TY - JOUR
T1 - Return to Work and Sport After Proximal Tibial Osteotomy and the Effects of Opening Versus Closing Wedge Techniques on Adverse Outcomes
T2 - A Systematic Review and Meta-analysis
AU - Kunze, Kyle N.
AU - Beletsky, Alexander
AU - Hannon, Charles P.
AU - LaPrade, Robert F.
AU - Yanke, Adam B.
AU - Cole, Brian J.
AU - Forsythe, Brian
AU - Chahla, Jorge
N1 - Funding Information:
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. proximal tibial osteotomy high tibial osteotomy knee sports work wedge edited-state corrected-proof One or more of the authors has declared the following potential conflict of interest or source of funding: A.B.Y. has received research support from Arthrex and Organogenesis; consulting fees from JRF Ortho and Aastrom Biosciences; and education and hospitality payments from Arthrex and Smith & Nephew. B.J.C. has received consulting fees from Acumed, Anika Therapeutics, Arthrex, Bioventus, Flexion Therapeutics, Geistlich Pharma North America, Genzyme Corp, Pacira Pharmaceuticals, Regentis, Smith & Nephew, Vericel, and Zimmer Biomet; research support from Aesculap/B.Braun, Arthrex, and National Institutes of Health; hospitality payments from Aesculap Biologics, Depuy Synthes, GE Healthcare, and Vericel Corp; IP royalties from Arthrex and DJO; other financial or material support from Athletico, Carticept Medical, JRF Ortho, Lifenet Health, and Smith & Nephew; education payments from Arthrex and Pacira Pharmaceuticals; and honoraria from Vericep Corp; and holds stock or stock options in Cartiva Inc, Ossio, and Regentis. J.C. has received education and hospitality payments from Arthrex and Smith & Nephew. R.F.L. has received royalties, hospitality, consulting fees, speaker’s fees, and travel payments from Arthrex and Smith & Nephew. B.F. has received research support from Arthrex, Smith & Nephew, and Stryker and holds stock or stock options in Jace Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. § - - - - References 1 3 , 5 , 6 , 11 , 14 , 17 20 , 22 , 23 , 26 , 29 31 , 33 , 35 -38, 40 42 , 45 , 50 . ‖ References 3 , 17 , 18 , 21 , 26 , 28 , 32 , 41 , 44 . ¶ - - References 1 3 , 5 , 6 , 11 , 17 , 19 , 20 , 23 , 26 , 28 , 29 , 31 , 33 , 35 , 37 41 , 44 , 47 , 50 . # References 2 , 11 , 17 , 19 , 21 , 36 , 44 , 45 , 47 . ** - - References 1 , 2 , 5 , 14 , 17 , 21 , 23 , 26 , 28 , 31 , 35 37 , 39 41 , 44 , 45 , 47 . †† - - - References 1 , 2 , 5 , 6 , 11 , 14 , 17 19 , 21 , 23 , 26 , 28 , 29 , 33 , 35 37 , 39 42 , 44 , 45 , 47 , 50 .
Publisher Copyright:
© 2019 The Author(s).
PY - 2020/7/1
Y1 - 2020/7/1
N2 - 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.
AB - 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.
KW - high tibial osteotomy
KW - knee
KW - proximal tibial osteotomy
KW - sports
KW - wedge
KW - work
UR - http://www.scopus.com/inward/record.url?scp=85076160004&partnerID=8YFLogxK
U2 - 10.1177/0363546519881638
DO - 10.1177/0363546519881638
M3 - Review article
C2 - 31774691
AN - SCOPUS:85076160004
SN - 0363-5465
VL - 48
SP - 2295
EP - 2304
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 9
ER -