Complications after high tibial osteotomy and distal femoral osteotomy are associated with increasing medical comorbidities and tobacco use

Abstract

Purpose The purpose of this study was to assess complications, reoperations, and their risk factors at 90 days and 2 years after high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) in a national cohort. Methods The PearlDiver Mariner Dataset was queried using International Classiication of Diseases (ICD) and Current Procedural Terminology (CPT) codes for HTO and DFO, complications, and subsequent surgery. Minimum follow-up was 2 years and complications were assessed at 90 days and 2 years. Hospital readmission in the irst 90 days was also assessed. Univariate and multiple logistic regression were utilized to identify risk factors for complications and re-operation. ResultsThe 90-day and 2-year complication rates after HTO (n = 1780) were 11.6% and 31.7%, compared to 21.5% (p < 0.0001) and 41.5% (p = 0.0001) after DFO (n = 446). Infection was the most frequent early (90-day) complication for both HTO and DFO cohorts, while hardware problems were most common at 2 years. Increasing Elixhauser Comorbidity Index (ECI) was associated with increased odds of infection, readmission, and hardware-associated complications in both cohorts. Gender and tobacco use were also associated with various complications after HTO. At 2 years, 23.7% of HTO patients and 26.2% of DFO patients had undergone subsequent surgery. Hardware removal occurred in 16.4% of HTO and 18.4% of DFO patients (n.s.), while 4.5% of HTO and 5.2% of DFO patients underwent total knee arthroplasty (TKA) within 2 years (n.s.). Conclusion HTO and DFO have substantial complication rates in the short and mid term, with a higher rate of overall complications observed after DFO as compared to the HTO cohort. After both procedures, roughly one quarter of patients will undergo subsequent surgery within 2 years. Patients with tobacco use and numerous medical co-morbidities may not be optimal candidates due to increased complication rates. Elixhauser Comorbidity Index (ECI) may be an useful tool for risk assessment prior to surgery. Level of evidence Retrospective cohort study, III.

Early Postoperative Complications and Associated Variables After High Tibial Osteotomy and Distal Femoral Osteotomy: A 15-Year Experience From a Single Academic Institution

“…A 2022 retrospective review of the Pearl-Diver Mariner data set reported a 90-day complication rate of 11.6% after HTO and 21.5% after DFO among a total of 2226 patients (1780 HTO, 446 DFO). 20 The most common complications after both HTO and DFO were infection (3.9% HTO, 6.1% DFO), hardware-related complications (2.8% HTO, 4.9% DFO), and wound disruption (1.8% HTO, 2.7% DFO). In a 2020 retrospective review of the American College of Surgeons National Surgical Quality Improvement Program, Cotter et al 11 reported complication rates of 22.3% among patients undergoing DFO and 9.9% among patients undergoing HTO.…”

Postoperative management following osteotomies around the knee: a narrative review

“…However, for patients with limited bone metabolism such as elderly patients, smokers, patients with diabetes or poor bone quality, according to the results of Ziegler et al , a supportive therapy for ossification can be justified ( 51 ). Especially since increased complication rates have been described for these patient groups ( 54 , 55 , 56 ). This is also conceivable in the case of postoperatively proven hinge fractures with higher rates of pseudarthrosis ( 57 , 58 ).…”

Lateral Opening-Wedge Distal Femoral Osteotomy Made Easy: Tips and Tricks

“… 6 , 7 One of the most common complications of a distal femoral osteotomy is symptomatic hardware. 5 , 8 , 9 The authors aim to limit this complication by their plate-positioning tips. By initially placing the plate flush on the bone distally, the planned osteotomy correction typically allows for the plate to sit flush on the bone proximally at the end of the procedure.…”