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

[Purpose] This study aimed to examine the impact of physiotherapy on various patients who underwent hybrid closed-wedge high tibial osteotomy. [Participants and Methods] Eighty-four patients were divided into three groups: non-weight-bearing, enhanced recovery after surgery, and grouping exercise. The number of hospital days, distinctions in the duration of cane-walking independence, and postoperative complications were compared among the three groups. Furthermore, the Japanese Orthopaedic Association score and physical function were assessed preoperatively and at 3 and 12 months postoperatively. [Results] There were no considerable differences in postoperative complications among the three groups, and the mean hospital stay was the shortest for the grouping exercise group. At 3 months postoperatively, the grouping exercise group reported less walking pain than the enhanced recovery after surgery group. At 3 and 12 months postoperatively, the grouping exercise group showed greater mean knee extensor strength and a higher mean Japanese Orthopaedic Association score than the non-weight-bearing group. [Conclusion] Grouping exercise therapy, in addition to enhanced recovery after surgery protocol, results in shorter hospital stays, no difference in postoperative complications, and good clinical outcomes.

Association between clinical symptoms and lateral thrust 12 months after high tibial osteotomy.

[Purpose] This study aimed to assess the correlation between lateral thrust and clinical symptoms after high tibial osteotomy and determine lower limb alignments that may decrease lateral thrust. [Participants and Methods] We included 54 patients (73 knees) who underwent high tibial osteotomy. Clinical symptoms, including the Japanese Orthopaedic Association score and the hip-knee-ankle angle measured via radiography, were assessed 12 months postoperatively. Lateral thrust was measured using three-dimensional motion analyses. Logistic regression was used to calculate the cut-off values with good Japanese Orthopaedic Association score and lateral thrust as dependent variables and both lateral thrust and hip-knee-ankle angle as independent variables. [Results] The lateral thrust cut-off was 3.1° (sensitivity: 0.83; specificity: 0.74; area under the curve: 0.76), while that of the hip-knee-ankle angle was 1.9° of valgus (sensitivity: 0.71; specificity: 0.81; area under the curve: 0.72). [Conclusion] Good clinical outcomes after high tibial osteotomy can be expected with a lateral thrust of ≤3.0°, indicating that the target hip-knee-ankle angle should be 2.0° valgus. In cases where valgus alignment is insufficient, lateral thrust may develop, which should be assessed using gait analysis.

Association of clinical symptoms and metabolic syndrome-related factors in patients undergoing high tibial osteotomy.

[Purpose] This study aimed to investigate the relationship between clinical outcomes after high tibial osteotomy and metabolic syndrome-related factors, such as hypertension, dyslipidemia, diabetes mellitus, and obesity. [Participants and Methods] A total of 73 patients (73 knees) who underwent high tibial osteotomy for knee osteoarthritis between 2018 and 2020 were included. We investigated the correlation between metabolic syndrome-related factors and clinical symptom assessment (Japanese Orthopedic Association Score) and examined knee function and lower alignment. [Results] At three months postoperatively, the Japanese Orthopedic Association score showed no main and synergistic effects on metabolic syndrome-related factors, and the preoperative Japanese Orthopedic Association score only showed a main effect on metabolic syndrome-related factors. At 12 months postoperatively, the Japanese Orthopedic Association score showed main and synergistic effects on diabetes mellitus, obesity, hypertension and dislipidemia. [Conclusion] Metabolic syndrome-related factors are associated with poorer clinical outcomes after high tibial osteotomy.