Postural Stability and Regulation before and after High Tibial Osteotomy and Rehabilitation

• Main Authors: Kay Brehme, Thomas Bartels, Martin Pyschik, Manuel Jenz, Karl-Stefan Delank, Kevin G. Laudner, René Schwesig
• Format: Article
• Language: English
• Published: MDPI AG 2020-09-01
• Series: Applied Sciences
• Subjects: knee osteoarthrosis; surgery; posturography; postural subsystems; pain; quality of life
• Online Access: https://www.mdpi.com/2076-3417/10/18/6517

Knee osteoarthrosis (OA) is a widespread orthopedic problem and a high tibial osteotomy (HTO) is a common treatment to minimize degeneration of the affected compartment. The primary aim of this study was to evaluate the postural regulation and stability among patients who underwent HTO and rehabilitation. This prospective study included 32 patients (55.3 ± 5.57 years) diagnosed with medial tibiofemoral OA. Each subject completed postural regulation and stability testing (Interactive Balance System), as well as pain intensity (visual analogue scale) and quality of life questionnaires (SF-36) prior to HTO (exam 1), and at six weeks (exam 2), twelve weeks (exam 3) and six months (exam 4) post HTO. For postural comparison, all patients were matched (sex, age, height) with asymptomatic subjects. Significant time effects (exam 1 vs. exam 4) were found for weight distribution index (WDI; η_p² = 0.152), mediolateral weight distribution η_p² = 0.163) and anterior–posterior weight distribution η_p² = 0.131). The largest difference (exam 3: η_p² = 0.251) and the most significant differences to the matched sample were calculated for the stability indicator (exam 1: η_p² = 0.237; exam 2: η_p² = 0.215; exam 3: η_p² = 0.251; exam 4: η_p² = 0.229). Pain intensity showed a significant reduction (η_p² = 0.438) from exam 1 (50.7 ± 20.0 mm) to exam 4 (19.3 ± 16.0 mm). Physical pain was the quality of life parameter with the largest improvement between exams 1 and 4 (η_p² = 0.560). HTO allows patients to improve their mediolateral weight distribution, whereas postural stability is consistently lower than in asymptomatic subjects. This surgery leads to marked improvements in quality of life and pain.