Background

A limited number of studies have speculated that subjective factors may explain observed changes in activity participation behaviours after HTO surgery. Such factors should be examined clinically since they may impact behaviour and, therefore, rehabilitation progress and overall outcome. Patients who have undergone other forms of knee surgery have cited numerous subjective variables that modified their post-operative physical activity behaviours such as: fear of reinjury, confidence in the knee, personal preference, lifestyle changes, expectations, and social support. Qualitative research has not yet been published pertaining to HTO patients. This study aimed to investigate which factors influence patient decisions to return to physical activity after HTO.

Methods

Semi-structured interviews were conducted and transcribed verbatim. Data were analysed thematically to realise codes, categories, and themes. Patient-reported outcome scores were completed as secondary measures. Eleven HTO patients (mean age: 52 ± 7.7 years) participated at a mean 32 ± 10.1 months post-operatively.

Results

Four themes emerged from the interviews: physical factors, psychological factors and intentions, information and experiences, and actual physical activity. Multiple factors contributed to pre- to post-operative changes in physical activity behaviours; not all of which related to the operated knee. A reduction in high-impact activities, and an increase in low-impact activities, was reported. Tegner scores showed an overall increase in activity levels post-operatively (4.4 ± 1.2) versus pre-operatively (2.8 ± 2.1). The “Sports” and “Quality of Life” KOOS subscales were the lowest (50.5 ± 21.4 and 51.7 ± 27.3, respectively).

Conclusion

Residual pain during high-impact activities, fear of reinjury, aging, subsequent injuries, reduced confidence, and a lack of guidance after the initial recovery period impacted the post-operative activity behaviour of HTO patients. A reduction of high-impact sports participation, but an overall increase in activity levels post-operatively, can be expected. Most patients changed the type of activity they performed rather than ceased to be active.