Background: Historically, high tibial osteotomy (HTO) has been performed to treat

Background: Historically, high tibial osteotomy (HTO) has been performed to treat isolated medial gonarthrosis with varus deformity. Complications occurred in 19.3% of knees (n = 39), with unplanned reoperation in 26 knees (12.8%). Fifty-three patients (40.7%) had minor activity limitations during military duty postoperatively. Eleven Rabbit polyclonal to ZNF138 knees (5.4%) underwent conversion to total knee arthroplasty. The cumulative failure rate was 28.2% (n = 51) at 2- to 8-12 months follow-up. Patient age younger than 30 years at the time of surgery was associated with an independently higher risk of failure, whereas sex, concomitant/staged procedures, and perioperative complications were not significantly associated with subsequent failure. Conclusion: At short- to midterm follow-up, nearly 72% of all service members undergoing HTO returned to military duty and were free from conversion knee arthroplasty. values <.05, with OR and 95% CI exclusive of 1 1.0. Calculations were performed using SAS software with the assistance of a biostatistician (version 9.2; SAS Institute). Results Of 522 cases isolated from the database, a total of 181 active duty service members underwent 202 HTOs, with mean follow-up of 47.5 months (range, 24-96 months) (Table 1 and Figure 1). The mean patient age was 35.7 years (range, 19-55 years), and the majority of the cohort was male (93%) and of enlisted MK-0518 military rank (78%). A total of 114 patients (63%) had undergone prior knee medical procedures, including 69 ligamentous, 88 meniscal, and 49 chondral procedures. Figure 1. Return to duty and failure rates of high tibial osteotomy (HTO). TKA, total knee arthroplasty. TABLE 1 Patient Demographics and Clinical Profile> .05). Univariate analysis demonstrated an increased rate of failure for patients with concomitant and/or staged procedure; however, this failed to achieve statistical significance on multivariate analysis (Tables 3 and ?and4).4). When analyzing patients <30 years to those 30 years, failure for service members <30 years old was nearly 2-fold greater (OR, 1.80; 95% CI, 1.00-3.22; = .049) than for those 30 years old. TABLE 3 Univariate Analysis of Factors Associated With Clinical Failure After High Tibial Osteotomya TABLE 4 Multivariate Analysis of Factors Associated With Clinical Failure After High Tibial Osteotomya Discussion Rates of success after opening MK-0518 wedge HTO for advanced medial knee arthrosis are variable in the current literature, with estimates ranging from 70% to 98% at 5- to 10-12 months follow-up and 50% to 60% at >15 years postoperatively.8,22 However, clinical success has traditionally been narrowly and subjectively defined, with concern of only survivorship from TKA. Similarly, this methodology fails to account for functional endpoints associated with suboptimal patient outcomes, including an inability to return to the same occupational activity after index knee surgery. Functional reports of HTO in young, athletic patient populations are also limited,3,14 particularly when combined with other intra-articular knee procedures.2,10,16,19,21,31 To this end, the current investigation reports around the clinical, functional, and occupational outcomes of 181 physically active military service members undergoing HTO with 2- to 8-year follow-up. Of this cohort, 72% of patients returned to military duty without secondary conversion to knee arthroplasty. Few MK-0518 studies have evaluated return to athletic activity or high-demand occupational function after HTO. Our findings are consistent with prior reports of functional outcomes after HTO in an active civilian subset. In their report of 139 patients (mean age, MK-0518 59 years) at an average 50-month follow-up, Bonnin et al5 identified that 78% of patients were satisfied or very satisfied after HTO. However, only 63% of patients reported having a normal knee with the option to return to recreational running, and only 36% of patients reported no limitations in function due to pain or other persistent knee symptoms. Nagel et al18 reported on 34 young, active patients with medial osteoarthrosis and noted that 26 individuals (76%) returned to physically demanding manual labor after HTO, and 25 patients (74%) resumed regular sporting activities, including downhill skiing, tennis, jogging, and cycling. MK-0518 Salzmann et al23 noted that 91% of 65 patients were engaged in sports and recreational athletic activity at an average 36 months after HTO for medial compartment arthritis, although no patient returned to a higher level of competition. In contrast, the current military cohort represents a younger patient populace (mean age, 35.5 years) with standardized occupational requirements. In addition to frequent military deployments lasting up to 12 months, support members must also perform routine tactical field training, bear.

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