Patient and surgeon factors affect return to sports after knee surgery

Return to sports has several advantages for patients with degenerative knees who undergo total knee arthroplasty (TKA), uni-compartamental arthroplasty, high tibial osteotomy or cartilage treatments and want to return to sports, according to presenters in a symposium on 31 May, moderated by Philippe Neyret MD, at the 18th EFORT Annual Congress in Vienna.

Online services offering access to medical experts in Europe and the US can prevent unnecessary surgery and provide alternative treatments, their founders say, as telemedicine gains traction. South China Morning Post

by Susan Rapp, Healio Orthopedics Today June 1, 2017

Stefano Zaffagnini MD, who discussed return to sports after TKA, noted patients can experience increased bone mineral density and decreased risk of early prosthesis loosening when they are active following TKA. The surgeon plays a key role in return to sports after TKA, he said.

“We need to motivate our patients much better.”

Obesity, female gender and co-morbidities make it difficult for patients to return to sports, Zaffagnini said. Although sports can often be pursued post-operatively by patients after TKA, surgeons must be aware of the risk of implant loosening after TKA in an active patient.

About 90% of patients can return to sports after uni-compartamental knee arthroplasty (UKA), Mahmut Nedim Doral, MD PhD, said, noting UKA functional results are traditionally better vs. TKA. The technique used is also important, particularly for alignment and posterior tibial slope.

“Do not forget conservative methods. Proper pre-operative evaluation is key and patient selection is very important,” Doral said.

“Patients want to and can be active after osteotomies,” said Ronald Van Heerwaarden MD.

He discussed high tibial osteotomy (HTO) and studies that focused on the number of patients who returned to sports after HTO and when they returned to sports.

In a 2016 study by S. Ekhtiari and colleagues, 90% of patients returned to sports earlier than 1 year after HTO. Of those patients, 78.6% returned at an equal or higher level than before surgery, Van Heerwaarden said.

Results of a 2013 study by Bonnin and colleagues showed “young, motivated patients can resume strenuous activity following HTO,” he said.

Van Heerwaarden explained over-correction of deformity is unnecessary in soccer players because valgus alignment offers little advantage.

However, the advice an orthopaedic surgeon gives to patients can impact the outcomes in terms of sports activities, he said.

“There are confounding factors. You are one of them. Motivate your patient. In a motivated patient, return to sports is definitely higher.”

René Verdonk MD PhD, said patient age and BMI appear to be important to return to sports after autologous chondrocyte implantation, micro-fracture, osteochondral autograft transfer system (Arthrex) and other cartilage repair techniques.

“Short-term vs. long-term return to sports depends on patients and treatment,” he said.

Source Healio Orthopedics Today

Return to Work and Sport Following High Tibial Osteotomy: A Systematic Review, Ekhtiari S, Haldane CE, de Sa D, Simunovic N, Musahl V, Ayeni OR. J Bone Joint Surg Am. 2016 Sep 21;98(18):1568-77. doi: 10.2106/JBJS.16.00036.

Can patients really participate in sport after high tibial osteotomy? Bonnin MP, Laurent JR, Zadegan F, Badet R, Pooler Archbold HA, Servien E. Knee Surg Sports Traumatol Arthrosc. 2013 Jan;21(1):64-73. doi: 10.1007/s00167-011-1461-9. Epub 2011 Mar 16.

Consultation patterns of children and adolescents with knee pain in UK general practice: analysis of medical records, Zoe A. Michaleff, Paul Campbell, Joanne Protheroe, Amit Rajani and Kate M. Dunn. BMC Musculoskeletal Disorders 201718:239 DOI: 10.1186/s12891-017-1586-1

Also see
Recommendations for patient activity after knee replacement vary among surgeons in Healio Orthopedics Today
How a doctor’s second opinion is just a click away for Hongkongers – and whether that’s a good thing in South China Morning Post

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