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Huang T, Kang K, Qiao Q, Li T, Liu T, Ji C, Gao S. Muti-factor analysis of sport activity level after high tibial osteotomy. J Orthop Surg Res 2023; 18:813. [PMID: 37907953 PMCID: PMC10617058 DOI: 10.1186/s13018-023-04305-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Although many studies have shown that high tibial osteotomy is appropriate for active patients, there are limited multifactorial studies on patients' sport activity level after HTO in general population. METHODS 158 patients who underwent HTO for knee osteoarthritis between January 2016 and December 2019 are included, with a 36-month follow-up. Information was collected from X-rays and questionnaire. The independent variables were age, sex, breadwinner (provide more than 50% income), sport activity level when the knee was pain-free before and after surgery, concomitant meniscal treatment history, Lysholm knee score, desire level for returning to sports. The 158 cases are divided into three groups according to their sports participation before and after operation, Chi-square tests and ANOVA analysis were adopted to identify the effect of these variables on sport activity level after HTO, and factors with statistical differences and clinical relevancies, or provided by previous research were assessed with the ordinal logistic regression analysis. RESULTS According to sport activity level analysis, 28(17.7%) patients were categorized into the sport level-reduced group, 97(61.4%) patients into the sport level-unchanged group, and 33(20.9%) patients into the sport level-improved group. Upon ordinal logistic regression analysis, postoperative MA%, age, BMI, and preoperative Lysholm knee score were statistically significant. CONCLUSIONS Higher postoperative MA%, younger age, lower BMI, and lower Lysholm score are associate with improvement on activity level after HTO. This finding provides valuable references in operation option and rehabilitation planning.
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Affiliation(s)
- Teng Huang
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
- Department of Orthopedic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Kai Kang
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Qi Qiao
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Tong Li
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Tao Liu
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Chenni Ji
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Shijun Gao
- Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China.
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Zhang Z, Tao H, Zhao Y, Xiang W, Cao H, Tao F. High tibial osteotomy improves balance control in patients with knee osteoarthritis and a varus deformity. J Orthop Surg Res 2023; 18:538. [PMID: 37507811 PMCID: PMC10375624 DOI: 10.1186/s13018-023-04041-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Impaired knee stability is observed in patients with medial compartment knee osteoarthritis (OA) and varus malalignment. Although high tibial osteotomy (HTO) is widely used to treat OA-related knee varus deformity, its long-term influence on balance control in OA patients is poorly reported. This study aimed to evaluate the impact of HTO on balance control and assess its biological and functional significance. METHODS Thirty-two patients with medial compartment knee OA as well as varus deformity who were scheduled for HTO underwent static posturographic tests one month pre- and three months as well as one year postoperatively, respectively, along with forty matched control subjects. Radiographic and clinical evaluations were synchronously carried out on patients pre- and postoperatively. RESULTS Decreased postural sway was observed in patients one year after HTO. When compared to the control subjects, more postural sway was found in patients one month pre- and three months postoperatively. No difference was observed between the patients and control subjects one year postoperatively. The alignment and joint function of the affected knees significantly improved after HTO. CONCLUSIONS This study revealed that HTO improves balance control in patients with knee OA and varus deformity. Correct alignment and improved joint function enhance the likelihood of normal postural stability. Hence, this intervention allows the knee joint to recover its corrective compensatory role in postural regulation and should be taken into account for managing knee OA patients.
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Affiliation(s)
- Zheng Zhang
- Department of Orthopedics, Renmin Hospital of Wuhan University, 238, Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China.
| | - Hai Tao
- Department of Orthopedics, Renmin Hospital of Wuhan University, 238, Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Yingchun Zhao
- Department of Orthopedics, Renmin Hospital of Wuhan University, 238, Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Wei Xiang
- Department of Orthopedics, Renmin Hospital of Wuhan University, 238, Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Hui Cao
- Department of Orthopedics, Renmin Hospital of Wuhan University, 238, Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Fenghua Tao
- Department of Orthopedics, Renmin Hospital of Wuhan University, 238, Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
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Otoshi A, Kumagai K, Yamada S, Nejima S, Fujisawa T, Miyatake K, Inaba Y. Return to sports activity after opening wedge high tibial osteotomy in patients aged 70 years and older. J Orthop Surg Res 2021; 16:576. [PMID: 34583736 PMCID: PMC8477492 DOI: 10.1186/s13018-021-02718-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate return to sports (RTS) after opening wedge high tibial osteotomy (OWHTO) in elderly patients and associated factors affecting RTS. METHODS Seventy-four patients (mean age 68 years) who underwent OWHTO were enrolled. Clinical outcomes were evaluated using the Knee Society Score (KSS). Patients were asked regarding types of sports activities and their levels of participation within preoperative 1 year and postoperative 1 year. Levels of participation in sports and recreational activities were examined using the Tegner activity scale. The outcomes were compared between two age groups (≥ 70 years vs. < 70 years). RESULTS Of the 74 patients overall, 59 participated in at least one sport preoperatively, and 55 returned to sports postoperatively (RTS 93%). The KSS knee score and function score were significantly improved after surgery in both age groups (P < 0.05), but no significant differences were found between the age groups. The Tegner activity scales for ≥ 70 years and < 70 years were 2.9 ± 1.1 and 4.0 ± 1.9 preoperatively (P < 0.01) and 2.7 ± 1.2 and 3.3 ± 1.4 postoperatively (P = 0.16), respectively. RTS was reported by 24 of 25 (96.0%) in the age < 70 years group and 31 of 34 (91.2%) in the age ≥ 70 years group. Majority of age ≥ 70 years participated in low-impact sports preoperatively and returned to the same impact level postoperatively. CONCLUSIONS The rate of RTS after OWHTO was high in patients aged 70 years and older with low-impact level. OWHTO is a preferred surgical option for elderly patients who desire RTS.
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Affiliation(s)
- Akio Otoshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takahiro Fujisawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Kazuma Miyatake
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Na YG, Lee BK, Hwang DH, Choi ES, Sim JA. Can osteoarthritic patients with mild varus deformity be indicated for high tibial osteotomy? Knee 2018; 25:856-865. [PMID: 29933934 DOI: 10.1016/j.knee.2018.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/03/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Whether osteoarthritic patients with mild varus deformity can be indicated for high tibial osteotomy (HTO) is not established. We examined the preoperative characteristics and postoperative outcomes of HTO in patients with mild genu varum compared to patients with greater varus deformity. METHODS Seventy-one patients who underwent HTO were included in this retrospective study. Patients were divided into either mild varus (MV, mechanical femorotibial angle (mFTA) ≤4°, n = 31 (44%)) and greater varus (GV, mFTA >4°, n = 40 (56%)) groups. Preoperative characteristics on single photon emission computed tomography-computed tomography (SPECT-CT), magnetic resonance image and radiograph were evaluated. Alignment parameters and functional outcomes were compared pre- and postoperatively between the groups. RESULTS Preoperative characteristics were similar between the two groups, except the severity of arthritis and coronal alignment. There was no difference in the proportion of hot uptake in the medial compartment; medial meniscus posterior horn root tear, complex or radial tear; bone marrow edema. Full-thickness cartilage defect of medial compartment was more frequent and arthritis grade was also more severe in GV group. Coronal alignment of the MV group was corrected into more valgus than the GV group (4.5° vs. 2.8° in mFTA, P = 0.012). Pre- and postoperative Knee Society knee and function scores were also comparable in the two groups. CONCLUSIONS Mild varus patients are similar to greater varus patients regarding preoperative features and achieve the comparable functional outcome. A selected subset of osteoarthritic patients with mild varus deformity might be indicated for HTO. LEVEL OF EVIDENCE III (Retrospective comparative study).
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Affiliation(s)
- Young Gon Na
- Department of Orthopaedic Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Beom Koo Lee
- Department of Orthopaedic Surgery, Armed Forces Capital Hospital, Seongnam, Gyeonggi-do, 81, Saemaeul-ro 177 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Do Hyun Hwang
- Department of Orthopaedic Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Eun Seok Choi
- Department of Orthopaedic Surgery, Chungnam Nationl University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Jae Ang Sim
- Department of Orthopaedic Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, Republic of Korea.
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Petrillo S, Papalia R, Maffulli N, Volpi P, Denaro V. Osteoarthritis of the hip and knee in former male professional soccer players. Br Med Bull 2018; 125:121-130. [PMID: 29385409 DOI: 10.1093/bmb/ldy001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 01/01/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Professional soccer (PS) players are at great risk of osteoarthritis (OA) of the knee and hip. SOURCES OF DATA Following the PRISMA guidelines, the key words 'osteoarthritis' and 'soccer' or 'football' were matched with 'players' or 'former' or 'retired' and with 'hip' or 'knee' on December 24, 2017 in the following databases: PubMed, Cochrane, Google scholar, Embase and Ovid. Only comparative studies reporting the prevalence rate of OA of both hip and knee joint in former PS athletes (fPSa) and age and sex matched controls were considered. AREAS OF AGREEMENT In fPSa, the prevalence rate of OA of both hip and knee is significantly higher compared to age and sex matched controls. AREAS OF CONTROVERSY The pathological pathways responsible for the development of OA of the hip and knee in PS athletes (PSa) are still not clearly understood. GROWING POINTS The prevalence rate of clinical OA of the hip was 8.6% in fPSa and 5.6% in controls (odd ratio (OR) = 1.5; 95% CI: 1.06-2.31). The radiographic rate of OA was 21.2% in fPSa and 9.8% in controls (OR = 2.4; 95% CI: 1.66-3.69). A total of 14.6 and 53.7% of fPSa presented clinical and radiographic signs of OA of the knee, respectively, vs 12.9% (OR = 1.16; 95% CI: 0.86-1.55) and 31.9% (OR = 2.47; 95% CI: 2.03-3.00) of controls. Sonographic evidence of OA of the knee was found in 52% of fPSa and 33% of controls (OR = 2.2; 95% CI: 1.24-3.89). AREAS TIMELY FOR DEVELOPING RESEARCH Preventive training programmes should be developed to reduce the number of fPSa presenting early OA.
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Affiliation(s)
- Stefano Petrillo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Via Giovanni Paolo II, 132 - 84084 Fisciano, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England
| | - Piero Volpi
- Knee Surgery and Sports Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
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Webb M, Dewan V, Elson D. Functional results following high tibial osteotomy: a review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:555-563. [PMID: 29302782 PMCID: PMC5906498 DOI: 10.1007/s00590-017-2112-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/13/2017] [Indexed: 02/06/2023]
Abstract
Introduction High tibial osteotomy (HTO) is an operation used to treat patients with medial compartment knee osteoarthritis. The United Kingdom Knee Osteotomy Registry (UKKOR) has been set up to gather contemporaneous data on HTO throughout the patient journey. UKKOR uses a variety of patient-reported outcome measures (PROMs) to gauge the surgical outcome. Aim The aim of this review is to analyse the published literature that has used PROMs to assess the outcomes following HTO. Methodology Two searches of the literature were performed and compiled highlighting 95 articles of interest. After screening and manual additions, 23 manuscripts were reviewed and appraised using the appropriate Critical Appraisal Skills Programme Checklist (Kai et al. in PLoS Med 4(11):1766–1775, 2007). Results and discussion There is a variety of published literature on HTO with a varied approach to the use of PROMs. Their use has increased recently, and studies have demonstrated that they are appropriate assessment tools for monitoring outcomes following HTO. In all of the studies that compared pre-operative to post-operative PROMs, there have been significant improvements. However, the data are varied due to differing study designs which in some instances have significant limitations. Conclusion PROMs are effective ways to measure outcomes following HTO. They can also be useful in predicting outcome. The heterogeneity of the data and limitations of the study designs limit the transferability of the data. It is therefore important to analyse data from a multi-surgeon, multi-centre source that uses robust and constant pre- and post-operative PROMs.
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Affiliation(s)
- Mark Webb
- Northern Deanery, Waterfront 4, Goldcrest Way, Newburn Riverside, Newcastle upon Tyne, NE15 8NY UK
| | - Varun Dewan
- Royal Wolverhampton NHS Trust, Wolverhampton Road, Heath Town, Wolverhampton, WV10 0QP UK
| | - David Elson
- Queen Elizabeth Hospital, Gateshead, NE9 6SX UK
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Cotic M, Vogt S, Feucht MJ, Saier T, Minzlaff P, Hinterwimmer S, Imhoff AB. Prospective evaluation of a new plate fixator for valgus-producing medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2015; 23:3707-16. [PMID: 25209206 DOI: 10.1007/s00167-014-3287-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 08/27/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to prospectively evaluate the clinical, radiographic, and sports-related outcome at 24 months after valgus-producing medial open-wedge high tibial osteotomy (owHTO) using a 2nd generation peek-carbon composite plate. METHODS Between 2010 and 2011, the 2nd generation PEEKPower HTO-Plate(®) was used for medial owHTO in 28 consecutive patients (19 men, 9 women; mean age ± SD: 45 ± 11 years; mean varus deviation ± SD: 4° ± 2°). All of the patients had an osteotomy gap height of ≤12 mm without bone grafting. Visual analog scale (VAS) for pain, WOMAC score, and Lysholm score were evaluated preoperatively and at 12 and 24 months postoperatively. Sports-related outcomes included the Tegner scale, and a self-designed questionnaire preoperatively and 24 months postoperatively. Fixation stability of the implant was evaluated radiographically in two planes by comparing the medial proximal tibial angle (MPTA) and tibial slope 2 days after medial owHTO (baseline measurements) and after implant removal (follow-up measurements). Complications were recorded during the whole study period. RESULTS Compared to preoperative conditions, VAS, WOMAC, and Lysholm scores improved significantly (p < 0.05) at the 12- and 24-month follow-up. No significant differences were found between the 12- and 24-month follow-up. After 24 months, the sports frequency increased significantly (p < 0.05). No significant differences between baseline and follow-up measurements for the MPTA and tibial slope were observed. Total complication rate was 4 %, with one patient developing non-union. CONCLUSION In the clinical practice, the 2nd generation PEEKPower HTO-Plate(®) is a safe and efficient implant for medial owHTO without bone grafting in patients with an osteotomy gap of ≤12 mm. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Matthias Cotic
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Stephan Vogt
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- Department of Orthopaedic Sports Medicine, Hessing Stiftung Augsburg, Augsburg, Germany
| | - Matthias J Feucht
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- Department of Orthopedic Surgery and Traumatology, University Hospital Freiburg, Freiburg, Germany
| | - Tim Saier
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Philipp Minzlaff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Stefan Hinterwimmer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- Sportsclinic Germany GmbH, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
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Waterman BR, Hoffmann JD, Laughlin MD, Burks R, Pallis MP, Tokish JM, Belmont PJ. Success of High Tibial Osteotomy in the United States Military. Orthop J Sports Med 2015; 3:2325967115574670. [PMID: 26665031 PMCID: PMC4622358 DOI: 10.1177/2325967115574670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Historically, high tibial osteotomy (HTO) has been performed to treat isolated medial gonarthrosis with varus deformity. PURPOSE To evaluate the occupational outcomes of HTO in a high-demand military cohort. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A retrospective analysis of active duty service members undergoing HTO for coronal plane malalignment and/or intra-articular pathology was performed using the Military Health System between 2003 and 2011. Demographic parameters and surgical variables, including rates of perioperative complications, secondary surgery, activity limitations, and medical discharge, were extracted from electronic medical records. For the current study, cumulative failure was defined as conversion to knee arthroplasty or postoperative medical discharge for persistent knee dysfunction. Univariate and multivariate analyses were performed to identify statistical associations with cumulative failure after HTO. RESULTS A total of 181 service members (202 HTOs) were identified at an average follow-up of 47.5 months (range, 24-96 months). Mean age was 35.7 years (range, 19-55 years), and the majority were men (93%) and of enlisted rank (78%). All index procedures utilized a valgus-producing, opening wedge technique. Concomitant or staged procedures were performed in 87 patients (48%), including 40 ligamentous, 48 meniscal, and 48 chondral procedures. Complications occurred in 19.3% of knees (n = 39), with unplanned reoperation in 26 knees (12.8%). Fifty-three patients (40.7%) had minor activity limitations during military duty postoperatively. Eleven knees (5.4%) underwent conversion to total knee arthroplasty. The cumulative failure rate was 28.2% (n = 51) at 2- to 8-year follow-up. Patient age younger than 30 years at the time of surgery was associated with an independently higher risk of failure, whereas sex, concomitant/staged procedures, and perioperative complications were not significantly associated with subsequent failure. CONCLUSION At short- to midterm follow-up, nearly 72% of all service members undergoing HTO returned to military duty and were free from conversion knee arthroplasty.
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Affiliation(s)
- Brian R. Waterman
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Jeffrey D. Hoffmann
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Matthew D. Laughlin
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Robert Burks
- Naval Postgraduate School, Monterey, California, USA
| | - Mark P. Pallis
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - John M. Tokish
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA
| | - Philip J. Belmont
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA
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9
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Return to sports after valgus osteotomy of the knee joint in patients with medial unicompartmental osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2014; 38:2109-14. [PMID: 24993653 DOI: 10.1007/s00264-014-2435-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this article was to evaluate the resumption of physical activity and sports after valgus osteotomy for medial femorotibial osteoarthritis. METHODS This series is composed of 83 patients, with 27 females and 56 males. The mean age was 50.4 ± 9.53 years (32-67) at the time of operation. Before the onset of symptoms of knee osteoarthritis, four (4.8%) patients practiced a competitive sport, 44 (53%) one (or more) recreational sport on a regular basis, 17 (20%) occasionally and 18 (21.6%) did not practice any sport but were active. Sixty-two opening wedge high tibial osteotomies were performed as well as 21 double level osteotomies for severe deformity. All the osteotomies were computer-assisted in order to reach the best overcorrection. RESULTS At a mean follow up of 5.75 ± 1.3 years (five to nine years), 71 patients (85.5%) resumed sporting activities and 66 (79.5%) felt they had found a sporting level equal to the level prior surgery. The mean Lysholm score increased from 62.51 ± 15.53 points (30-100) pre-operatively to 90.49 ± 8.62 points (55-100) postoperatively (p < 0.001). The Tegner and UCLA scores didn't decrease significantly after surgery (4.53 and 7.14 pre-operatively versus 4.1 and 6.55 postoperatively, p = 0.07 and 0.09). The mean postoperative KOO score was 73.52 ± 17.20. The frequency of sports sessions per week (2.36 ± 1.6) did not decrease significantly after surgery (2.13 sessions, p = 0.34). On the other hand, the duration of activities decreased significantly from 4.68 hours/week ± 4.25 to 3.48 hours/week (p = 0.04). Of the patients who practiced running before surgery 85% (17 of 20) were able to resume this activity. CONCLUSION This study demonstrates that knee osteotomies for medial femorotibial osteoarthritis allow the resumption of sustained physical activity such as jogging or skiing downhill in a majority of patients.
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Abstract
Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament injuries in athletes result in incomplete recovery (up to 40% at 6 months), and OA in the long term (latency period more than 25 years). Spine pathologies are associated more commonly with certain sports (e.g. wrestling, heavy-weight lifting, gymnastics, tennis, soccer). Evolution in arthroscopy allows more accurate assessment of hip, ankle, shoulder, elbow and wrist intra-articular post-traumatic pathologies, and possibly more successful management. Few well-conducted studies are available to establish the long-term follow-up of former athletes. To assess whether benefits from sports participation outweigh the risks, future research should involve questionnaires regarding the health-related quality of life in former athletes, to be compared with the general population.
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Affiliation(s)
- Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, UK.
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Maffulli N, Longo UG, Spiezia F, Denaro V. Sports injuries in young athletes: long-term outcome and prevention strategies. PHYSICIAN SPORTSMED 2010; 38:29-34. [PMID: 20631461 DOI: 10.3810/psm.2010.06.1780] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Physical activity plays a significant role in the physical and emotional well-being of a child. In the past 15 to 20 years, there has been a dramatic increase in sports participation at a young age, which has offered numerous health benefits, including self-esteem, confidence, team play, fitness, agility, and strength. Children are playing sports at younger ages. This article assesses the long-term outcome of sports injuries in young athletes, with suggestions on how to prevent such injuries. There are no definitive epidemiological data on withdraw from sports activities due to injury in young athletes. Disturbed physeal growth as a result of injury can result in length discrepancy, angular deformity, or altered joint mechanics, and may cause significant long-term disability. Sequelae of Osgood-Schlatter lesion include painful ossicle in the distal patellar tendon. Fragmentation or separation of the apophysis appears to be the result of adaptive changes to the increased stress that occurs in overuse activities. The presence of these changes undeniably demonstrates an osseous reaction, although they are not disabling. Promotion of a physically active lifestyle is encouraged worldwide, particularly with regard to the many health benefits. Reduction of only a moderate proportion of all sports injuries is of significance for the young athletes' health and could have a long-term economic impact on health care costs. It is therefore important to convince medical doctors, physical therapists, athletic trainers and coaches, as well as athletes of the necessity to implement active prevention measures in their therapy and training programs, thus decreasing the injury and re-injury rate and enhancing athletic performance.
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