Yüksek Tibial Osteotomide Fizyoterapi ve Rehabilitasyon

Amaç: Yüksek tibial osteotomi özellikle genç ve aktif hastaların alt ekstremite dizilim bozukluğuyla birlikte seyreden medial kompartman tutulumlu diz osteoartritinin tedavisinde kabul edilen ve yaygın olarak kullanılan cerrahi bir yöntemdir. Yüksek tibial osteotomide kullanılan cerrahi teknikler yıllar içinde değişse de temel prensipler hep aynı kalmıştır. Bununla birlikte fiksasyon araçlarının gelişmesi ile birlikte aktiviteye dönüşün daha erken ve daha agresif izin verilmesi hastanın patolojisine, beklentisine ve yeteneklerine göre rehabilitasyon ve egzersiz programlarının güncellenmesini gerektirmektedir. Bu derlemenin amacı gelişen cerrahi yöntemlere uygun olarak yüksek tibial osteotomide en güncel fizyoterapi ve rehabilitasyon uygulamalarına genel bir bakış açısı sunmaktır. Sonuç: Yüksek tibial osteotomi öncesi ve sonrasında uygulanan rehabilitasyon uygulamaları ile ilgili güncel yaklaşımlar oldukça kısıtlıdır. Cerrahi sonrası ilk hedef günlük yaşam aktivitelerinde optimal düzeyde fonksiyonel bağımsızlığı kazandırmak ve yaşam kalitesini arttırmaktır. Hastalara uygulanan fizyoterapi ve rehabilitasyon programı her hastaya özgü olmalı ve egzersiz uygulamaları basamak basamak ilerlemelidir. Ayrıca hastanın özellikle ekstremite üzerine ağırlık verme ve fiziksel aktiviteye dönüş zamanı açısından uygun bir şekilde bilgilendirilmesi ve yönlendirilmesi gerekmektedir.

Anahtar Kelimeler:

Osteotomi, rehabilitasyon, egzersiz, ağırlık verme

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1. 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.
2. Phisitkul P, Wolf BR, Amendola A. Role of high tibial and distal femoral osteotomies in the treatment of lateral-posterolateral and medial instabilities of the knee. Sports medicine and arthroscopy review. 2006;14(2):96-104.
3. Aalderink KJ, Shaffer M, Amendola A. Rehabilitation following high tibial osteotomy. Clinics in sports medicine. 2010;29(2):291-301, ix.
4. van 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.
5. Attia ME. Opening wedge high tibial osteotomy in varus osteoarthritis of the knee without bone graft. The Egyptian Orthopaedic Journal. 2018;53(1):38.
6. 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.
7. 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.
8. 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.
9. 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 one-year randomised controlled study. International orthopaedics. 2010;34(2):201-7.
10. 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.
11. Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy. 2003;11(3):132-8.
12. 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.
13. 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.
14. 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.
15. 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.
16. 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.
17. 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.
18. Kisner C, Colby LA, Borstad J. Therapeutic exercise: Foundations and techniques: Fa Davis; 2017.
19. 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.
20. 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):1295-300.
21. 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.
22. 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.
23. 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.