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Early results of medial opening wedge high tibial osteotomy using an intraosseous implant with accelerated rehabilitation

  • Original Article • KNEE - OSTEOTOMY
  • Published:
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Abstract

Background

Accelerated rehabilitation protocols for medial opening wedge high tibial osteotomy (MOW HTO) using intraosseous implants have not previously been described. The present study provides early clinical and radiological outcomes of MOW HTO using a polyetheretherketone (PEEK) intraosseous system, in combination with an early weight-bearing protocol.

Methods

Twenty consecutive knees (17 patients) underwent navigated MOW HTO using a PEEK implant with accelerated rehabilitation. Time to union and maintenance of correction were assessed radiographically for 12 months post-operative. Patient outcomes were monitored for a mean follow-up of 38 months (range 23–42) using standardised instruments (WOMAC, IKDC and Lysholm scores).

Results

All knees were corrected to valgus. The mean time to unassisted weight-bearing was 55 days (SD 24, range 21–106). Bone union occurred in 95% of knees by 6 months, with correction maintained for 15 knees at 12 months post-operative. Knees for which correction was lost within 1 year of surgery had significantly greater preoperative varus alignment. Implant survivorship was 95% and 80% at 12 and 38 months post-operative, respectively. Significant improvements in patient-reported satisfaction, knee function and return to daily activities from preoperative to 38 months post-operative were reported (WOMAC 36 v 0; IKDC 35.6 v 96; Lysholm 44.5 v 100).

Conclusions

Accelerated rehabilitation following MOW HTO with an intraosseous PEEK implant did not delay bone union, with significantly improved functional outcomes within 3 months post-operative. Early findings suggest that this approach may be suitable for a defined patient subset, with consideration for the extent of preoperative genu varum.

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Abbreviations

HKA:

Hip-knee-ankle angle

HTO:

High tibial osteotomy

IKDC:

International Knee Documentation Committee

MCL:

Medial collateral ligament

MOW:

Medial opening wedge

PCN:

Precision computer navigation

PEEK:

Polyetheretherketone

ROM:

Range of motion

TKA:

Total knee arthroplasty

WOMAC:

Western Ontario and McMaster Universities Osteoarthritis Index

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Acknowledgements

The authors express their gratitude to the study participants. In addition, we thank Dr Ryan Bishal-Faruque for assisting with data registry and patient follow-up. This study was supported by internal funding from the Orthopaedic Research Institute of Queensland.

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Authors and Affiliations

  1. Orthopaedic Research Institute of Queensland, Townsville, QLD, 4812, Australia

    Jodie Morris, Andrea Grant, Rohit Kulkarni, Kenji Doma, Alicia Harris & Kaushik Hazratwala

  2. College of Healthcare Sciences, James Cook University, Townsville, 4811, Australia

    Kenji Doma

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  1. Jodie Morris
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  2. Andrea Grant
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Correspondence to Jodie Morris.

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Conflict of interest

The Orthopaedic Research Institute of Queensland receives annual funding from ARGO for offer of a Surgical Research Fellowship, as well as Stryker and Arthrex to support the salary of a Research Coordinator and an Orthopaedic PHO position. KH is a consultant for De Puy Synthes.

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Morris, J., Grant, A., Kulkarni, R. et al. Early results of medial opening wedge high tibial osteotomy using an intraosseous implant with accelerated rehabilitation. Eur J Orthop Surg Traumatol 29, 147–156 (2019). https://doi.org/10.1007/s00590-018-2280-1

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  • DOI: https://doi.org/10.1007/s00590-018-2280-1

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