Proefschrift

Chapter 9 126 When comparing the PWB regime to a RWB regime in a smaller non-randomized cohort (N=91) in this thesis in terms of quality of life, time to full weight bearing, and number of complications in patients with surgically treated tibial plateau fractures, no differences were found in either patient-reported SF-12 (quality of life) or VAS scores (pain) between the PWB group and RWB group. Time to full weight bearing was significantly shorter in the PWB than in the RWB group, i.e., 14.7 versus 20.7 weeks, (p=0.02). No differences were found regarding postoperative complications between the PWB and the RWB groups, i.e., 6.5% versus 10.0%, respectively. Furthermore, no significant differences were found in rates of postoperative removal of osteosynthesis material or the need for total knee prostheses after tibial plateau fractures. In our study 28.3% of patients in the RWB were already bearing full weight within 12 weeks, highlighting the contrast to the standard protocol of 12 weeks non-weight bearing. The patients in the PWB group were already bearing full weight 6 weeks earlier than the RWB group. In addition, earlier studies reported that one third of the patients do not (fully) comply to a non- or restricted weight bearing regimen.15,17,22 A number of studies found patients to exceed the prescribed amount of partial weight bearing even when self-reported compliance was high.17,22 In another prospective multicenter study in this thesis, the aim was to investigate the effectiveness of a PWB in surgically treated trauma patients with peri- and intraarticular fractures of the lower extremities. This study included 106 trauma patients (N=53 in both the PWB and RWB groups). Significantly better ADL and QoL but no significant differences in postoperative complication rates were found for the PWB group compared to the RWB groups. In comparison in a larger literature study on 4918 elderly patients with a fracture of the hip23 it was found that postoperative weight-bearing restrictions even led to a significantly greater risk of developing most adverse events compared with those who are encouraged to bear weight as tolerated. In another randomized literature study on 115 ankle fractures24 unprotected weightbearing and mobilization as tolerated as postoperative care regimen compared to restricted weight bearing regimens improved short-term functional outcomes similarly to our study and led to earlier return to work and sports. On the other hand it did not result in a significant increase of complications or reduction of quality of life scores. Interestingly was the data from this thesis on weight bearing, as measured with the Moticon insoles. The measurements showed that there was no significant difference in mean weight bearing between the RWB and PWB groups. Point of discussion here is that even while instructions for rehabilitation given to patients may be clear, patient compliance with a non-weight bearing or limited weight bearing regime has been found to be poor.17 Several studies found that patients had actually exceeded the prescribed amount of partial weight bearing even though their selfreported compliance was high.17,22 For example, Braun et al used for their study a

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