This longitudinal study shows that fatigue is a chronic problem after LTx and that daily functioning and HRQoL do not improve over time. This study supports the need for intervention programs to address fatigue after LTx.

Fatigue is often experienced after liver transplantation. The aims of this cross-sectional study were to assess physical Wtness (cardiorespiratory Wtness, neuromuscular Wtness, body composition) in liver transplant recipients and to explore whether physical Wtness is related to severity of fatigue. In addition, we explored the relationship between physical Wtness and health-related quality of life. Included were 18 patients 1-5 years after transplantation (aged 48.0 § 11.8 years) with varying severity of fatigue. Peak oxygen uptake during cycle ergometry, 6-min walk distance, isokinetic muscle strength of the knee extensors, body mass index, waist circumference, skinfold thickness, severity of fatigue, and health-related quality of life were measured. Cardiorespiratory Wtness in the liver transplant recipients was on average 16-34% lower than normative values (P · 0.05). Furthermore, the prevalence of obesity seemed to be higher than in the general population (17 vs. 10%). We found no deWcit in neuromuscular Wtness. Cardiorespiratory Wtness was the only Wtness component that was related with severity of fatigue (r s = ¡0.61 to r s = -0.50, P · 0.05). Particularly cardiorespiratory Wtness was related with several aspects of health-related quality of life (r s = 0.48 to r s = 0.70, P · 0.05). Results of our study imply that cardiorespiratory Wtness and body composition are impaired in liver transplant recipients and that Wtness is related with severity of fatigue (only cardiorespiratory Wtness) and quality of life (particularly cardiorespiratory Wtness) in this group. These Wndings have implications for the development of rehabilitation programs for liver transplant recipients.

Varus deformity can be localized in the tibia, in the femur or in both. If varus deformity is localized within the femur, it is mandatory to correct it in the femur. This report presents the technique and results of a consecutive case series of lateral uniplanar and biplanar closed-wedge valgus osteotomy of the distal femur for the treatment of varus deformity of the knee. Retrospectively, fifteen patients (sixteen knees) were identified. Indications for surgery varied from unloading an osteoarthritic medial compartment to reduction to symmetrical varus leg alignment. Pre- and post-operative X-rays, including a full leg radiograph, were assessed as well as bone healing time at follow-up intervals. Clinical outcome was assessed using different questionnaires. There were nine male and six female patients with a median age at surgery of 45 (±14) years. The mLDFA changed from 95.9° (±2.7°) preoperatively to 89.3° (±2.9°) post-operatively. Preoperative planning and the use of angle stable implants resulted in accurate corrections according to preoperative aims in all but one patient. At follow-up (mean, 40 months), the mean VAS score was 2.5 (±2.4) and the WOMAC score averaged 80 (±20). The mean bone healing time of biplanar osteotomies (4 ± 3 months) was shorter than in the uniplanar osteotomies (6 ± 3 months). Distal lateral closed-wedge valgus osteotomy of the femur for the treatment of femoral varus deformities resulted in clinical improvement and accurate corrections in patients with different aims for correction. A biplanar osteotomy technique shortens bone healing time.

Rehabilitation using supervised exercise training and daily physical activity counselling can positively influence daily functioning, participation and HRQoL among fatigued liver transplant recipients.

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