Good clinical outcomes and return to sports after hybrid closed-wedge high tibial osteotomy

Abstract

Purpose This study aimed to investigate preoperative sports participation and postoperative clinical outcomes including a return to sports (RTS) after hybrid closed-wedge high tibial osteotomy (CWHTO) for medial compartment osteoarthritis of the knee. Characteristic of Hybrid CWHTO was deined as extra-articular lateral closed and medial open wedge osteotomy. Methods The patients who underwent hybrid CWHTO from January 2016 to December 2018 were retrospectively reviewed and divided them into sports and non-sports groups. The preoperative demographic and radiographic characteristics were compared in both groups. And the clinical outcomes including the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS), Lysholm score, University of California at Los Angeles (UCLA) activity score, and RTS in the sports group were also investigated. Statistical analysis was performed for comparisons among the preoperative factors between the two groups. Inluence of sports impact and bone union of ibular osteotomy was also statistically investigated for RTS. Results Of the 161 knees (129 patients; 46 males, 83 females), 20 knees (16 patients; 13 males, 3 females; 12.3%) belonged to sports group. Although there were no signiicant diferences regarding the age and radiographic parameters, there were signiicant diferences in the body mass index and proportion of males between both groups. The JOA, VAS, Lysholm, and UCLA activity scores signiicantly improved after surgery. RTS was 80% at a mean duration of 7.2 ± 3.1 months. RTS in the high-impact sports group was signiicantly lower than that in the low-impact sports group (high-impact 60% vs. low-impact 100%, p = 0.043). There was no signiicant diference in RTS regarding bone union after ibular osteotomy. ConclusionThe clinical outcomes including RTS were satisfactory in patients with hybrid CWHTO. Level of evidence IV.

Effect of delayed bone union after hybrid closed-wedge high tibial osteotomy on radiological and clinical parameters

“…There was no correction loss with or without delayed bone, and there was no signi cant difference in the clinical outcomes at 1 year postoperatively. In a previous study, the mean JOA score at 1 year postoperatively was 89 [14], which is similar to that in the present study. The data from the present study suggest that, even in the absence of bone union at 3 months postoperatively, good results can be achieved at 1 year postoperatively with appropriate weight-bearing management.…”

In-hospital grouping rehabilitation of hybrid closed-wedge high tibial osteotomy results in shorter hospital stays and better clinical outcomes

“…Our GE group participants’ characteristics were age (66.9 ± 8.3 years), KL grade (severe OA rate: 75%), complication rate (bone resorption: 8.0%, Delayed union 3.8%), JOA score (preoperatively: 71.2 ± 11.9 to post 12 months: 91.4 ± 6.1), VAS (preoperatively: 29.4 ± 20.4 to post 12 months 1.2 ± 3.3). Previous study 3 , 5 , 15 – 17 ) , reported that age (56.7–69.2 years), KL grade (severe OA rate: 52–100%), and JOA score (preoperatively: 61.0–72.2 to post 12 months: 86.4–92.0), VAS (preoperatively: 46.0 ± 19.0 to post 12 months: 10.0 ± 0.9), complication (Delayed union 4.0%–8.5%). Compared to these previous studies, the present study resulted in less pain, fewer post-operative complications, and higher JOA scores.…”

“…HCWHTO is also identified for patellofemoral joint OA, strong varus deformity, and knee flexion contracture 2 ) . Although arthroplasty was prevalently the treatment of choice for severe knee OA, HCWHTO is increasingly being chosen when recreational and sports activities are desired 3 ) . The stable contact surface of the lateral tibial osteotomy side enables full loading at 2–3 weeks postoperatively, and the expeditious time to the bony union has the advantage of influencing a swift return to sports 3 , 4 ) .…”

“…Although arthroplasty was prevalently the treatment of choice for severe knee OA, HCWHTO is increasingly being chosen when recreational and sports activities are desired 3 ) . The stable contact surface of the lateral tibial osteotomy side enables full loading at 2–3 weeks postoperatively, and the expeditious time to the bony union has the advantage of influencing a swift return to sports 3 , 4 ) . However, there is a risk that excessive loading may induce bone resorption and delayed union of the osteotomy 5 ) .…”