Proximal osteotomy of the tibia in the treatment of osteoarthritis of the knee

Isolauri, J; Lapinsuo, Matti; Aho, Heikki; Tervo, Tapio; Rokkanen, P

doi:10.1007/bf02498725

Cited by 3 publications

(2 citation statements)

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“…One study that reported a RTW rate of 41.4% evaluated 29 patients between 1972 and 1977 who underwent PTO with a Charnley’s compression device or plaster. 19 The second study found an RTW rate of 51.2% in 43 patients who were treated with the opening wedge hemicallotasis technique, but the authors noted that the 21 patients who did not RTW reported that they retired without listing reasons. 47 The final study evaluated a military population of 181 patients who underwent opening wedge PTO.…”

Section: Resultsmentioning

confidence: 99%

“…A further 2 studies (22.2%) provided information on postoperative RTW level after opening wedge PTO equating to 210 patients. 19,45 Of these, 1 study noted that of the 12 patients who returned to work, a total of 10 (83.3%) returned to work at the same or higher level. 1 The second study reported that 77 (42.5%) patients returned to the same or higher level postoperatively.…”

Section: Resultsmentioning

confidence: 99%

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Return to Work and Sport After Proximal Tibial Osteotomy and the Effects of Opening Versus Closing Wedge Techniques on Adverse Outcomes: A Systematic Review and Meta-analysis

et al. 2019

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Background: Although many studies have reported successful functional outcomes after proximal tibial osteotomy (PTO), a paucity of literature has sought to quantify outcomes and current rates of return to sport (RTS) and return to work (RTW) after PTO. Purpose: To (1) determine current rates of RTS and RTW after PTO and (2) quantify the incidence of complications and conversion to total knee arthroplasty (TKA) after PTO for all patients as well as those undergoing opening and closing wedge PTO. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), EMBASE (2008-2019), and MEDLINE (2008-2019) databases were queried. Data pertaining to article information, patient demographics, surgical techniques, rates of complication and conversion to TKA, patient-reported outcome scores, RTS, and RTW were extracted. Data were synthesized, and a random effects meta-analysis of proportions using continuity correction methods was performed to determine the proportion of patients receiving opening and closing wedge PTO who experienced adverse events. Results: The review and meta-analysis included 33 studies involving 1914 patients who underwent PTO with a weighted mean ± SD age of 50.3 ± 9.9 years and body mass index of 26.9 ± 2.3 kg/m2. The pooled RTS and RTW rates were 75.7% (range, 55%-100%) in 814 patients and 80.8% (range, 41%-100%) in 505 patients, respectively. The pooled TKA rate was 12.5% (range, 0%-35.7%) at a mean of 70.6 months and the pooled complication rate was 11.1% (range, 0%-28.6%). The overall random pooled summary estimate of the proportion of patients who underwent opening wedge PTO and subsequently converted to TKA was 2.0% (95% CI, 1.0%-4.0%; I2 = 63.65) at a mean of 43.4 ± 31.9 months and who experienced a complication was 6.0% (95% CI, 3.0%-9.0%; I2 = 87.10%). For closing wedge PTO, the proportion of patients who converted to TKA was 5.0% (95% CI, 1.0%-9.0%; I2 = 93.1%) and experienced a complication was 2.0% (95% CI, 1.0%-3.0%; I2 = 90.0%). Only 53.8% of studies that referenced RTS provided postoperative RTS rates, and 80% of studies that referenced RTW provided RTW rates. Only 1 study defined RTS criteria, no studies defined RTW criteria, and 31 different outcome measures were reported across all studies. Conclusion: Patients undergoing PTO for osteoarthritis, cartilage defects, and symptomatic malalignment of the knee experience high rates of RTS and RTW. These patients also experience low rates of complications and conversion to TKA, regardless of opening or closing wedge technique. Significant heterogeneity exists with regard to criteria used to define RTS and RTW and patient-reported outcome measures used to assess clinical and functional improvements after PTO.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Return to Work and Sport After Proximal Tibial Osteotomy and the Effects of Opening Versus Closing Wedge Techniques on Adverse Outcomes: A Systematic Review and Meta-analysis

et al. 2019

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Effect of upper tibial osteotomy on fibula movement and ankle joint motion

Forst

Heller

Prescher

et al. 1993

Arch Orthop Trauma Surg

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Several techniques of upper tibial osteotomy in the treatment of unicompartmental osteoarthritis of the knee have been described. Osteotomy of the fibula is normally also carried out, or alternatively, dissection of the capsule of the proximal tibiofibular joint. There is concern, however, that this latter procedure may have an adverse effect on the mobility of the ankle joint and on fibula rotation. To investigate these suspected interactions we performed experimental studies in 14 cadaver legs. The vertical, lateral and rotational movements of the fibula were measured with the ankle in neutral (0 degrees) and maximal ankle dorsiflexion before and after performing an interligamental upper tibial osteotomy of a standardised valgus wedge. Maximal ankle dorsiflexion before the osteotomy produced external rotation of the fibula in most specimens, whereas after osteotomy this movement caused mainly internal rotation. In the neutral position of the ankle, upper tibial osteotomy lead to external rotation of the fibula. The upward movement of the fibula head after osteotomy was 0.64 cm on average. There was no measurable vertical motion of the fibula during ankle dorsiflexion either before nor after upper tibial osteotomy. Ankle dorsiflexion improved minimally after osteotomy. In conclusion, this study shows that upper tibial osteotomy with dissection of the capsule of the proximal tibiofibular joint has no adverse effect on movement of the fibula or of the ankle joint. In addition, unlike fibular osteotomy, this technique also has the advantage that the risk of common peroneal nerve injury is minimal.

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High Rates of Return to Sports Activities and Work After Osteotomies Around the Knee: A Systematic Review and Meta-Analysis

et al. 2017

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BackgroundKnee osteotomies are proven treatment options, especially in younger patients with unicompartmental knee osteoarthritis, for certain cases of chronic knee instability, or as concomitant treatment for meniscal repair or transplantation surgery. Presumably, these patients wish to stay active. Data on whether these patients return to sport (RTS) activities and return to work (RTW) are scarce.ObjectivesOur aim was to systematically review (1) the extent to which patients can RTS and RTW after knee osteotomy and (2) the time to RTS and RTW.MethodsWe systematically searched the MEDLINE and Embase databases. Two authors screened and extracted data, including patient demographics, surgical technique, pre- and postoperative sports and work activities, and confounding factors. Two authors assessed methodological quality. Data on pre- and postoperative participation in sports and work were pooled.ResultsWe included 26 studies, involving 1321 patients (69% male). Mean age varied between 27 and 62 years, and mean follow-up was 4.8 years. The overall risk of bias was low in seven studies, moderate in ten studies, and high in nine studies. RTS was reported in 18 studies and mean RTS was 85%. Reported RTS in studies with a low risk of bias was 82%. No studies reported time to RTS. RTW was reported in 14 studies; mean RTW was 85%. Reported RTW in studies with a low risk of bias was 80%. Time to RTW varied from 10 to 22 weeks. Lastly, only 15 studies adjusted for confounders.ConclusionEight out of ten patients returned to sport and work after knee osteotomy. No data were available on time to RTS. A trend toward performing lower-impact sports was observed. Time to RTW varied from 10 to 22 weeks, and almost all patients returned to the same or a higher workload.Electronic supplementary materialThe online version of this article (doi:10.1007/s40279-017-0726-y) contains supplementary material, which is available to authorized users.

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Proximal osteotomy of the tibia in the treatment of osteoarthritis of the knee

Cited by 3 publications

References 12 publications

Return to Work and Sport After Proximal Tibial Osteotomy and the Effects of Opening Versus Closing Wedge Techniques on Adverse Outcomes: A Systematic Review and Meta-analysis

Return to Work and Sport After Proximal Tibial Osteotomy and the Effects of Opening Versus Closing Wedge Techniques on Adverse Outcomes: A Systematic Review and Meta-analysis

Effect of upper tibial osteotomy on fibula movement and ankle joint motion

High Rates of Return to Sports Activities and Work After Osteotomies Around the Knee: A Systematic Review and Meta-Analysis

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