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

Abstract

Background: High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are well-recognized treatments to address varus and valgus malalignment, respectively, in the setting of symptomatic unicompartmental arthritis of the tibiofemoral joint. The existing literature is limited in its ability to characterize complications after HTO or DFO procedures. Purpose: The objective of this study was to determine the rate of early (≤90 days) postoperative complications and associated variables from the 15-year experience of a single academic institution. Study Design: Case series; Level of evidence, 4. Methods: Patients treated at a single academic institution between 2008 and 2022 who underwent HTO or DFO procedures were identified. All patients with minimum 90-day follow-up were considered for inclusion in the study. Exclusion criteria were inadequate follow-up, unavailable medical records, age <14 years, and revision osteotomy. Patient demographic characteristics, surgical history, and concomitant procedures were identified, and risk factor analysis was performed to identify variables associated with early postoperative complications. All intraoperative complications were recorded. Results: A total of 243 knees in 232 patients met eligibility and were included in the final analysis. Three intraoperative complications (1.2%) involving fracture extension of the osteotomy occurred. There were 127 early postoperative complications (121 surgical, 6 medical) in 102 knees (68 with HTO and 34 with DFO). Medical complications included pulmonary embolus in 3 patients (1.2%), urinary tract infection in 2 patients (0.8%), and postoperative ileus requiring prolonged hospitalization in 1 patient (0.4%). The most common complications were stiffness requiring a non–standard of care intervention (17.7%), superficial wound infection or wound dehiscence (13.2%), and hemarthrosis or effusion requiring aspiration (6.6%). The rate of deep infection requiring irrigation and debridement was 4.1%. Variables associated with early postoperative complications included smoking (odds ratio [OR], 3.05; 95% CI, 1.34-6.94; P = .008), concomitant chondroplasty and/or loose body removal (OR, 2.55; 95% CI, 1.50-4.33; P = .001), and concomitant ligament reconstruction (OR, 3.97; 95% CI, 1.37-11.53; P = .011). Conclusion: These 15-year data revealed a low rate of intraoperative complications (1.2%) and a relatively high rate of early (≤90 days) postoperative complications (42.0%) after an HTO or DFO procedure. Surgeons should be aware of the increased postoperative complications associated with smoking, concomitant chondroplasty, and concomitant ligament reconstruction and should use this information to counsel patients regarding appropriate expectations in the postoperative period.

Infection in osteotomy around the knee: Incidence, management and outcomes in a high‐volume case series

“…To the authors' knowledge, this is the largest reported series of osteotomy around the knee, demonstrating incidence, treatment and successful management of infection with no clear sequelae or impact upon subsequent arthroplasty. In comparison with available recent studies using locking plates, this deep infection rate is lower than the 2% reported by Sidhu et al [25] and 4.1% by Berk et al [3], the former reporting from a series of 200, and the latter 243 osteotomies.…”

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

“…Many complications of distal femoral osteotomy occur in the early postoperative period, with one study showing a ≤90-day complication rate of 42%. 6 Risks for complications or lower survivorship in the literature include smoking, concomitant cartilage or ligament procedures, surgical indication for arthritis, and other medical conditions. 6 , 7 One of the most common complications of a distal femoral osteotomy is symptomatic hardware.…”

“… 6 Risks for complications or lower survivorship in the literature include smoking, concomitant cartilage or ligament procedures, surgical indication for arthritis, and other medical conditions. 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.…”

“…Another complication that may occur is fracture, including intra-articular fractures and medial cortical fractures. 6 By ensuring the line on the plate does not intersect the femoral trochlea medially, the plate position is more proximal to avoid risk of intra-articular fracture. Intraoperatively, to limit medial cortical breach, the saw and osteotome are stopped short of the cortex by 1 cm.…”

Risk Factors and Dynamic Nomogram Development for Surgical Site Infection Following Open Wedge High Tibial Osteotomy for Varus Knee Osteoarthritis: A Retrospective Cohort Study

“…13,14 Currently, there are a few publications that have looked at postoperative SSI events following OWHTO. [15][16][17] However, the understanding of its relevant factors is not deep enough. Woodacre et al reported epidemiological data on complications after OWHTO in 115 patients followed for at least 2 years, with a 3.5% incidence of SSI.…”