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Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial

Abstract

Purpose

The need for a period of non-weight bearing after medial opening wedge high tibial osteotomy remains controversial. It is hypothesized that immediate weight bearing after medial opening wedge high tibial osteotomy would have no difference in functional scores at one year compared to delayed weight bearing.

Methods

Fifty patients, median age 54 years (range 40–65), with medial compartment osteoarthritis, underwent a medial opening wedge high tibial osteotomy utilizing a locking plate without bone grafting. Patients were randomized into an Immediate or a Delayed (2 months) weight bearing group. All patients were assessed at one-year follow-up and the two groups compared. The primary outcome measure was the IKS score. Secondary outcome measures included the IKDC score, the VAS pain score and rate of complications.

Results

The functional scores significantly improved in both groups. The IKS score increased from 142 ± 31 to 171 ± 26 in the Immediate group (p < 0.001) and from 148 ± 22 to 178 ± 23 in the Delayed group (p < 0.001). The IKDC score increased from 49 ± 17 pre-operatively to 68 ± 14 one-year post-operatively in the Immediate group (p < 0.0001) and from 44 ± 16 to 69 ± 19 in the Delayed group (p < 0.001). The average VAS for pain 2 months after surgery was 3 ± 3 in the Immediate group and 3 ± 2 in the Delayed (n.s.). There was no significant difference between the two groups in any of the outcome measures. The mean mechanical femorotibial angle changed from 6° of varus (0°–15° of varus, SD = 3°) to 4° of valgus (5°–11° of valgus, SD = 3°) in the Immediate group and from 5° of varus (0°–10° of varus, SD = 3°) to 3° of valgus (2° of varus to 8° of valgus, SD = 3°) in the Delayed group. No difference was seen between groups, and no loss of correction was observed in any patient. Two cases of non-union occurred, one in each group. One infection and one deep vein thrombosis occurred in the Immediate group.

Conclusion

Immediate weight bearing after medial opening wedge high tibial osteotomy had no effect on functional scores at 1 year follow-up and did not significantly increase the complication rate. Immediate weight bearing after medial opening wedge high tibial osteotomy appears to be safe and can allow some patients a quicker return to activities of daily living and a decreased convalescence period.

Level of evidence

II.

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Correspondence to Elvire Servien.

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Lansdaal, J.R., Mouton, T., Wascher, D.C. et al. Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 25, 3670–3678 (2017). https://doi.org/10.1007/s00167-016-4225-8

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  • DOI: https://doi.org/10.1007/s00167-016-4225-8

Keywords

  • Opening wedge
  • High tibial osteotomy
  • Osteoarthritis
  • Immediate weight bearing
  • Knee