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Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Open wedge high tibial osteotomy is a widespread treatment option in patients with varus malalignment and medial compartment osteoarthritis. There is no standardised protocol for post-operative rehabilitation available. The purpose of this study was to compare two post-operative rehabilitation protocols and to evaluate the clinical outcome of early full weight-bearing after open wedge HTO.

Methods

One hundred and twenty consecutive patients with varus malalignment and medial compartment osteoarthritis received an open wedge HTO using an angular locking plate fixation between December 2008 and December 2011. All patients were assigned randomly into one of two groups with different post-operative rehabilitation protocols (11-day vs. 6-week 20-kg partial weight-bearing). Clinical outcome was evaluated using established instruments (Lequesne, Lysholm, HSS and IKDC scores) preoperatively, 6, 12 and 18 months post-operatively. Deformity analysis was performed preoperatively and during follow-up.

Results

All clinical scores showed a significant pre- to post-operative improvement. After 6 months, there was a higher improvement in the group of early full weight-bearing. The difference between preoperative and 6-month follow-up for the group with early full weight-bearing and for the group with 20-kg PWB for 6 weeks was 28 ± 26 and 18 ± 22, respectively, for the Lysholm score and −5.0 ± 5.1 and −3.0 ± 3.6, respectively, for the Lequesne score.

Conclusions

Early full weight-bearing (11-day 20-kg partial weight-bearing) after open wedge HTO without bone graft leads to earlier improvement of the clinical results and can be recommended for post-operative rehabilitation after open wedge HTO and fixation with an angular locking plate.

Level of evidence

Therapeutic study, Level I.

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Acknowledgments

The gratitude of the authors goes to the participants who have made this study possible. Furthermore, the authors would, in particular, like to thank the staff of the Radiology Department of the BG Trauma Centre Tübingen. Grant supported by DGUV (Deutsche Gesetzliche Unfallversicherung) FR150.

Conflict of interest

S.S. is a member of the AO Joint Preservation Expert Group. The other authors have no conflicts of interest to declare.

Ethical standard

The study was performed with the approval of the local ethics committee (142/2008MPG2). A registration in the German register for clinical trials (approved primary register in the WHO network) is present (DRKS00005614).

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Schröter, S., Ateschrang, A., Löwe, W. et al. Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation. Knee Surg Sports Traumatol Arthrosc 25, 325–332 (2017). https://doi.org/10.1007/s00167-015-3592-x

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  • DOI: https://doi.org/10.1007/s00167-015-3592-x

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