Can patients really participate in sport after high tibial osteotomy?

PURPOSE: The possibility to return to sporting activity can be an important consideration in the decision-making process in femorotibial osteoarthritis. We analyzed functional outcomes and sport participation in a continuous series of HTO and asked whether this procedure could match expectations in active and motivated patients. METHODS: We retrospectively investigated activities, sports participation, and the level of satisfaction in 139 patients with unilateral noncomplicated HTO. The study included 41 women and 98 men with a mean age of 59 years and a mean 50 months of follow-up. RESULTS: Eighty-seven patients (63%) reported that their knee was "normal," and eighty-six patients (62%) felt that their activities were limited by their knee. A total of 78 patients (56%) reported that they were as active as they expected to be before the intervention. Of these patients, 98% were satisfied. Of the patients who were not as active as they thought they would be, 51% were satisfied (P < 0.0001). The duration of preoperative pain, the age at evaluation, and the number of previous surgeries did not influence the subjective result. Among patients under 75 years, 28% regularly participated in strenuous sports, but 40% were motivated for these activities. 66% of the motivated patients regularly participated in at least one impact sport. CONCLUSION: This study shows that young motivated patients are able to resume strenuous activities following HTO. However, patients must be informed that they will typically not recover their pre-pathology level and that residual pain during strenuous sports is not exceptional. LEVEL OF EVIDENCE: Therapeutic study, Level IV.

The Salto total ankle arthroplasty: survivorship and analysis of failures at 7 to 11 years.

BACKGROUND: Despite the appearance of new-generation, mobile-bearing, cementless prostheses, total ankle arthroplasty remains controversial. Among the criteria guiding the choice between arthrodesis and arthroplasty, the long-term survival and postoperative function are of critical importance. The mobile-bearing Salto prosthesis has been used in Europe since 1997, but only 2 to 5 years of followup data have been reported. QUESTIONS/PURPOSES: We analyzed the longer-term survivorship and causes of failures of the Salto prosthesis in a cohort of previously studied patients. We asked whether this prosthesis provided a functional ankle (AOFAS score) and durable radiographic fixation. PATIENTS AND METHODS: We retrospectively reviewed 96 prospectively followed patients with 98 prostheses implanted between 1997 and 2000. Of those, 85 patients (87 prostheses) had a minimum followup of 6.8 years (mean, 8.9 years; range, 6.8-11.1 years). RESULTS: The survival rate was 65% (95% CI, 50-80) with any reoperation of the ankle and 85% (95% CI, 75-95) with revision of a component as the end points. Six prostheses were removed for arthrodesis, and 18 ankles underwent reoperation without arthrodesis. We observed three main causes of reoperations: bone cysts (11 patients), fracture of the polyethylene (five patients), and unexplained pain (three patients). The mean AOFAS score was 79 ± 12 points. Radiographic subsidence was observed in three patients and bone cysts in eight patients. CONCLUSIONS: Our data suggest a high rate of reoperations but only six revisions with arthrodesis with mid-term followup. We observed few patients with loosening and/or subsidence. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Is the anterior tibial tuberosity a reliable rotational landmark for the tibial component in total knee arthroplasty?

To analyze the morphology of the tibial plateau, we studied 100 computed tomographic scans of arthritic knees and measured the mediolateral (ML) and anteroposterior (AP) dimensions as well as their aspect ratio using 3 reference axes of rotation: transepicondylar axis (TEA), posterior tibial margin (PTM), and anterior tibial tuberosity (ATT) axis. Relative to the TEA, the PTM was internally rotated by 1.6° ± 5.1°, and the ATT externally rotated by 14.8° ± 7.2°. The AP and ML dimensions and aspect ratio differ significantly when the reference axis was ATT compared with PTM or TEA and variations were greater while using ATT axis. Our data demonstrate (1) that design of the tibial component restricts the choice of rotational alignment and (2) that ATT is not a reliable landmark for rotation of the tibial component.

Ankle function and sports activity after total ankle arthroplasty.

BACKGROUND: The return to sporting activities after ankle arthroplasty has rarely been evaluated. The purpose of the present study was to evaluate function and return to sports after total ankle arthroplasty. MATERIALS AND METHODS: One hundred seventy-nine Salto Total Ankle Arthroplasties (TAA) were implanted between 1997 and 2005. A self-administered questionnaire including the Foot Function Index (FFI) and Foot and Ankle Ability Measurement (FAAM) was sent to all patients. At last followup, six were deceased, 22 were not available for evaluation, and six questionnaires were incomplete. One hundred forty-five questionnaires were available. The mean age was 60.9 years and the mean followup was 53.8 months. The main indications for TAA were osteoarthritis (OA) in 100 cases and Rheumatoid arthritis (RA) in 40 cases. RESULTS: 15.2% of the patients said that their operated ankle was "normal'' 60.7%" nearly normal''; 20% "abnormal'' and 4.1% "highly abnormal.'' The FFI scores were 13.7 +/- 17 for "activity limitations'', 31.7 +/- 23 for "disability'' and 16.9 +/- 19 for "pain''. The FAAM scores were 74.9 +/- 18 for activities of daily living and 48.9 +/- 28 for sports activities. On a Visual Analog Scales (0 to 100 were 100 is the "pre-pathology level'') the mean rating was 70.2 +/- 19.6 for Activities of Daily Living and 53.7 +/- 28 for sport activities. In the OA patients, 38 regularly road bicycle, 21 perform recreational gymnastics, 58 swimming, 50 home gardening, 27 dancing, and 43 hiking. Seven patients regularly practice tennis, nine cross-country skiing, 17 downhill skiing, and six regularly run more than 500 m. CONCLUSION: This study showed that TAA improved the quality of life and that return to recreational activities was generally possible but the return to impact sport was rarely possible.