Yüksek Tibial Osteotomide Fizyoterapi Rehabilitasyon

Yüksek tibial osteotomi özellikle genç ve aktif hastaların altekstremite dizilim bozukluğuyla birlikte seyreden medialkompartman tutulumlu diz osteoartritinin tedavisinde kabuledilen ve yaygın olarak kullanılan cerrahi bir yöntemdir. Buyöntem ile alt ekstremite mekanik ekseninin düzeltilmesiile dizin medial kompartmanına binen yükün ve bunabağlı olarak ağrının da azaltılması sağlanır. Yüksek tibialosteotomide kullanılan cerrahi teknikler yıllar içinde değişsede temel prensipler hep aynı kalmıştır. Bununla birlikte sonyıllarda fiksasyon cihazları ve tekniklerinin geliştirilmesiile daha erken yük verme ve daha agresif rehabilitasyonprogramları denenmektedir. Cerrahide kullanılan fiksasyonaraçlarının gelişmesi ile birlikte aktiviteye dönüşün dahaerken ve daha agresif izin verilmesi açısından rehabilitasyonve egzersiz programlarının güncellenmesini gerektirmektedir.Bu derlemenin amacı gelişen cerrahi yöntemlere uygunolarak yüksek tibial osteotomide en güncel fizyoterapi verehabilitasyon uygulamalarına genel bir bakış açısı sunmaktır.Yüksek tibial osteotomi ile birlikte uygulanan fizyoterapive rehabilitasyon programı cerrahinin başarısı ve iyileşmeaçısından oldukça önemlidir. Rehabilitasyon sürecicerrahiden hemen sonra hastane ortamında başlamalı günlükyaşam aktivitelerine bağımsız ve ağrısız dönüşe kadar devametmelidir. Cerrahi tekniğe ve fiksasyon tipine bağlı olarakağırlık verme eğitiminin osteotomi sonrası iki ay içindehiç yük vermeden kısmi ağırlık vermeye doğru ilerlemesiönerilmektedir. Cerrahi sonrası rehabilitasyon ve egzersizuygulamalarında hedef günlük yaşam aktivitelerinde optimaldüzeyde fonksiyonel bağımsızlığı kazandırmak ve yaşamkalitesini arttırmaktır. Ek olarak rehabilitasyon programınınher fazı hastanın fonksiyonel değerlendirmelerini içermelidir.Hastalara uygulanan fizyoterapi ve rehabilitasyon programıher hastaya özgü olmalı ve egzersiz uygulamaları basamakbasamak ilerlemelidir. Ayrıca hastanın özellikle ekstremiteüzerine ağırlık verme ve fiziksel aktiviteye dönüşzamanı açısından uygun bir şekilde bilgilendirilmesi veyönlendirilmesi gerekmektedir.

Physiotherapy and Rehabilitation After High Tibial Osteotomy

High tibial osteotomy is an accepted and widely used surgical method in the treatment of knee osteoarthritis with medial compartment involvement especially in young and active patients with lower extremity malalignment. With this method, the load on the medial compartment of the knee is reduced by correcting the mechanical axis of the lower limbs, and therefore the pain is reduced. Although the surgical techniques used in high tibial osteotomy have changed over the years, the basic principles have always remained the same. In addition, with the development of fixation devices and techniques, earlier loading and more aggressive rehabilitation programs have been tried in recent years. By the advanced fixation tools used in surgery, it requires updating of rehabilitation and exercise programs in order to allow return to activity earlier and more aggressively. The goal of this review is provide an overview of current physiotherapy and rehabilitation program options for high tibial osteotomy in accordance with the developing surgical methods. The physiotherapy and rehabilitation program implemented with high tibial osteotomy is very important for the success of the surgery and recovery. The rehabilitation process should start immediately after surgery in the hospital room and continues until the independent and painless return to the activities in daily living. Depending on the surgical technique and type of fixation, it is recommended that non-weight bearing training should proceed to partial weight-bearing training within two months after osteotomy. In post-surgical rehabilitation and exercise applications, the goal is to provide optimal functional independence in daily life activities and increase the quality of life. In addition, each phase of the rehabilitation program should include functional assessment of the patient. The physiotherapy and rehabilitation program applied to patients should be specific to each patient and exercise practices should progress step by step. Besides, the patient should be informed and directed appropriately especially in terms of weighting on the limb and returning to physical activity.

PDF

___

1. Kyung H-S. High tibial osteotomy for medial knee osteoarthritis. Knee Surgery & Related Research. 2016;28(4):253-4.
2. Naudie DD, Amendola A, Fowler PJ. Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust. The American Journal of Sports Medicine. 2004;32(1):60-70.
3. Phsitkul P, Wolf BR, Amendola A. Role of high tibial and distal femoral osteotomies in the treatment of lateralposterolateral and medial instabilities of the knee. Sports Medicine and Arthroscopy Review. 2006;14(2):96-104.
4. Alderink KJ, Shaffer M, Amendola A. Rehabilitation following high tibial osteotomy. Clinics in sports medicine. 2010;29(2):291-301.
5. Egmond N, van Grinsven S, van Loon CJ, Gaasbeek R, van Kampen A. Better clinical results after closed-compared to open-wedge high tibial osteotomy in patients with medial knee osteoarthritis and varus leg alignment. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24(1):34-41.
6. Habib MK, Khan ZA. Radiological, functional, and anatomical outcome in patients with osteoarthritic knee undergoing high tibial osteotomy. Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie. 2016;12(4):34-40.
7. Nelissen E, Van Langelaan E, Nelissen R. Stability of medial opening wedge high tibial osteotomy: a failure analysis. International Orthopaedics. 2010;34(2):217-23.
8. Attia ME. Opening wedge high tibial osteotomy in varus osteoarthritis of the knee without bone graft. The Egyptian Orthopaedic Journal. 2018;53(1):38.
9. El-Assal MA, Khalifa YE, Abdel-Hamid MM, Said HG, Bakr HM. Opening-wedge high tibial osteotomy without bone graft. Knee Surgery, Sports Traumatology, Arthroscopy. 2010;18(7):961-6.
10. Lee DC, Byun SJ. High tibial osteotomy. Knee Surgery & Related Research. 2012;24(2):61.
11. Hou Y, Wei J, Jia Z, Wang X. Medium and long term results of high tibial osteotomy for the treatment of knee joint osteoarthritis. China Journal of Orthopaedics and Traumatology. 2016;29(9):795-9.
12. Brouwer R, Bierma-Zeinstra S, Van Raaij T, Verhaar J. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate: a one-year randomised, controlled study. The Journal of bone and joint surgery British volume. 2006;88(11):1454-9.
13. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Does obesity and nicotine abuse influence the outcome and complication rate after open-wedge high tibial osteotomy? A retrospective evaluation of five hundred and thirty three patients. International orthopaedics. 2014;38(1):55-60.
14. Gaasbeek RD, Nicolaas L, Rijnberg WJ, van Loon CJ, van Kampen A. Correction accuracy and collateral laxity in open versus closed wedge high tibial osteotomy. A oneyear randomised controlled study. International orthopaedics. 2010;34(2):201-7.
15. Fowler PJ, Tan JL, Brown GA. Medial opening wedge high tibial osteotomy: how I do it. Operative Techniques in Sports Medicine. 2012;20(1):87-92.
16. Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy. 2003;11(3):132- 8.
17. Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K, et al. Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2009;25(1):46-53.
18. Birmingham TB, Giffin JR, Chesworth BM, Bryant DM, Litchfield RB, Willits K, et al. Medial opening wedge high tibial osteotomy: A prospective cohort study of gait, radiographic, and patient‐reported outcomes. Arthritis Care & Research: Official Journal of the American College of Rheumatology. 2009;61(5):648-57.
19. Schröter S, Ateschrang A, Löwe W, Nakayama H, Stöckle U, Ihle C. Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation. Knee Surgery, Sports Traumatology, Arthroscopy. 2017;25(1):325-32.
20. Spahn G, Kirschbaum S, Kahl E. Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results. Osteoarthritis And Cartilage. 2006;14(2):190-5.
21. Kendoff D, Board TN, Citak M, Gardner MJ, Hankemeier S, Ostermeier S, et al. Navigated lower limb axis measurements: Influence of mechanical weight‐bearing simulation. Journal of Orthopaedic Research. 2008;26(4):553-61.
22. Sim JA, Kwak JH, Yang SH, Choi ES, Lee BK. Effect of weight-bearing on the alignment after open wedge high tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy. 2010;18(7):874-8.
23. Brosseau L, Taki J, Desjardins B, Thevenot O, Fransen M, Wells GA, et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. Clinical rehabilitation. 2017;31(5):596-611.
24. Morris J, Grant A, Kulkarni R, Doma K, Harris A, Hazratwala K. Early results of medial opening wedge high tibial osteotomy using an intraosseous implant with accelerated rehabilitation. European Journal of Orthopaedic Surgery & Traumatology. 2019;29(1):147-56.
25. Choi M-Y, Kong D-H, Kim J-S, Chung K-S, Lee J-H, Kim S-B, et al. Rehabilitation program after medial open wedge high tibial osteotomy. Arthroscopy and Orthopedic Sports Medicine. 2019;6(1):1-8.
26. Bennell K, Hinman R. Exercise as a treatment for osteoarthritis. Current opinion in rheumatology. 2005;17(5):634-40.
27. Baker K, McAlindon T. Exercise for knee osteoarthritis. Current Opinion in Rheumatology. 2000;12(5):456-63.
28. Lorbergs AL, Birmingham TB, Primeau CA, Atkinson HF, Marriott KA, Giffin JR. Improved Methods to Measure Outcomes After High Tibial Osteotomy. Clinics in Sports Medicine. 2019;38(3):317-29.
29. Lee O-S, Ahn S, Lee YS. Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: a systematic review and meta-analysis. Archives of Orthopaedic and Trauma Surgery. 2017;137(7):903-11.
30. Lee YS, Lee BK, Kwon JH, Kim JI, Reyes FJV, Suh DW, et al. Serial assessment of weight-bearing lower extremity alignment radiographs after open-wedge high tibial osteotomy. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2014;30(3):319-25.
31. Hernigou P, Lachaniette CF, Delambre J, Guissou I, Dahmani O, Ouali MI, et al. Full weight bearing and dynamisation with Limmed® locked plate fixation accelerates bone regeneration in the volume of opening wedge high tibial osteotomy. International Orthopaedics. 2015;39(7):1295- 1300.
32. Brinkman J-M, Luites JW, Wymenga AB, van Heerwaarden RJ. Early full weight bearing is safe in open-wedge high tibial osteotomy: RSA analysis of postoperative stability compared to delayed weight bearing. Acta Orthopaedica. 2010;81(2):193-8.
33. Lansdaal JR, Mouton T, Wascher DC, Demey G, Lustig S, Neyret P, et al. Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy. 2017;25(12):3670-8.
34. Bode G, von Heyden J, Pestka J, Schmal H, Salzmann G, Südkamp N, et al. Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy. 2015;23(7):1949-55.
35. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews. 2015;6(2):8-16.
36. Vannini F, Spalding T, Andriolo L, Berruto M, Denti M, Espregueira-Mendes J, et al. Sport and early osteoarthritis: the role of sport in aetiology, progression and treatment of knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24(6):1786-96.
37. Munukka M, Waller B, Häkkinen A, Nieminen MT, Lammentausta E, Kujala U, et al. Physical activity is related with cartilage quality in women with knee osteoarthritis. Medicine and Science in Sports and Exercise. 2017;10(49):46-52.
38. Van Rossom S, Smith CR, Thelen DG, Vanwanseele B, Van Assche D, Jonkers I. Knee joint loading in healthy adults during functional exercises: implications for rehabilitation guidelines. Journal of Orthopaedic & Sports Physical Therapy. 2018;48(3):162-73.