect in the precollapse treatment of femoral head necrosis. Even if most patients eventually progress to the late stage of joint collapse and require total knee replacement, the use of this technology has effectively delayed the progression of the disease and delayed the arrival of knee replacement. Therefore, we advocate early diagnosis and early treatment, and early intervention for femoral head necrosis is very important. We believe that with the deepening of research on VKOH, whether it is arthroscopic-assisted surgery or other hip-saving surgery, it will eventually help patients recover from this intractable joint disease.


### 2.3. Electronic Medical Records

The electronic medical record (EHR) stores the patient’s diagnosis and treatment information, which helps to provide convenient health record storage services. For severe or chronic diseases, if the doctor can see the previous medical history when the patient sees the doctor, he can synthesize the previous diagnosis and treatment effect, analyze the condition more comprehensively and accurately, and provide the patient with a more efficient treatment plan. At the same time, for major infectious diseases, the sharing of EHR can also enable excellent medical teams from various regions to conduct comprehensive, accurate, and rapid assessment of the epidemic situation, improving the efficiency of treatment and the level of public medical health [30]. However, the current data interoperability between different hospitals is relatively poor, and medical data generally have the problem of data islands. Most of the electronic medical record data are controlled by hospitals, and patients are not fully aware of the use of their medical records. The personal information and medical records of patients are stored in the EHR. Once attacked, sensitive information such as patient privacy will be leaked, causing security risks and conflicts between doctors and patients. Therefore, the protection of data and identity privacy during EHR sharing is very important. In order to realize the safe sharing of medical data between different hospitals, the medical records are encrypted and the ciphertext is stored on the cloud server to realize the sharing of EHR. The cloud server is usually semitrusted, and it executes the user’s commands but is still curious about the user’s information [31]. In the absence of supervision and specific attacks, the cloud may tamper with, lose, or leak user data. The blockchain can also hide the data on the blockchain in certain scenarios, so it can be used to achieve safe and credible EHR management. Due to the current performance bottleneck of the blockchain, and because EHR usually includes large-scale, cross-media health data, such as CT, X-ray, and other medical imaging data, it is not efficient to simply use the blockchain to store and share HER [32], and it is urgently necessary to combine cloud storage and blockchain to complement each other’s advantages and achieve safe and efficient EHR sharing.


### 2.4. Electronic Medical Joint Diagnosis and Diagnosis Information Protection Model

Based on the Practical Byzantine Joint Recognition Algorithm (PBFT), this paper improves the KPBFT joint recognition algorithm and forms an alliance blockchain among hospitals at all levels across the country. Forn hospitals, k cluster centers are randomly selected as proxy nodes to form a proxy node group. Number them, and members of the proxy node group take turns to become the master nodes on duty. Consider the geographical location, equipment hardware, network delay, and other factors among the hospitals to perform clustering. The joint recognition knot formula is as follows:(1)Pd,n=∑k=10n−210n−1−1log1+110k+d,where E represents the number of samples correctly classified, and K represents the number of samples tested. The activation function has a slope gradient of 1 for all positive inputs, indicating that using the IC activation function can make the gradient descent run faster and effectively reduce the training time:(2)fx=∑n=0∞fnx0n!x−x0n.In the Detection Net model structure proposed in this article, different convolutional layers use multiple convolution kernels to extract the characteristics of knee joint bone and joint disease:(3)SC=P×Q−1,(4)Ej=1/2uj∑i=1nj∑r=1njyji−yjrnj2,(5)Ew=∑j=1kGjjpjsj.In addition, the knee joint bones have rich detailed features. If the convolutional field of view is too large, it is not conducive to the extraction of detailed features. The convolutional neural network in this article uses two 3 × 3 convolutions to replace a 5 × 5 convolution in the module:(6)IB=∑Z=1hj∑r=1nhyji−yhrnjnhuj+uh,(7)Enb=∑j=2k∑h=1j−1Gjhpjsh+phsjDjh,(8)σt=1/n∑i=1nFIit−FIit2FIit.First, joint recognition is achieved between each type of node, then joint recognition is performed between the agent node groups, and finally joint recognition is achieved. After a period of time, change the cluster center and recluster. The joint recognition process is as follows:(9)M=djh−Pjhdjh+Pjh.The joint recognition process is described as the request stage: when the patient wants to upload the medical record data or the data userDu wants to access the transaction, the client initiates a request to the master node on duty. The master node verifies the legitimacy of the transaction and discards the transaction directly if it is illegal. Otherwise, the transaction is numbered, put into the list, and broadcast to other members of the proxy node group [33]. In this process, the node needs to verify whether the CSP signature in the transaction is correct and whether the access policy in the blockchain is the same as that in the cloud(10)vui,pk=fui,pk×logm/mui+0.01∑pkuiufui,pk×logm/mui+0.01×constpk,(11)djh=∫0∞dFhy∫0yy−xdFjy.When attribute LX of Du is revoked, in order to ensure the security of the file, AA first adds the revoked attribute LX to the attribute revocation list XARL and sends it to inform them that a certain attribute of the user has been revoked and then performs the following operations:(12)fx=1Nh∑i=1NkXi−xh,(13)kx=12πexp−x22.Cloud server is semitrusted; it will execute the user’s request, but it is also interested in the user’s privacy data. In this model, the encrypted file is stored, and the cloud server cannot obtain the decryption key, so the file cannot be decrypted, so the data privacy can be guaranteed(14)lnFIitFIit−1=α+βlnFIit−1+vi+ℑt,(15)ht=ztΘht−1+1−ztΘht.The quality of data directly affects the quality of medical monitoring, analysis, and decision-making. The accuracy, integrity, and consistency of the three elements to ensure data quality are shown in(16)P=σt=1/n∑i=1nFIit−FIit2FIit,(17)uj|i=wijAi,(18)sj=∑icijuj|i.A probability valuep is given to the point, and P is a random number between 0 and 1. Compared with the generating probability prob, P has the following formula:(19)lnPIitPIit−1=α+βlnPIit−1+vi+ℑt.The proposed loss function makes the frame regression process of target detection faster and more accurate than the previous loss function(20)ht=tanhwcxt+ucrtΘht−1+bc,(21)lnFIitFIit−1=α+βlnFIit−1+ϕXit−1+vi+τt.After the electronic medical intelligent computing system updates the attribute key and the public attribute key [34], the updated private key, and the corresponding ciphertext, the updated ciphertext is sent to the medical and blockchain nodes according to the method in the construction, and the block is restored on the chain. After performing the above operations, the person who does not have the corresponding attribute will not be able to view the file encrypted with the corresponding attribute, and the security of the patient’s file information will be ensured.


## 2.1. Electronic Medical Arthroscopy and Its Clinical Application in the Treatment of Varus Knee Osteoarthritis

In knee arthroscopic surgery, a large amount of normal saline is used as lavage fluid to fill the surgical field and clean up free tissue during the operation [12]. Due to the destruction of normal joint tissue by knee arthroscopy and continuous lavage and expansion of the joint cavity, patients will experience knee joint pain and swelling after surgery, which affects postoperative rehabilitation training and resuming sports [13]. Clinically, preoperative preventive medication, intraoperative intervention, and postoperative pain medication are used to reduce the impact of knee arthroscopy [14]. It is pointed out in literature that the use of saline lavage at different temperatures during knee arthroscopy will not affect postoperative knee joint pain and swelling [15]. However, there is currently a question about whether continuous saline lavage during knee arthroscopy will affect early postoperative pain and swelling. The situation has not been reported yet [16]. At this stage, there are mainly two methods for the treatment of VKOH: surgical and nonsurgical [17]. Nonsurgical treatment mainly includes using crutches or walking aids to limit weight-bearing, movement correction, and physical therapy to reduce the pressure on the hip [18]. However, these methods have no effect in the treatment of advanced osteonecrosis and have limited effects in preventing disease progression, even in the early stage of VKOH (ARCO stages I and II) [19]. In terms of treatment, patients are encouraged to adopt methods such as weight control, quitting smoking and alcohol, and avoiding the use of hormones to delay the early progression of VKOH [20]. At present, the most common indications for arthroscopy in the treatment of knee joint diseases include femoral acetabular impingement, knee cleft labrum, and articular cartilage injury [21]. The earliest description of arthroscopic treatment of VKOH was to use arthroscopy to record the exact position of VKOH core decompression in the study. As more and more joint surgeons apply arthroscopy to the knee-saving treatment of early and midterm femoral head necrosis, they have obtained reliable midterm survival rates and acceptable total knee replacement rates.


## 2.2. Arthroscopy Is Used in the Diagnosis and Treatment of VKOH

The staging and treatment of varus knee osteoarthritis are closely related. Different stages of VKOH mean that the disease goes into different stages, needs to solve different problems, and faces different surgical methods. Therefore, accurate staging is very important for treatment guidance [22]. The clinical staging of femoral head necrosis mainly relies on the results of the patient’s imaging examination and estimates the location and extent of the necrosis based on the X-ray, CT, and MRI of the patient’s knee and evaluates the patient’s condition [23]. Although MRI is more sensitive to the diagnosis of VKOH than other tests, when MRI shows changes in the femoral head such as ischemia, there is already cartilage damage on the surface of the femoral head under arthroscopy [24]. Therefore, imaging examinations cannot confirm the diagnosis of injuries in the knee joint. The final diagnosis requires arthroscopic surgery to assist in the diagnosis [25]. Therefore, in terms of diagnostics, arthroscopic technology can accurately assess the articular surfaces of the femoral head and acetabulum for accurate staging [26]. Although there is no standard method to guide the hip-preserving treatment of VKOH, in order to reduce the intramedullary pressure that increases due to the process of osteonecrosis and inflammatory cell infiltration in the process of varus knee osteoarthritis, core decompression (CD) has been considered to be the most common treatment for early lesions [27]. In addition to the treatment of bone necrosis, the assistance of arthroscopy also plays a vital role in the accompanying pathological changes of soft tissue or cartilage and is less traumatic, which is conducive to rehabilitation. The report on the treatment of femoral head necrosis with core decompression and platelet-rich plasma (PRP) under arthroscopy describes the unique advantages of arthroscopy, which can accurately locate and drill the necrosis under direct vision of the arthroscopy and is effective in avoiding penetrating the articular surface and help guide the decompression of the core to the necrotic area [28]. Therefore, whether it is diagnosis or treatment, the assistance of arthroscopy will provide an important role for early VKOH. With clinical efficacy and complications core decompression (CD) is considered to be the most common treatment for the precollapse lesions of varus knee osteoarthritis. Although CD is the most common and basic method of femoral head preservation, it has been proven that successful results were achieved in the staged lesions before collapse. Excessive flushing pressure in the joint cavity will increase the pressure on the femoral head and easily aggravate ischemia; improper traction time and strength during lower limb traction may cause perineal soft tissue damage, compressed bruising of the foot, and perineal nerve and sciatic nerve damage [29].Knee joint bone and joint surgery has gradually become the focus of joint surgeons. Although various hip-preserving surgeries have not achieved breakthrough development, hip-preserving surgery assisted by arthroscopy is a new, evolving, and promising surgery method; in continuous follow-up observation and in-depth analysis, it is found that it has a significant clinical effect in the precollapse treatment of femoral head necrosis. Even if most patients eventually progress to the late stage of joint collapse and require total knee replacement, the use of this technology has effectively delayed the progression of the disease and delayed the arrival of knee replacement. Therefore, we advocate early diagnosis and early treatment, and early intervention for femoral head necrosis is very important. We believe that with the deepening of research on VKOH, whether it is arthroscopic-assisted surgery or other hip-saving surgery, it will eventually help patients recover from this intractable joint disease.


## 2.3. Electronic Medical Records

The electronic medical record (EHR) stores the patient’s diagnosis and treatment information, which helps to provide convenient health record storage services. For severe or chronic diseases, if the doctor can see the previous medical history when the patient sees the doctor, he can synthesize the previous diagnosis and treatment effect, analyze the condition more comprehensively and accurately, and provide the patient with a more efficient treatment plan. At the same time, for major infectious diseases, the sharing of EHR can also enable excellent medical teams from various regions to conduct comprehensive, accurate, and rapid assessment of the epidemic situation, improving the efficiency of treatment and the level of public medical health [30]. However, the current data interoperability between different hospitals is relatively poor, and medical data generally have the problem of data islands. Most of the electronic medical record data are controlled by hospitals, and patients are not fully aware of the use of their medical records. The personal information and medical records of patients are stored in the EHR. Once attacked, sensitive information such as patient privacy will be leaked, causing security risks and conflicts between doctors and patients. Therefore, the protection of data and identity privacy during EHR sharing is very important. In order to realize the safe sharing of medical data between different hospitals, the medical records are encrypted and the ciphertext is stored on the cloud server to realize the sharing of EHR. The cloud server is usually semitrusted, and it executes the user’s commands but is still curious about the user’s information [31]. In the absence of supervision and specific attacks, the cloud may tamper with, lose, or leak user data. The blockchain can also hide the data on the blockchain in certain scenarios, so it can be used to achieve safe and credible EHR management. Due to the current performance bottleneck of the blockchain, and because EHR usually includes large-scale, cross-media health data, such as CT, X-ray, and other medical imaging data, it is not efficient to simply use the blockchain to store and share HER [32], and it is urgently necessary to combine cloud storage and blockchain to complement each other’s advantages and achieve safe and efficient EHR sharing.


## 2.4. Electronic Medical Joint Diagnosis and Diagnosis Information Protection Model

Based on the Practical Byzantine Joint Recognition Algorithm (PBFT), this paper improves the KPBFT joint recognition algorithm and forms an alliance blockchain among hospitals at all levels across the country. Forn hospitals, k cluster centers are randomly selected as proxy nodes to form a proxy node group. Number them, and members of the proxy node group take turns to become the master nodes on duty. Consider the geographical location, equipment hardware, network delay, and other factors among the hospitals to perform clustering. The joint recognition knot formula is as follows:(1)Pd,n=∑k=10n−210n−1−1log1+110k+d,where E represents the number of samples correctly classified, and K represents the number of samples tested. The activation function has a slope gradient of 1 for all positive inputs, indicating that using the IC activation function can make the gradient descent run faster and effectively reduce the training time:(2)fx=∑n=0∞fnx0n!x−x0n.In the Detection Net model structure proposed in this article, different convolutional layers use multiple convolution kernels to extract the characteristics of knee joint bone and joint disease:(3)SC=P×Q−1,(4)Ej=1/2uj∑i=1nj∑r=1njyji−yjrnj2,(5)Ew=∑j=1kGjjpjsj.In addition, the knee joint bones have rich detailed features. If the convolutional field of view is too large, it is not conducive to the extraction of detailed features. The convolutional neural network in this article uses two 3 × 3 convolutions to replace a 5 × 5 convolution in the module:(6)IB=∑Z=1hj∑r=1nhyji−yhrnjnhuj+uh,(7)Enb=∑j=2k∑h=1j−1Gjhpjsh+phsjDjh,(8)σt=1/n∑i=1nFIit−FIit2FIit.First, joint recognition is achieved between each type of node, then joint recognition is performed between the agent node groups, and finally joint recognition is achieved. After a period of time, change the cluster center and recluster. The joint recognition process is as follows:(9)M=djh−Pjhdjh+Pjh.The joint recognition process is described as the request stage: when the patient wants to upload the medical record data or the data userDu wants to access the transaction, the client initiates a request to the master node on duty. The master node verifies the legitimacy of the transaction and discards the transaction directly if it is illegal. Otherwise, the transaction is numbered, put into the list, and broadcast to other members of the proxy node group [33]. In this process, the node needs to verify whether the CSP signature in the transaction is correct and whether the access policy in the blockchain is the same as that in the cloud(10)vui,pk=fui,pk×logm/mui+0.01∑pkuiufui,pk×logm/mui+0.01×constpk,(11)djh=∫0∞dFhy∫0yy−xdFjy.When attribute LX of Du is revoked, in order to ensure the security of the file, AA first adds the revoked attribute LX to the attribute revocation list XARL and sends it to inform them that a certain attribute of the user has been revoked and then performs the following operations:(12)fx=1Nh∑i=1NkXi−xh,(13)kx=12πexp−x22.Cloud server is semitrusted; it will execute the user’s request, but it is also interested in the user’s privacy data. In this model, the encrypted file is stored, and the cloud server cannot obtain the decryption key, so the file cannot be decrypted, so the data privacy can be guaranteed(14)lnFIitFIit−1=α+βlnFIit−1+vi+ℑt,(15)ht=ztΘht−1+1−ztΘht.The quality of data directly affects the quality of medical monitoring, analysis, and decision-making. The accuracy, integrity, and consistency of the three elements to ensure data quality are shown in(16)P=σt=1/n∑i=1nFIit−FIit2FIit,(17)uj|i=wijAi,(18)sj=∑icijuj|i.A probability valuep is given to the point, and P is a random number between 0 and 1. Compared with the generating probability prob, P has the following formula:(19)lnPIitPIit−1=α+βlnPIit−1+vi+ℑt.The proposed loss function makes the frame regression process of target detection faster and more accurate than the previous loss function(20)ht=tanhwcxt+ucrtΘht−1+bc,(21)lnFIitFIit−1=α+βlnFIit−1+ϕXit−1+vi+τt.After the electronic medical intelligent computing system updates the attribute key and the public attribute key [34], the updated private key, and the corresponding ciphertext, the updated ciphertext is sent to the medical and blockchain nodes according to the method in the construction, and the block is restored on the chain. After performing the above operations, the person who does not have the corresponding attribute will not be able to view the file encrypted with the corresponding attribute, and the security of the patient’s file information will be ensured.


## 3. Cost-Effectiveness Study of Varus Knee Osteoarthritis

### 3.1. Treatment of Research Samples

There were 12 male patients (66.67%) and 6 female patients (33.33%). The average age of the patients was (38.22 ± 7.55) years, the average height was (159.89 ± 10.25) cm, the average body mass index (BMI) was 28.08 ± 3.47, the average time from the first knee discomfort to the operation was (28.44 ± 20.20) months, the average operation time of arthroscopic debridement for VKOH knee osteoarthritis patients was (143.11 ± 42.74) min, the average intraoperative blood loss was (393.89 ± 174.28) ml, and the postoperative time to go to the ground was (143.11 ± 42.74) min. One case of perioperative complication occurred within 35 days after operation, which was soleus intramuscular venous thrombosis. After immobilization and strengthening anticoagulation for one week, it was stable without falling off risk. The average postoperative study time was (20.00 ± 9.49) months.


### 3.2. Treatment Methods and Data Processing

The operation was performed by the same sports medicine doctor with 15 years of clinical experience. Normal saline at room temperature (23°C) was used as lavage solution, which was hung on the bedside infusion rack, the pressure was about 10.64 kpa, the water inlet was connected with arthroscope, the water outlet was connected with planer and suction device [35], and meniscus plasty was completed at about 2 bags of 3 L normal saline. Group A did not continue to lavage normal saline, and group B and group C continued to lavage 1 L and 3 L room temperature normal saline, respectively. Celecoxib, a nonsteroidal anti-inflammatory and analgesic drug, was used for 2 weeks, 200 mg once a day. After the operation, quadriceps femoris and hamstring muscle isometric contraction exercise can be started. On the second day after the operation, according to the standard rehabilitation training plan after arthroscopic meniscus plasty, functional exercise can be gradually carried out to recover muscle function and joint activity.Three days after operation, the circumference was measured at 2 cm above the patella of both knees, and the swelling degree was evaluated by the difference between the circumference of the affected side and the healthy side (swelling value). One and three days after the operation, the lower limbs were exposed at room temperature for 15 minutes. The skin temperature of the knee joints adjacent to the patella was measured twice, and the mean value was taken as the final skin temperature, with an interval of 5 minutes. Functional score and data measurement were performed by the same doctor with 7 years of clinical experience.


## 3.1. Treatment of Research Samples

There were 12 male patients (66.67%) and 6 female patients (33.33%). The average age of the patients was (38.22 ± 7.55) years, the average height was (159.89 ± 10.25) cm, the average body mass index (BMI) was 28.08 ± 3.47, the average time from the first knee discomfort to the operation was (28.44 ± 20.20) months, the average operation time of arthroscopic debridement for VKOH knee osteoarthritis patients was (143.11 ± 42.74) min, the average intraoperative blood loss was (393.89 ± 174.28) ml, and the postoperative time to go to the ground was (143.11 ± 42.74) min. One case of perioperative complication occurred within 35 days after operation, which was soleus intramuscular venous thrombosis. After immobilization and strengthening anticoagulation for one week, it was stable without falling off risk. The average postoperative study time was (20.00 ± 9.49) months.


## 3.2. Treatment Methods and Data Processing

The operation was performed by the same sports medicine doctor with 15 years of clinical experience. Normal saline at room temperature (23°C) was used as lavage solution, which was hung on the bedside infusion rack, the pressure was about 10.64 kpa, the water inlet was connected with arthroscope, the water outlet was connected with planer and suction device [35], and meniscus plasty was completed at about 2 bags of 3 L normal saline. Group A did not continue to lavage normal saline, and group B and group C continued to lavage 1 L and 3 L room temperature normal saline, respectively. Celecoxib, a nonsteroidal anti-inflammatory and analgesic drug, was used for 2 weeks, 200 mg once a day. After the operation, quadriceps femoris and hamstring muscle isometric contraction exercise can be started. On the second day after the operation, according to the standard rehabilitation training plan after arthroscopic meniscus plasty, functional exercise can be gradually carried out to recover muscle function and joint activity.Three days after operation, the circumference was measured at 2 cm above the patella of both knees, and the swelling degree was evaluated by the difference between the circumference of the affected side and the healthy side (swelling value). One and three days after the operation, the lower limbs were exposed at room temperature for 15 minutes. The skin temperature of the knee joints adjacent to the patella was measured twice, and the mean value was taken as the final skin temperature, with an interval of 5 minutes. Functional score and data measurement were performed by the same doctor with 7 years of clinical experience.


## 4. Cost-Effectiveness Analysis of Varus Knee Osteoarthritis

### 4.1. Symptoms and Treatment of Common Varus Knee Osteoarthritis

As shown in Figure1, the difference of varus angle can not fully represent the dynamic lower limb force line. Compared with the peak varus angle of the knee, the peak varus angular velocity of the knee is closer to the visual varus extension, and the varus angular velocity of the knee not only reflects the direction of motion, but also reflects the speed of motion, which may be more suitable for capturing the dynamic characteristics of varus extension. From a biomechanical point of view, the increased medial load of the knee caused by varus deformity can lead to cartilage degeneration, bone marrow damage, and meniscal damage, which has a greater effect on VKOH progression than static varus deformity. In addition, varus extension has stronger correlation with knee pain and stiffness in weight-bearing activities, which may also be associated with cartilage injury and bone marrow edema.Figure 1
Adequately represent the dynamic line of force of the lower limbs.As shown in Table1, patients with varus extension are more likely to suffer from pain. Varus extension is a risk factor for knee pain and pain deterioration. Whether or not varus deformity was present during varus extension was associated with knee pain. Considering the effect of varus extension on pain and VKOH progression, the treatment targeted to correct dynamic varus can prevent the development or deterioration of knee pain in VKOH patients to a certain extent. Conservative treatment methods, such as gait adjustment strategy and wedge insole, are used to improve varus extension. High tibial osteotomy is a common method to change the mechanical bearing axis and the load of the knee joint, which can improve the varus extension of the knee joint. Total knee arthroplasty can also achieve long-term improvement of varus extension. Varus extension can only reflect the force arm of adduction moment and impulse, but not the force.Table 1
Varus extension is the occurrence of knee joint pain and pain deterioration.
ItemBone marrow injuryMeniscus injuryCartilageBone marrowJoint painStiffVKOH3.785.223.513.414.275.04Inversion1.933.994.481.285.622.57Peak angle2.412.964.893.564.433.81Angular2.256.224.042.656.924.83Visualization4.486.642.665.666.163.87Biology2.394.174.425.671.81As shown in Figure2, intra-articular injection of arthroscopic debridement injection can improve knee joint function better than sodium hyaluronate injection group in the early stage of treatment, and the long-term effect is similar to that of sodium hyaluronate injection group. The larger the KAM is, the easier the medial meniscus is to be injured, the more severe the injury is, and the greater the ratio of the medial tibial subchondral bone area is. However, the cartilage thickness and spalling area of femur and tibia were not related to KAM. This shows that biomechanical changes have different effects on different tissue structures of the knee joint, which is not only related to the structural strength of the tissue, but also related to the mechanical biological characteristics of the body to mechanical response, and its mechanism needs further study.Figure 2
The important role of removing albumin status in improving MA.As shown in Table2, due to the advantages of overall adjustment, internal and external treatment, being simple and cheap, and being safe and reliable, the drugs for clearing and treating joint drug factors are gradually recognized in the treatment of knee osteoarthritis. Performing the Chinese herbal medicine iontophoresis after arthrocentesis can lower the pain threshold, ease the limitation of joint activity, and help the patient recover smoothly.Table 2
The overall regulation of drug factors for cleaning and treating joint drug factors.
ItemMMP1IL-17VKOHInversion anglePeak angleROSKAM2.354.492.673.892.045.76Tibia2.012.582.991.212.62.62Meniscus3.41.444.024.261.64.45Curative effect2.365.284.254.133.293.34Peel off4.783.226.751.296.141.96CXCL121.114.93.923.441.031.81As shown in Figure3, the average BMI of the patients was 28.08 ± 3.47, which was significantly higher than the average level of 23.71 of the national population, indicating that the stature of VKOH patients was short and fat, and the load of the spine and knee joint was in a high load state, thus accelerating the wear, damage, and osteoarthritis, which may also be the primary reason why the age of the first arthroscopic debridement of VKOH patients was only 38.22 years. The average time from the first knee discomfort to surgery was (28.44 ± 20.20) months. The clinical manifestations of VKOH patients were typical vertebral body widening, flattening, typical ladder like changes, and kyphosis deformity. This also needs to be considered before arthroscopic debridement and corrected during operation; so as to make the arthroscopic debridement of VKOH patients more effective the difficulty of treatment increased significantly.Figure 3
Urine microalbumin detection and analysis results.As shown in Table3, the knee osteoarthritis of 9 patients with VKOH in this paper was at T3 level at the time of clinical first diagnosis, and they had lost the opportunity of hip preservation, so they all received arthroscopic debridement treatment. In order to improve the appearance and function and improve the quality of life of patients, arthroscopic debridement treatment should be carried out.Table 3
Hip osteoarthritis in VKOH patients.
ItemVKOHMAULeNetDetectionInceptionROSBMI1.150.080.921.641.570.9DKD2.452.893.491.343.071.71THA5.395.235.43.1542.02Excretion1.935.823.932.055.822.24Gender2.131.21.981.552.122.7FPG3.313.164.793.194.054.86


### 4.2. Cost Analysis of Varus Knee Osteoarthritis

As shown in Figure4, patients with knee pain for a long time can not carry out normal physical exercise, often accompanied by obvious bone deficiency or osteoporosis; there is a potential risk of knee, thoracic, and lumbar fractures, and the cost of treatment is large, and it seriously affects the quality of life of patients. The electronic medical arthroscopic lavage treatment scheme in this paper can significantly improve the patient’s quality of life and allow timely checks of morbidity at less cost. During the course of treatment, you can save 45% on the cost of comprehensive treatment.Figure 4
Cost analysis of knee osteoarthritis treatment.As shown in Table4, the prevalence of VKOH over 40 years of age is 36.4%. With the increase of age, the prevalence increases. How to protect and slow down the process of knee joint is the research focus of many scholars. Clinically, the purpose is to improve symptoms, relieve pain and inflammation, correct deformities, improve structure, prevent joint degeneration, and maintain joint function. The concept of step-by-step treatment provides a safe, effective, and popularized diagnosis and treatment strategy for clinical treatment of VKOH. Mild VKOH is generally recognized as a clean-up treatment. With the initial use of basic treatment such as exercise therapy, weight management, physical therapy after treatment, the symptoms worsen or the effect is not good, which can be upgraded to drug treatment, and the total cost is greatly reduced.Table 4
The prevalence of VKOH in recent studies.
ItemMMP1IL-17VKOHInversion anglePeak angleROSIliac wings2.893.283.791.811.861.93Varus deformity3.563.82.624.255.035.8Hip5.144.222.181.664.531.54Thoracic2.21.262.242.023.183.36Lumbar spine2.385.741.652.031.611.08FPG6.486.876.381.872.33.28


### 4.3. Effect Analysis of Arthroscopic Debridement in the Treatment of Varus Knee Osteoarthritis

All patients with VKOH knee osteoarthritis who underwent arthroscopic debridement were studied postoperatively. The perioperative characteristics of patients are shown in Figure5. No serious complications such as vascular and nerve injury, thrombosis, pulmonary infection, cardiovascular and cerebrovascular complications, and death were found. In addition, the early complications of VKOH patients after arthroscopic debridement are prosthesis dislocation and aseptic loosening, and the less common complications are pain, infection, periprosthetic fracture, etc. These can be fully evaluated by preoperative comprehensive evaluation of VKOH patients with knee joint lesions, selection of appropriate prosthesis, standardization of various operations, improvement of surgical proficiency, reconstruction of normal anatomical structure, so as to make the rotation heart down, and so on.Figure 5
Patients undergoing THA due to VKOH knee osteoarthritis.As shown in Figure6, arthroscopic debridement can not only relieve knee pain and other discomfort symptoms, but also correct the problem of unequal length of both lower limbs, so as to avoid spinal degeneration caused by knee instability. Therefore, arthroscopic debridement is the first choice for the treatment of advanced knee osteoarthritis in patients with VKOH. The average pelvic incidence angle of VKOH patients after arthroscopic debridement was significantly higher than that before operation. With the improvement of sagittal plane balance, VAS score also improved. It is speculated that sagittal plane balance may be closely related to the above evaluation indexes after arthroscopic debridement.Figure 6
THA improves knee pain and other uncomfortable symptoms.As shown in Figure7, during the perioperative period within 35 days after operation, one patient with VKOH who underwent bilateral arthroscopic debridement developed thrombosis in the right operating limb (left side was normal). On the second day after operation, the patient had continuous swelling pain in the right leg and behind the knee, limited venous return, and occasional numbness. Color doppler ultrasound found that there was thrombosis in the soleus muscle, with a diameter of less than 1 cm. The patients were given immobilization, limb elevation, strengthening anticoagulation, and monitoring of coagulation indexes. On the 7th day when the thrombus was stable, the patient was guided to perform routine postoperative rehabilitation. On the 35th day after the operation, the thrombus was stable. The reasons may be obesity (BMI = 30.38), longer operation time (178 min), more blood loss (720 ml), and infusion of allogeneic plasma and colloid solution, which lead to increased blood viscosity. Therefore, we should be alert and standardize anticoagulation therapy.Figure 7
VKOH patient with bilateral THA right operative limb.As shown in Table5, patients with spinal deformity showed flat vertebral body, narrow intervertebral space, and kyphosis, with or without compression of lumbosacral plexus. According to the data of Tonnis, the severity of preoperative knee osteoarthritis can be graded and analyzed on the pelvic anteroposterior X-ray film in standing position.Table 5
Patient manifestations of spinal deformity.
ItemBMIBlood vesselNerve damageThrombusLung infectionCardiovascular102.253.842.081.252.321.51202.793.552.964.853.543.38301.31.143.71.95.051.7402.443.32.754.593.351.23502.192.414.253.853.094.87603.793.383.065.292.222.02In this paper, the data of patients who underwent arthroscopic debridement due to VKOH were analyzed retrospectively. The postoperative clinical function and imaging results were analyzed, as shown in Figure8. VKOH patients are mostly young and have a large amount of activity. Due to bone dysplasia and short stature, abnormal bone morphology of knee joint, early knee conserving surgery, and so on, the spinal and pelvic parameters are significantly abnormal, which brings great challenges to arthroscopic treatment.Figure 8
Patients with THA underwent retrospective data.As shown in Figure9, the incidence rate of epiphyseal defects secondary to collagen type II is about 0.1–0.4/10. It is easily confused with the dwarfism caused by the disease such as myxosomal storage disease, vertebral epiphyseal plate ischemic necrosis, and osteogenesis imperfection. VKOH patients often have complex knee deformities due to abnormal bone and joint development and biomechanical changes. Although these deformities can be solved by a variety of knee preserving techniques such as proximal femur, periacetabular osteotomy, or knee arthroplasty in the early stage, most VKOH patients still progress to knee osteoarthritis quickly.Figure 9
Abnormal joint development in patients with VKOH.


## 4.1. Symptoms and Treatment of Common Varus Knee Osteoarthritis

As shown in Figure1, the difference of varus angle can not fully represent the dynamic lower limb force line. Compared with the peak varus angle of the knee, the peak varus angular velocity of the knee is closer to the visual varus extension, and the varus angular velocity of the knee not only reflects the direction of motion, but also reflects the speed of motion, which may be more suitable for capturing the dynamic characteristics of varus extension. From a biomechanical point of view, the increased medial load of the knee caused by varus deformity can lead to cartilage degeneration, bone marrow damage, and meniscal damage, which has a greater effect on VKOH progression than static varus deformity. In addition, varus extension has stronger correlation with knee pain and stiffness in weight-bearing activities, which may also be associated with cartilage injury and bone marrow edema.Figure 1
Adequately represent the dynamic line of force of the lower limbs.As shown in Table1, patients with varus extension are more likely to suffer from pain. Varus extension is a risk factor for knee pain and pain deterioration. Whether or not varus deformity was present during varus extension was associated with knee pain. Considering the effect of varus extension on pain and VKOH progression, the treatment targeted to correct dynamic varus can prevent the development or deterioration of knee pain in VKOH patients to a certain extent. Conservative treatment methods, such as gait adjustment strategy and wedge insole, are used to improve varus extension. High tibial osteotomy is a common method to change the mechanical bearing axis and the load of the knee joint, which can improve the varus extension of the knee joint. Total knee arthroplasty can also achieve long-term improvement of varus extension. Varus extension can only reflect the force arm of adduction moment and impulse, but not the force.Table 1
Varus extension is the occurrence of knee joint pain and pain deterioration.
ItemBone marrow injuryMeniscus injuryCartilageBone marrowJoint painStiffVKOH3.785.223.513.414.275.04Inversion1.933.994.481.285.622.57Peak angle2.412.964.893.564.433.81Angular2.256.224.042.656.924.83Visualization4.486.642.665.666.163.87Biology2.394.174.425.671.81As shown in Figure2, intra-articular injection of arthroscopic debridement injection can improve knee joint function better than sodium hyaluronate injection group in the early stage of treatment, and the long-term effect is similar to that of sodium hyaluronate injection group. The larger the KAM is, the easier the medial meniscus is to be injured, the more severe the injury is, and the greater the ratio of the medial tibial subchondral bone area is. However, the cartilage thickness and spalling area of femur and tibia were not related to KAM. This shows that biomechanical changes have different effects on different tissue structures of the knee joint, which is not only related to the structural strength of the tissue, but also related to the mechanical biological characteristics of the body to mechanical response, and its mechanism needs further study.Figure 2
The important role of removing albumin status in improving MA.As shown in Table2, due to the advantages of overall adjustment, internal and external treatment, being simple and cheap, and being safe and reliable, the drugs for clearing and treating joint drug factors are gradually recognized in the treatment of knee osteoarthritis. Performing the Chinese herbal medicine iontophoresis after arthrocentesis can lower the pain threshold, ease the limitation of joint activity, and help the patient recover smoothly.Table 2
The overall regulation of drug factors for cleaning and treating joint drug factors.
ItemMMP1IL-17VKOHInversion anglePeak angleROSKAM2.354.492.673.892.045.76Tibia2.012.582.991.212.62.62Meniscus3.41.444.024.261.64.45Curative effect2.365.284.254.133.293.34Peel off4.783.226.751.296.141.96CXCL121.114.93.923.441.031.81As shown in Figure3, the average BMI of the patients was 28.08 ± 3.47, which was significantly higher than the average level of 23.71 of the national population, indicating that the stature of VKOH patients was short and fat, and the load of the spine and knee joint was in a high load state, thus accelerating the wear, damage, and osteoarthritis, which may also be the primary reason why the age of the first arthroscopic debridement of VKOH patients was only 38.22 years. The average time from the first knee discomfort to surgery was (28.44 ± 20.20) months. The clinical manifestations of VKOH patients were typical vertebral body widening, flattening, typical ladder like changes, and kyphosis deformity. This also needs to be considered before arthroscopic debridement and corrected during operation; so as to make the arthroscopic debridement of VKOH patients more effective the difficulty of treatment increased significantly.Figure 3
Urine microalbumin detection and analysis results.As shown in Table3, the knee osteoarthritis of 9 patients with VKOH in this paper was at T3 level at the time of clinical first diagnosis, and they had lost the opportunity of hip preservation, so they all received arthroscopic debridement treatment. In order to improve the appearance and function and improve the quality of life of patients, arthroscopic debridement treatment should be carried out.Table 3
Hip osteoarthritis in VKOH patients.
ItemVKOHMAULeNetDetectionInceptionROSBMI1.150.080.921.641.570.9DKD2.452.893.491.343.071.71THA5.395.235.43.1542.02Excretion1.935.823.932.055.822.24Gender2.131.21.981.552.122.7FPG3.313.164.793.194.054.86


## 4.2. Cost Analysis of Varus Knee Osteoarthritis

As shown in Figure4, patients with knee pain for a long time can not carry out normal physical exercise, often accompanied by obvious bone deficiency or osteoporosis; there is a potential risk of knee, thoracic, and lumbar fractures, and the cost of treatment is large, and it seriously affects the quality of life of patients. The electronic medical arthroscopic lavage treatment scheme in this paper can significantly improve the patient’s quality of life and allow timely checks of morbidity at less cost. During the course of treatment, you can save 45% on the cost of comprehensive treatment.Figure 4
Cost analysis of knee osteoarthritis treatment.As shown in Table4, the prevalence of VKOH over 40 years of age is 36.4%. With the increase of age, the prevalence increases. How to protect and slow down the process of knee joint is the research focus of many scholars. Clinically, the purpose is to improve symptoms, relieve pain and inflammation, correct deformities, improve structure, prevent joint degeneration, and maintain joint function. The concept of step-by-step treatment provides a safe, effective, and popularized diagnosis and treatment strategy for clinical treatment of VKOH. Mild VKOH is generally recognized as a clean-up treatment. With the initial use of basic treatment such as exercise therapy, weight management, physical therapy after treatment, the symptoms worsen or the effect is not good, which can be upgraded to drug treatment, and the total cost is greatly reduced.Table 4
The prevalence of VKOH in recent studies.
ItemMMP1IL-17VKOHInversion anglePeak angleROSIliac wings2.893.283.791.811.861.93Varus deformity3.563.82.624.255.035.8Hip5.144.222.181.664.531.54Thoracic2.21.262.242.023.183.36Lumbar spine2.385.741.652.031.611.08FPG6.486.876.381.872.33.28


## 4.3. Effect Analysis of Arthroscopic Debridement in the Treatment of Varus Knee Osteoarthritis

All patients with VKOH knee osteoarthritis who underwent arthroscopic debridement were studied postoperatively. The perioperative characteristics of patients are shown in Figure5. No serious complications such as vascular and nerve injury, thrombosis, pulmonary infection, cardiovascular and cerebrovascular complications, and death were found. In addition, the early complications of VKOH patients after arthroscopic debridement are prosthesis dislocation and aseptic loosening, and the less common complications are pain, infection, periprosthetic fracture, etc. These can be fully evaluated by preoperative comprehensive evaluation of VKOH patients with knee joint lesions, selection of appropriate prosthesis, standardization of various operations, improvement of surgical proficiency, reconstruction of normal anatomical structure, so as to make the rotation heart down, and so on.Figure 5
Patients undergoing THA due to VKOH knee osteoarthritis.As shown in Figure6, arthroscopic debridement can not only relieve knee pain and other discomfort symptoms, but also correct the problem of unequal length of both lower limbs, so as to avoid spinal degeneration caused by knee instability. Therefore, arthroscopic debridement is the first choice for the treatment of advanced knee osteoarthritis in patients with VKOH. The average pelvic incidence angle of VKOH patients after arthroscopic debridement was significantly higher than that before operation. With the improvement of sagittal plane balance, VAS score also improved. It is speculated that sagittal plane balance may be closely related to the above evaluation indexes after arthroscopic debridement.Figure 6
THA improves knee pain and other uncomfortable symptoms.As shown in Figure7, during the perioperative period within 35 days after operation, one patient with VKOH who underwent bilateral arthroscopic debridement developed thrombosis in the right operating limb (left side was normal). On the second day after operation, the patient had continuous swelling pain in the right leg and behind the knee, limited venous return, and occasional numbness. Color doppler ultrasound found that there was thrombosis in the soleus muscle, with a diameter of less than 1 cm. The patients were given immobilization, limb elevation, strengthening anticoagulation, and monitoring of coagulation indexes. On the 7th day when the thrombus was stable, the patient was guided to perform routine postoperative rehabilitation. On the 35th day after the operation, the thrombus was stable. The reasons may be obesity (BMI = 30.38), longer operation time (178 min), more blood loss (720 ml), and infusion of allogeneic plasma and colloid solution, which lead to increased blood viscosity. Therefore, we should be alert and standardize anticoagulation therapy.Figure 7
VKOH patient with bilateral THA right operative limb.As shown in Table5, patients with spinal deformity showed flat vertebral body, narrow intervertebral space, and kyphosis, with or without compression of lumbosacral plexus. According to the data of Tonnis, the severity of preoperative knee osteoarthritis can be graded and analyzed on the pelvic anteroposterior X-ray film in standing position.Table 5
Patient manifestations of spinal deformity.
ItemBMIBlood vesselNerve damageThrombusLung infectionCardiovascular102.253.842.081.252.321.51202.793.552.964.853.543.38301.31.143.71.95.051.7402.443.32.754.593.351.23502.192.414.253.853.094.87603.793.383.065.292.222.02In this paper, the data of patients who underwent arthroscopic debridement due to VKOH were analyzed retrospectively. The postoperative clinical function and imaging results were analyzed, as shown in Figure8. VKOH patients are mostly young and have a large amount of activity. Due to bone dysplasia and short stature, abnormal bone morphology of knee joint, early knee conserving surgery, and so on, the spinal and pelvic parameters are significantly abnormal, which brings great challenges to arthroscopic treatment.Figure 8
Patients with THA underwent retrospective data.As shown in Figure9, the incidence rate of epiphyseal defects secondary to collagen type II is about 0.1–0.4/10. It is easily confused with the dwarfism caused by the disease such as myxosomal storage disease, vertebral epiphyseal plate ischemic necrosis, and osteogenesis imperfection. VKOH patients often have complex knee deformities due to abnormal bone and joint development and biomechanical changes. Although these deformities can be solved by a variety of knee preserving techniques such as proximal femur, periacetabular osteotomy, or knee arthroplasty in the early stage, most VKOH patients still progress to knee osteoarthritis quickly.Figure 9
Abnormal joint development in patients with VKOH.


## 5. Conclusions

There are some technical limitations in the treatment of arthritis, and there is a risk of recurrence. Generally speaking, women of the same age have lower body mass than men, and men are more engaged in physical work than women. Moreover, the level of estrogen in women is significantly higher than that in men. Estrogen can reduce the bone loss of bone and joint, inhibit osteoporosis, and protect the vascular system of bone. Therefore, premenopausal women are at lower risk of joint disease than men of the same age, and postmenopausal women are at higher risk of joint disease than men of the same age because of their reduced estrogen.Arthroscopic debridement technology can break the molecular chemical bond of tissue by producing high-energy charged plasma layer, stimulate local neovascularization, enhance the expression of growth factors such as vascular endothelial factor, improve the blood supply of avascular area, and promote the healing reaction of joint. Some studies have also shown that perforation at the end of the joint can stimulate cell activity, start cell proliferation, and directly inhibit the pain receptor, so the pain of patients can be alleviated early after surgery. In traditional open surgery to remove part of the lesions of the radial wrist short extension joint, some doctors use rivets to reconstruct the joint insertion, which has the disadvantages of large trauma, long operation time, long postoperative recovery period, slow recovery, and so on. With the development of minimally invasive concept and the requirements of patients for rapid postoperative rehabilitation, percutaneous release, needle knife, small incision surgery, and arthroscopic minimally invasive surgery are also widely carried out in clinic.Cleaning treatment of varus knee osteoarthritis can reduce knee pain and improve its function, and no allergy, fever, muscle weakness, osteoporosis, intra-articular infection, joint instability, and other adverse reactions occurred in the study patients, indicating the effectiveness and safety of compound betamethasone intra-articular injection. The results show that, after reducing the dose of compound betamethasone, it can achieve the same therapeutic effect as the full dose. Reducing the dose of betamethasone while ensuring the same curative effect can reduce the occurrence of adverse reactions. This paper provides a new idea for how to safely and effectively reduce the dose of kallikrein in the application of local cleaning treatment.



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*Source: 5569872-2021-05-07.xml*