In-hospital grouping rehabilitation of hybrid closed-wedge high tibial osteotomy results in shorter hospital stays and better clinical outcomes.

This was an observational study with groups defined by calendar time, so differences in staff, patient care, or secular changes could explain the results. Patients were not randomised, and the group exercise cohort had a more varus preoperative mechanical axis than the other cohorts. Only 74 patients were analysed (26 non-weight-bearing, 22 ERAS, and 26 group exercise), so complication rates and some functional outcomes may be unstable. The paper did not control voluntary physical activity or steps during hospitalisation, and it did not assess whether exercise habits continued after discharge. The paper states that 22 cases per group were required for hospital stay and cane walking, 26 for Japanese Orthopaedic Association score and knee extension strength, and 40 for walking pain; the sample was considered adequate except for walking pain. There was a trend toward more females in the group exercise cohort, and gender may affect outcomes, but the paper did not analyse gender separately. The group exercise cohort received early loading, individual physiotherapy, and group exercise together, so the contribution of group exercise alone cannot be separated.

All authors declared no known competing financial interests or personal relationships.

Do not conclude that group exercise alone caused shorter hospital stays or better function. Patients received early loading, individual physiotherapy, and group exercise together, and the groups were observational historical cohorts, not randomised groups.