Abstract
High tibial osteotomy (HTO) is a form of knee surgery that treats painful osteoarthritis. It achieves this by correcting deformity in a malaligned tibia to adjust the weightbearing line through the joint. HTO preserves, rather than replaces, the knee and is therefore particularly relevant for physically active patients. Despite physical activity being a key surgical indication for HTO, previous research shows that most patients only return to physical activity at a level similar to their pre-operative status, and only a small proportion of patients improve any further. The aim of this thesis was to provide a greater understanding of the interaction between HTO and physical activity to improve outcomes after surgery; and to determine the factors that limit post-operative activity participation.This thesis presents the findings of six original studies plus a systematic review of the literature. The use of graft materials during HTO – both the type of graft material and whether they are necessary at all – is an operative variable that was highlighted as having a potential influence on physical activity levels (Chapters 2 and 4). Biomechanical and clinical studies (Chapters 5 and 6) were conducted to test this. In addition to operative variables, it was clear that other unknown factors influenced the post-operative return to physical activity. Two qualitative studies (Chapters 7 and 8) were conducted in which patients and surgeons were interviewed to determine these factors. Pain and a number of psychosocial variables were commonly identified by patients as having a role in their physical activity behaviours. The surgeons reported that the management of patient expectations is prominent in the information they provide to patients prior to surgery. Areas of contention among surgeons were detected including timelines to achieve post-operative milestones and whether to advise limitations on certain types of physical activity. The final two studies (Chapters 9 and 10) focused on the interaction between return to physical activity, pain, and patient expectations.
Overall, this thesis found that more attention should be paid to improving physical activity outcomes after HTO, since being active is a key indication for the procedure. The use of allograft wedges during HTO is recommended for routine use where possible because they are clinically and biomechanically preferable to the alternatives, allowing patients to return to higher levels of physical activity after surgery. Physical pain is not necessarily a limiting factor for activity participation once recovered from surgery, although a certain residual level is likely. Addressing psychosocial factors and improving the accuracy of patient expectations is likely to result in additional positive activity outcomes after HTO. The implications for the findings presented, and recommendations for areas of future research, are discussed.
| Date of Award | 26 Oct 2020 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Simon Jobson (Supervisor), James Faulkner (Supervisor) & Adrian Wilson (Supervisor) |