The Pitfalls of Opening Wedge High Tibial Osteotomy and Clinical Results

Abstract

Objective: The medial opening wedge high tibial osteotomy (OWHTO) is a standard procedure in the treatment of varus osteoarthritis. This is potentially associated with various complications. The purpose of this study was to analyze complications and potential mistakes in surgical technique.
Methods: A total of 160 knees (38 male and 122 female) suffering from varus osteoarthritis underwent the OWHTO between 2008 and 2011. Medical records, operative reports, and radiographs were retrospectively reviewed for all patients who experienced a complication postoperatively. All complications were identified for analysis.
Results: The average Japan Orthopaedic Association score improved from 51.8 points to 85.3 points. The average of FTA changed from 182.7° to 170.5°. The average of %MA changed from 22.3% to 60.8%. The average of posterior tibial slope changed from 6.4° to 7.1°. The average Carton index changed from 0.92 to 0.62. There were 21 knees (13.1%) with lateral cortex fractures, one (0.6%) with screw failure, one (0.6%) with arterial injury, and five (3.1%) with infection.
Conclusion: With careful selection of patients with indications for knee surgery, good short-term and intermediate-term results can be achieved by OWHTO. The OWHTO is associated with a moderate frequency of complications. Although there are technical advantages offered by the OWHTO, their influence on the frequency and type of complications experienced by patients in our series was not apparent. Further evaluation of this procedure is required for long-term surgical outcome.