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Return to work and sporting activities after high tibial osteotomy

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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.

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References

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

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  3. 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 124:575–584

    Article  CAS  PubMed  Google Scholar 

  4. 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 23:852–861

    Article  PubMed  Google Scholar 

  5. 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) 90:592–596

    Article  CAS  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  8. 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

    CAS  Google Scholar 

  9. 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):851–856

    Article  PubMed  Google Scholar 

  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) 91:1459–1465

    Article  CAS  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  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

    Google Scholar 

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

    PubMed  Google Scholar 

  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 38:2077–2084

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  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 19:122–127

    Article  PubMed  Google Scholar 

  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) 90:592–596

    Article  CAS  Google Scholar 

  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):312–318

    Article  PubMed  Google Scholar 

  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):150–154

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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):1688–1695

    Article  PubMed  Google Scholar 

  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):1397–1402

    Article  PubMed  Google Scholar 

  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 34:55–62

    Article  Google Scholar 

  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 34:167–172

    Article  PubMed Central  PubMed  Google Scholar 

  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 28:282–296

    CAS  PubMed  Google Scholar 

  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):638–643

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  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):193–198

    Article  PubMed Central  PubMed  Google Scholar 

  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 91:2581–2588

    Article  PubMed  Google Scholar 

  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):2109–2114

    Article  PubMed  Google Scholar 

  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):64–73

    Article  PubMed  Google Scholar 

  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):1420–1424

    Article  PubMed  Google Scholar 

  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):1607–1616

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  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):213–219

    Article  PubMed  Google Scholar 

  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):15–22

    Article  PubMed  Google Scholar 

  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):153–160

    Article  CAS  PubMed  Google Scholar 

  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):819–826

    Article  PubMed Central  PubMed  Google Scholar 

  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):2273–2280

    Article  PubMed  Google Scholar 

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Conflict of interest

I certify that I have not signed any agreement with commercial interest related to this study, which would, in any way, limit publication of any and all data generated for the study or to delay publication for any reason.

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Authors and Affiliations

  1. Department of Orthopaedics and Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany

    Martin Faschingbauer, Manfred Nelitz, Stefanie Urlaub, Heiko Reichel & Daniel Dornacher

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  1. Martin Faschingbauer
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  2. Manfred Nelitz
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Correspondence to Martin Faschingbauer.

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Faschingbauer, M., Nelitz, M., Urlaub, S. et al. Return to work and sporting activities after high tibial osteotomy. International Orthopaedics (SICOT) 39, 1527–1534 (2015). https://doi.org/10.1007/s00264-015-2701-2

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  • DOI: https://doi.org/10.1007/s00264-015-2701-2

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