Complications of osteotomies about the knee.
High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are effective techniques in the treatment of knee monocompartmental osteoarthritis, osteochondral lesions and joint instability. A literature review demonstrates that at each stage of surgery complications may occur. The aim was to summarize current literature over the last 10 years on the complications of osteotomy around the knee. Both prospective and retrospective studies were considered. The focus here is on postoperative complications:
- Superficial infection of 1-9% and deep infection of 0.5-4.7% were reported in a recent review. However, information on infection rate varied considerably between studies.
- Delayed union occurred with an incidence of 4-8.5% and was more frequent with osteotomies distal to the tibial tubercle because of the low healing potential of the bone below the metaphysis. The incidence of nonunion after HTO has been reported to be as high as 1-5.7%.
- Neural complications of osteotomies around the knee are most likely to involve the peroneal nerve. The most commonly reported complication was peroneal nerve palsy with an incidence of as high as 20%. Extensor hallucis longus is the most common muscle deficit. Incidence of thrombosis was 10.8% on average with the highest incidence within 4 days postoperatively.
Conclusion: The first essential step to ensure optimal results is the careful selection of patients. While opening wedge is technically more accurate, it is associated with a higher incidence of osteotomy failure, nonunion and delayed union. Closing wedge osteotomy is more likely associated with inaccuracy of correction of the deformity. > From: Vena et al., Sports Med Arthrosc Rev 21 (2013) 113-120. All rights reserved to Lippincott Williams & Wilkins.
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