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British Medical Bulletin Advance Access originally published online on June 23, 2009
British Medical Bulletin 2009 91(1):111-121; doi:10.1093/bmb/ldp023
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© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Sports activities after lower limb osteotomy

Nikolaos Gougoulias{dagger}, Anil Khanna{dagger} and Nicola Maffulli*,{ddagger}

{dagger} Department of Trauma and Orthopaedic Surgery, University Hospital of North Staffordshire, Stoke on Trent, Staffordshire, UK
{ddagger} Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK

* Correspondence to: Nicola Maffulli, Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK. E-mail: n.maffulli{at}qmul.ac.uk

Introduction: Active sports participation can be important in some patients with degenerative joint disease in the lower limb. We investigated whether this is possible after an osteotomy for osteoarthritis of the hip, knee and ankle joints.

Sources of data: We performed a literature search using Medline, Cochrane, CINAHL and Google Scholar with no restriction to time period or language using the keywords: ‘osteotomy and sports’. Eleven studies (all level IV evidence) satisfied our inclusion and exclusion criteria. Nine reported on high tibial osteotomies, one on periacetabular osteotomies and one on distal tibial osteotomies. The Coleman Methodology Score to assess the quality of studies showed much heterogeneity in terms of study design, patient characteristics, management methods and outcome assessment.

Areas of agreement: Participation in recreational sports is possible in most patients who were active in sports before lower limb osteotomy. In no study were patients able to participate in competitive sports.

Areas of controversy: Intensive participation in sports after osteotomy may adversely affect outcome and lead to failures requiring re-operation.

Growing points: Patients may be able to remain active in selected sports activities after a lower limb osteotomy for osteoarthritis. More rapid progression of arthritis is however a possibility.

Areas timely for developing research: Prospective comparative studies investigating activities and sports participation in age-matched patients undergoing osteotomy or joint replacement could lead to useful conclusions. Increased activity and active sports participation may lead to progression of arthritis and earlier failure requiring additional surgery.

Keywords: sport • arthritis • osteotomy • ankle • knee

Accepted for publication June 4, 2009.


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