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Patient and surgeon factors affect patients’ ability to return to sports after knee surgery
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VIENNA — Return to sports has several advantages for patients with degenerative knees who undergo total knee arthroplasty (TKA), unicompartamental 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.
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 comorbidities make it difficult for patients to return to sports, Zaffagnini said. Although sports can often be pursued postoperatively 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 unicompartamental 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 preoperative 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 overcorrection 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, microfracture, 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. – by Susan M. Rapp
Reference:
Neyret P, et al. Symposium: Return to sports after surgery for degenerative knee. Presented at 18th EFORT Annual Congress: 31 May - 2 June 2017, Vienna.
Disclosures:
Doral, Neyret, Van Heerwaarden, Verdonk and Zaffagnini report no relevant financial disclosures.