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Erschienen in: International Orthopaedics 8/2015

01.08.2015 | Original Paper

Return to work and sporting activities after high tibial osteotomy

verfasst von: Martin Faschingbauer, Manfred Nelitz, Stefanie Urlaub, Heiko Reichel, Daniel Dornacher

Erschienen in: International Orthopaedics | Ausgabe 8/2015

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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.
Literatur
1.
Zurück zum Zitat Aglietti P, Rinonapoli E, Stringa G, Taviani A (1983) Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res 176:239–251PubMed Aglietti P, Rinonapoli E, Stringa G, Taviani A (1983) Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res 176:239–251PubMed
2.
Zurück zum Zitat Coventry MB (1985) Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 67:1136–1140PubMed Coventry MB (1985) Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 67:1136–1140PubMed
3.
Zurück zum Zitat 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 124:575–584PubMedCrossRef 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 124:575–584PubMedCrossRef
4.
Zurück zum Zitat 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 23:852–861PubMedCrossRef 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 23:852–861PubMedCrossRef
5.
Zurück zum Zitat 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) 90:592–596CrossRef 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) 90:592–596CrossRef
7.
Zurück zum Zitat Bonnin M, Chambat P (2004) Der stellenwert der valgisierenden, zuklappenden tibiakopfosteotomie bei der medialen gonarthrose. Orthopade 33:135–142PubMedCrossRef Bonnin M, Chambat P (2004) Der stellenwert der valgisierenden, zuklappenden tibiakopfosteotomie bei der medialen gonarthrose. Orthopade 33:135–142PubMedCrossRef
8.
Zurück zum Zitat 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 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
9.
Zurück zum Zitat 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):851–856PubMedCrossRef 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):851–856PubMedCrossRef
10.
Zurück zum Zitat 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) 91:1459–1465CrossRef 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) 91:1459–1465CrossRef
12.
Zurück zum Zitat Song EK, Seon JK, Park SJ, Jeong MS (2010) The complications of high tibial osteotomy. J Bone Joint Surg (Br) 92:1245–1252CrossRef Song EK, Seon JK, Park SJ, Jeong MS (2010) The complications of high tibial osteotomy. J Bone Joint Surg (Br) 92:1245–1252CrossRef
13.
Zurück zum Zitat 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 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.
Zurück zum Zitat Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. J Bone Joint Surg (Br) 75:745–749 Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. J Bone Joint Surg (Br) 75:745–749
15.
Zurück zum Zitat Dejour H, Neyret P, Boileau P, Donell ST (1994) Anterior curciate reconstruction combined with valgus tibial osteotomy. Clin Orthop Relat Res 299:220–228PubMed Dejour H, Neyret P, Boileau P, Donell ST (1994) Anterior curciate reconstruction combined with valgus tibial osteotomy. Clin Orthop Relat Res 299:220–228PubMed
16.
Zurück zum Zitat DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC (2010) Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med 38:2077–2084PubMedCrossRef DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC (2010) Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med 38:2077–2084PubMedCrossRef
17.
Zurück zum Zitat Hernigou PH, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. J Bone Joint Surg Am 69:332–354PubMed Hernigou PH, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. J Bone Joint Surg Am 69:332–354PubMed
18.
Zurück zum Zitat Imhoff AB, Linke RD, Agneskirchner J (2004) Korrekturosteomie bei primary-, varus-, double-varus- und triple-varus-knieinstabilität mit kreuzbandersatz. Orthopade 33:201–207PubMedCrossRef Imhoff AB, Linke RD, Agneskirchner J (2004) Korrekturosteomie bei primary-, varus-, double-varus- und triple-varus-knieinstabilität mit kreuzbandersatz. Orthopade 33:201–207PubMedCrossRef
19.
20.
Zurück zum Zitat Maquet P (1976) Valgus osteotomy for osteoarthritis of the knee. Clin Orthop Relat Res 120:143–148PubMed Maquet P (1976) Valgus osteotomy for osteoarthritis of the knee. Clin Orthop Relat Res 120:143–148PubMed
21.
Zurück zum Zitat Rudan JF, Simurda MA (1990) High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res 255:251–256PubMed Rudan JF, Simurda MA (1990) High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res 255:251–256PubMed
22.
Zurück zum Zitat 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 19:122–127PubMedCrossRef 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 19:122–127PubMedCrossRef
23.
Zurück zum Zitat 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) 90:592–596CrossRef 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) 90:592–596CrossRef
24.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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):312–318PubMedCrossRef 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):312–318PubMedCrossRef
27.
Zurück zum Zitat 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):150–154PubMedCrossRef 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):150–154PubMedCrossRef
28.
Zurück zum Zitat Naal FD, Maffiuletti NA, Munzinger U, Hersche O (2007) Sports after hip resurfacing arthroplasty. Am J Sports Med 35(5):705–711PubMedCrossRef Naal FD, Maffiuletti NA, Munzinger U, Hersche O (2007) Sports after hip resurfacing arthroplasty. Am J Sports Med 35(5):705–711PubMedCrossRef
29.
Zurück zum Zitat 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):1688–1695PubMedCrossRef 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):1688–1695PubMedCrossRef
31.
Zurück zum Zitat 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):1397–1402PubMedCrossRef 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):1397–1402PubMedCrossRef
32.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 34:55–62CrossRef 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 34:55–62CrossRef
34.
Zurück zum Zitat 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 34:167–172PubMedCentralPubMedCrossRef 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 34:167–172PubMedCentralPubMedCrossRef
35.
Zurück zum Zitat 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 28:282–296PubMed 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 28:282–296PubMed
36.
Zurück zum Zitat 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):638–643PubMedCrossRef 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):638–643PubMedCrossRef
37.
Zurück zum Zitat Lobenhoffer P, Agneskircher JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138PubMed Lobenhoffer P, Agneskircher JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138PubMed
38.
Zurück zum Zitat 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):193–198PubMedCentralPubMedCrossRef 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):193–198PubMedCentralPubMedCrossRef
39.
Zurück zum Zitat 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 91:2581–2588PubMedCrossRef 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 91:2581–2588PubMedCrossRef
40.
Zurück zum Zitat 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):2109–2114PubMedCrossRef 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):2109–2114PubMedCrossRef
41.
Zurück zum Zitat 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):64–73PubMedCrossRef 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):64–73PubMedCrossRef
42.
Zurück zum Zitat 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):1420–1424PubMedCrossRef 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):1420–1424PubMedCrossRef
43.
Zurück zum Zitat 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):1607–1616PubMedCrossRef 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):1607–1616PubMedCrossRef
44.
Zurück zum Zitat Nagel A, Insall JN, Scuderi GR (1996) Proximal tibial osteotomy: a subjective outcome study. J Bone Joint Surg Am 78:1353–1358PubMed Nagel A, Insall JN, Scuderi GR (1996) Proximal tibial osteotomy: a subjective outcome study. J Bone Joint Surg Am 78:1353–1358PubMed
45.
Zurück zum Zitat 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):213–219PubMedCrossRef 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):213–219PubMedCrossRef
46.
Zurück zum Zitat Puddu G, Cipolla M, Cerullo G, Franco V, Giannì E (2007) Osteotomies: the surgical treatment of the valgus knee. Sports Med Arthrosc 15(1):15–22PubMedCrossRef Puddu G, Cipolla M, Cerullo G, Franco V, Giannì E (2007) Osteotomies: the surgical treatment of the valgus knee. Sports Med Arthrosc 15(1):15–22PubMedCrossRef
47.
Zurück zum Zitat Lobenhoffer P, Agneskirchner J, Zoch W (2004) Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade 33(2):153–160PubMedCrossRef Lobenhoffer P, Agneskirchner J, Zoch W (2004) Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade 33(2):153–160PubMedCrossRef
48.
Zurück zum Zitat 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):819–826PubMedCentralPubMedCrossRef 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):819–826PubMedCentralPubMedCrossRef
49.
Zurück zum Zitat 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):2273–2280PubMedCrossRef 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):2273–2280PubMedCrossRef
Metadaten
Titel
Return to work and sporting activities after high tibial osteotomy
verfasst von
Martin Faschingbauer
Manfred Nelitz
Stefanie Urlaub
Heiko Reichel
Daniel Dornacher
Publikationsdatum
01.08.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 8/2015
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-015-2701-2

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