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International Orthopaedics

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01-08-2015 | Original Paper

Return to work and sporting activities after high tibial osteotomy

Authors: Martin Faschingbauer, Manfred Nelitz, Stefanie Urlaub, Heiko Reichel, Daniel Dornacher

Published in: International Orthopaedics | Issue 8/2015

Abstract

Purpose

High tibial osteotomy (HTO) is a commonly used treatment to correct varus malalignment of the knee. The purpose of this study was, first, to determine, whether HTO allows return to pre-operative work, depending on the amount of work load. Second, the restoration of sports ability and a difference in sports activities pre- to postoperative should be analyzed.

Methods and patients

Fifty-one patients were included in this study. Patients were divided into three groups dependent on work intensity. Sporting activity was evaluated by an activity score (Naal). Clinical examination includes Tegner-score, Lysholm-score and visual analog pain scale. General health was assessed using the 36-Item Short Form Survey questionnaire.

Results

On an average of 16.7 ± 15.6 weeks after surgery patients returned to work, and 93.8 % of the patients returned to pre-operative work load. The Tegner activity score did not show significant changes pre- and postoperatively. At the time of survey Lysholm score reached a value of 68.7 ± 23.9 points on average. Postoperatively, patients remarked on decreased pain by VAS by an average of 2.6 ± 2.3 points.

Conclusions

In total, 92.3 % returned to pre-operative sports activities after surgery. A shift away from high impact activities to lower impact activities, a significant decrease of the duration of sports activities and number of sports disciplines was detected. In summary, HTO allows the young, active patient with medial osteoarthritis of the knee to return to work with the same work intensity and to return to sports.

Aglietti P, Rinonapoli E, Stringa G, Taviani A (1983) Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res 176:239–251PubMed

Coventry MB (1985) Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 67:1136–1140PubMed

Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Arch Orthop Trauma Surg 124:575–584PubMedCrossRef

Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861PubMedCrossRef

Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg (Br) 90:592–596CrossRef

Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160PubMedCentralPubMedCrossRef

Bonnin M, Chambat P (2004) Der stellenwert der valgisierenden, zuklappenden tibiakopfosteotomie bei der medialen gonarthrose. Orthopade 33:135–142PubMedCrossRef

Coventry MB (1979) Upper tibial osteotomy for gonarthrosis. The evolution of the operation in the last 18 years and long term results. Orthop Clin N Am 10:191–210

Hinterwimmer S, Beitzel K, Paul J, Kirchhoff C, Sauerschnig M, von Eisenhart-Rothe R, Imhoff AB (2011) Control of posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy. Am J Sports Med 39(4):851–856PubMedCrossRef

10.

Luites JWH, Brinkmann JM, Wymenga AB, Van Heerwaarden RJ (2009) Fixation stability of opening- versus closing-wedge high tibial osteotomy. J Bone Joint Surg (Br) 91:1459–1465CrossRef

11.

Tunggal JAW, Higgins GA, Waddell JP (2010) Complications of closing wedge high tibial osteotomy. Int Orthop 34:255–261PubMedCentralPubMedCrossRef

12.

Song EK, Seon JK, Park SJ, Jeong MS (2010) The complications of high tibial osteotomy. J Bone Joint Surg (Br) 92:1245–1252CrossRef

13.

Kohn L, Sauerschnig M, Iskansar S, Lorenz S, Meidinger G, Imhoff AB, Hinterwimmer S (2013) Age does not influence the clinical outcome after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):146–151

14.

Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. J Bone Joint Surg (Br) 75:745–749

15.

Dejour H, Neyret P, Boileau P, Donell ST (1994) Anterior curciate reconstruction combined with valgus tibial osteotomy. Clin Orthop Relat Res 299:220–228PubMed

16.

DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC (2010) Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med 38:2077–2084PubMedCrossRef

17.

Hernigou PH, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. J Bone Joint Surg Am 69:332–354PubMed

18.

Imhoff AB, Linke RD, Agneskirchner J (2004) Korrekturosteomie bei primary-, varus-, double-varus- und triple-varus-knieinstabilität mit kreuzbandersatz. Orthopade 33:201–207PubMedCrossRef

19.

Koshino T (2010) Osteotomy around young deformed knees: 38-year super-long-term follow-up to detect osteoarthritis. Int Orthop 34:263–269PubMedCentralPubMedCrossRef

20.

Maquet P (1976) Valgus osteotomy for osteoarthritis of the knee. Clin Orthop Relat Res 120:143–148PubMed

21.

Rudan JF, Simurda MA (1990) High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res 255:251–256PubMed

22.

Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob RP (2011) High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13–21 years. Knee Surg Sports Traumatol Arthrosc 19:122–127PubMedCrossRef

23.

Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg (Br) 90:592–596CrossRef

24.

Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21(1):170–180

25.

Schröter S, Mueller J, van Heerwaarden R, Lobenhoffer P, Stöckle U, Albrecht D (July 10, 2012) Return to work and clinical outcome after open wedge HTO. Knee Surg Sports Traumatol Arthrosc 21(1):213–219

26.

Salzmann GM, Ahrens P, Naal FD, El-Azab H, Spang JT, Imhoff AB, Lorenz S (2009) Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med 37(2):312–318PubMedCrossRef

27.

Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150–154PubMedCrossRef

28.

Naal FD, Maffiuletti NA, Munzinger U, Hersche O (2007) Sports after hip resurfacing arthroplasty. Am J Sports Med 35(5):705–711PubMedCrossRef

29.

Naal FD, Fischer M, Preuss A, Goldhahn J, von Knoch F, Preiss S, Munzinger U, Drobny T (2007) Return to sports and recreational activity after unicompartmental knee arthroplasty. Am J Sports Med 35(10):1688–1695PubMedCrossRef

30.

http://www.rand.org/health/surveys_tools/mos/mos_core_36item.html

31.

Van den Borne MP, Raijmakers NJ, Vanlauwe J, Victor J et al (2007) International cartilage repair society (ICRS) and Oswestry macroscopic cartilage evaluation scores validated for use in autologous chondrocyte implantation (ACI) and microfracture. Osteoarthr Cartil 15(12):1397–1402PubMedCrossRef

32.

Lobenhoffer P, Agneskirchner J, Zoch W (2004) [Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator].[Article in German]. Orthopade 33:153–160

33.

Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) Tomofix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia - early results in 992 cases. Injury 34:55–62CrossRef

34.

Staubli AE, Jacob HAC (2010) Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material. Int Orthop 34:167–172PubMedCentralPubMedCrossRef

35.

Noyes FR, Barber-Westin SE, Hewett TE (2000) High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med 28:282–296PubMed

36.

Hoell S, Suttmoeller J, Stoll V, Fuchs S, Gosheger G (2005) The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients. Arch Orthop Trauma Surg 125(9):638–643PubMedCrossRef

37.

Lobenhoffer P, Agneskircher JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138PubMed

38.

Brinkman JM, Luites JW, Wymenga AB, van Heerwaarden RJ (2010) Early full weight bearing is safe in open-wedge high tibial osteotomy. Acta Orthop 81(2):193–198PubMedCentralPubMedCrossRef

39.

Kolb W, Guhlmann J, Windisch C, Kolb K, Koller H, Grützner P (2009) Opening-wedge high tibial osteotomy with a locked low-profile plate. J Bone Joint Surg Am 91:2581–2588PubMedCrossRef

40.

Saragaglia D, Rouchy RC, Krayan A, Refaie R (2014) Return to sports after valgus osteotomy of the knee joint in patients with medial unicompartmental osteoarthritis. Int Orthop 38(10):2109–2114PubMedCrossRef

41.

Bonnin M, Laurent J, Zadegan F et al (2013) Can patients really participate in sport after high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc 21(1):64–73PubMedCrossRef

42.

Sterett WI, Steadman JR, Huang MJ, Matheny LM, Briggs KK (2010) Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med 38(7):1420–1424PubMedCrossRef

43.

Niemeyer P, Schmal H, Hauschild O, von Heyden J, Sudkamp NP, Kostler W (2010) Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 26(12):1607–1616PubMedCrossRef

44.

Nagel A, Insall JN, Scuderi GR (1996) Proximal tibial osteotomy: a subjective outcome study. J Bone Joint Surg Am 78:1353–1358PubMed

45.

Schröter S, Mueller J, van Heerwaarden R, Lobenhoffer P, Stöckle U, Albrecht D (2013) Return to work and clinical outcome after open wedge HTO. Knee Surg Sports Traumatol Arthrosc 21(1):213–219PubMedCrossRef

46.

Puddu G, Cipolla M, Cerullo G, Franco V, Giannì E (2007) Osteotomies: the surgical treatment of the valgus knee. Sports Med Arthrosc 15(1):15–22PubMedCrossRef

47.

Lobenhoffer P, Agneskirchner J, Zoch W (2004) Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade 33(2):153–160PubMedCrossRef

48.

Maffulli N, Loppini M, Longo UG, Denaro V, Oliva F (2013) Bovine xenograft locking Puddu plate versus tricalcium phosphate spacer non-locking Puddu plate in opening-wedge high tibial osteotomy: a prospective double-cohort study. Int Orthop 37(5):819–826PubMedCentralPubMedCrossRef

49.

Feucht MJ, Minzlaff P, Saier T, Cotic M, Südkamp NP, Niemeyer P, Imhoff AB, Hinterwimmer S (2014) Degree of axis correction in valgus high tibial osteotomy: proposal of an individualised approach. Int Orthop 38(11):2273–2280PubMedCrossRef

Title: Return to work and sporting activities after high tibial osteotomy
Authors: Martin Faschingbauer
Manfred Nelitz
Stefanie Urlaub
Heiko Reichel
Daniel Dornacher
Publication date: 01-08-2015
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 8/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-2701-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Return to work and sporting activities after high tibial osteotomy

Abstract

Purpose

Methods and patients

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods and patients

Results

Conclusions

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