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

Schröter, Steffen; Ateschrang, Atesch; Lowe, Walter R.; Nakayama, Hiroshi; Stöckle, Ulrich; Ihle, Christoph

doi:10.1007/s00167-015-3592-x

Cited by 69 publications

(62 citation statements)

References 28 publications

(40 reference statements)

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“…PWB is frequently applied in fracture treatment, after surgery, especially after fracture osteosynthesis, joint replacement, and corrective osteotomies, as well as in pseudarthrosis, to only mention a few indications [1][2][3]. Loading schemes may include rear-or forefoot/toe-touch-loading, and usually comprise a percentage of body weight or a number of kilos or pounds, e.g.…”

Section: Introductionmentioning

confidence: 99%

Partial weight bearing of the tibia

Ganse

Yang

Gardlo³

et al. 2016

Injury

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Section: Introductionmentioning

confidence: 99%

Partial weight bearing of the tibia

Ganse

Yang

Gardlo³

et al. 2016

Injury

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“…Another study by Hernigou et al (2013) 45 reported no differences in terms of hip-knee-ankle angle, tibial slope, or Caton index. Lansdaal et al 10 and Schröter et al 12 measured the mechanical tibiofemoral angle and found no difference between early and delayed weight-bearing groups. Although the verification methods used differed, most reports show that early weight-bearing does not compromise OWHTO outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent studies have found that immediate weight-bearing was essentially harmless. [10][11][12] Thus, the most appropriate form of postoperative management remains controversial; no consensus protocol has yet been firmly established.…”

mentioning

confidence: 99%

“…18,19 The postoperative rehabilitation protocol and osteotomy type also affected stability. [10][11][12]20 Finite element (FE) models yield local mechanical information that cannot be obtained in vivo or via experimental tests, allowing comparison of mechanical factors affecting the healing environment around various HTO implants. 21 An FE model showed that medial plate positioning was associated with poorer structural stability, and was less safe, than open-wedge osteotomy associated with anteromedial plate positioning.…”

mentioning

confidence: 99%

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Distribution of the Force in the Knee Joint during Daily Activities after Open Wedge High Tibial Osteotomy: A Rationale for the Proper Postoperative Management

Seo

Lim

Jang³

et al. 2019

J Knee Surg

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The present study was conducted to evaluate the force distribution in knee joint during daily activities after open-wedge high tibial osteotomy (OWHTO). A three-dimensional proximal tibial finite element model (FEM) was created using Mimics software to evaluate computed tomography (CT) scans of the tibia after OWHTO. The anterior and posterior gaps were 7.0 and 12.1 mm, respectively, and the target opening angle was 12 degrees. The loading ratio of the medial and lateral tibial plateaus was 6:4. To evaluate force distribution in the knee joint during activities of daily living (ADLs) after OWHTO, peak von Mises stresses (PVMSs) were analyzed at the plate and posterolateral edge region of osteotomized tibia. ADLs associated with greater knee flexion (sitting 90 degrees, standing 90 degrees, bending 90 degrees, stepping up stairs 60 degrees, and stepping downstairs 30 and 60 degrees) yielded PVMSs ranging from 195.2 to 221.5 MPa at the posterolateral edge region. In particular, stepping downstairs with knee flexion to 60 degrees produced the highest PVMS (221.5 MPa), greater than the yield strength (100–200 MPa). The highest plate PVMS was greater than 300 MPa during ADLs associated with flexion angles of approximately 90 degrees. However, these values did not exceed the yield stress (760.0 MPa). Conclusively, higher force was generated during higher flexion associated with weight-bearing and stepping downstairs produced a high force (even at lower flexion) on the posterolateral area of the tibial plateau. Therefore, a caution should be exercised when engaging in knee flexion of approximately 90 degrees and stepping downstairs in the early postoperative period when patients follow a weight-bearing rehabilitation protocol. However, this study is based on modeling; further translational studies are needed prior to clinical application.

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“…Studienkollektiv 120 Patienten willigten vor erfolgter operativer Versorgung mittels valgisierender Open-Wedge-HTO zwischen Dezember 2008 und Dezember 2011 zur Studienteilnahme ein. Im Rahmen einer ersten prospektiven klinischen Untersuchung wurden alle Patienten zunächst präoperativ und im Verlauf postoperativ zu weiteren 3 vordefinierten Zeitpunkten bis 18 Monate nach operativer Versorgung klinisch evaluiert [18,19]. In der vorliegenden Arbeit erfolgte eine weitere klinische Nachuntersuchung mindestens 6 Jahre nach bereits erfolgter Open-Wedge-HTO, um mittelfristige Behandlungsergebnisse darzustellen.…”

Section: Materials Und Methodenunclassified

Health-Related Quality of Life – an Underestimated Factor to Evaluate the Treatment Success after Open Wedge HTO Surgery: Prospective 6-Years Follow-Up

Herbst

Kuwashima²,

Ahrend

et al. 2020

Z Orthop Unfall

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Background The subjective health related quality of life in patients with degenerative joint diseases is an important variable to evaluate the treatment outcome. In this study, mid-term results of open wedge HTO were analysed and compared to the subjective quality of life (SF 36) of the general population. Furthermore, the relationships of preoperative assessed subscales of the health-related quality of life (SF 36) and the conversion to knee arthroplasty were analysed. Methods The cohort consisted of 120 patients who were prospectively followed-up after open wedge HTO. At five follow-up points of time, patients were examined and asked about their subjective, health-related quality of life using the SF 36 score. Results 104 patients were included and evaluated until the last follow-up (mean: 81.2 ± 11.3 months after open wedge HTO; follow-up rate: 86.7%). Six years after open wedge HTO, similar values in several psychologic subscales of the SF 36 (BP, GH, V, MH) and the mental health component summary score (MCS) compared to the general population were found. The physical health component summary score (PCS) showed a significant improvement relative to the preoperative values. Nine out of 104 patients (8.7%) received a knee arthroplasty (50.1 ± 25.0 months). Low preoperative values of the subscales “physical functioning” (PF) and “bodily pain” (BP) were identified as risk factors in terms of conversion to a total knee arthroplasty. Conclusions Patients with medial unicompartimental knee osteoarthrosis treated with open wedge HTO showed very good results. The health-related quality of life was nearly as high as in the general population. Patients with preoperative low physical function and high pain values have a higher risk to have a conversion to knee arthroplasty. Surgeons should be aware of these factors if an open wedge HTO is considered.

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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

Abstract: Therapeutic study, Level I.

Cited by 69 publications

References 28 publications

Partial weight bearing of the tibia

Partial weight bearing of the tibia

Distribution of the Force in the Knee Joint during Daily Activities after Open Wedge High Tibial Osteotomy: A Rationale for the Proper Postoperative Management

Health-Related Quality of Life – an Underestimated Factor to Evaluate the Treatment Success after Open Wedge HTO Surgery: Prospective 6-Years Follow-Up

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