Tsuyoshi Matsuo is a physician who worked in a psychiatric institution in Japan for four years.
High tibial osteotomy in cases of early osteoarthritis and spontaneous osteonecrosis of the knee may enable joint preservation and knee function recovery.Opening wedge high tibial osteotomy using a locking compression plate and Beta-tricalcium phosphate is a technique that provides excellent early fixation and enablesshorter postoperative rehabilitation with fewer serious complications.We performed opening wedge high tibial osteotomy on 135 patients between 2010 and 2013.
Methods: Here we report our postoperative rehabilitation program after opening wedge high tibial osteotomy and describe the postoperative complications.A total of 135 patients (39 men, 96 women) underwent opening wedge high tibial osteotomy between January 2010 and December 2013.
Results: Our rehabilitation program, which included active movement of the ankle, was started on postoperative day 1. Weight bearing was permitted starting on day 2 to the extent that it did not cause pain and the patients started transitioning to a wheelchair. Joint range of motion training focusing on active movement was also started. On day 3, patients started using parallel bars or a walker for gait training to the extent that it did not cause pain. The aim was for each patient to be able to walk on crutches 1 week after surgery and on a single crutch 2 weeks after surgery.Postoperative complications included leg discrepanciesin 64 cases, intraoperative fracture in 20, infection in four, cutaneous necrosis of the surgical wound in three, and non-union in one.In most cases, leg discrepancy was within the 1–2 cm range and was correctable with a silicone shoe insole. Intraoperative fracture did not necessitate any changes to the postoperative rehabilitation program as long as it did not involve the joint surface. If a fracture involved the joint surface, 2–3 weeks without weight bearing was required. The infections were all merely superficial and did not affect postoperative rehabilitation, but repeat surgery was necessary for the patient with non-union.
Conclusions: We believe that opening wedge high tibial osteotomy, which we introduced in 2010, is a surgical procedure that requires only a short period of limited movement and features very few potential postoperative complications requiring changes to the postoperative rehabilitation program.
Cathy Ciolek has a bachelor’s degree in physical therapy from Ithaca College and DPT from AT Still University. She has been board certified as a geriatric clinical specialist since 1996. She is an assistant professor and director of clinical education at the University of Delaware where she teaches geriatrics and principals of adult education and learning theory. She was recently awarded the Lucy Blair Service award from the American Physical Therapy Association.
In 2011, approximately 65% of PT students were American Physical Therapy Association (APTA) members with even less participating as actively engaged members. Given this limited engagement, improved strategies are required to elucidate the benefits associated with professional involvement. Barriers to student engrossment in the APTA anecdotally include expense, lack of time, and decreased awareness of opportunities. To address these barriers, a conceptual framework, modeled after the International Classification of Function (ICF), was developed to demonstrate linkages between related concepts in the process of professional growth. Students explored this new professional development model simultaneous to their education on the ICF. Both models embodied a similar visual structure and “ablement” focus. Use of a graphic, interconnected model allowed students to appreciate the opportunities associated with professional development and reinforced the multifaceted and individualized nature of establishing goals and maximizing outcomes. For example, the model demonstrated how “PT interests” (affinity to a specialty or practice setting) directly influence “PT-related activities” (opportunities reflective of professional goals), and further elucidated how mere “activity” attendance is not “participation” without active engagement and value recognition. The model further demonstrated how individual interests can impact activity selection which, in turn, can facilitate ongoing participation within the activity or organization. Through use of similar precepts to the ICF, this development model provided a useful and vivid depiction of the factors most influential in the establishment and obtainment of professional goals to ultimately promote involvement within the professional organization. Applicability to other rehabilitative professions is most probable.