Avoiding and managing complications in osteotomies of the knee
Osteotomies around the knee are technically demanding surgical procedures requiring careful preoperative planning and precise surgical technique. When procedures do not go as planned, it is important that the surgeon recognizes the problem and/or complication and has an appropriate course of action to rectify the situation. In this chapter, the complications associated with both high tibial osteotomies and distal femoral osteotomies of the knee will be reviewed. Strategies for prevention and management of these complications will be discussed. High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are both widely accepted treatment options for young, active patients with symptomatic medial or lateral compartment gonarthrosis that is associated with a varus or valgus malaligned lower extremity. Realignment surgery may also performed in conjunction with other surgical procedures aimed at addressing concomitant ligamentous instability, meniscal deficiency, patellar maltracking, and chondral defects. Failure to recognize and/or address an underlying malalignment problem may lead to premature failure of other reconstructive surgical procedures about the knee due to mechanical overload. In a recent review at the University of Iowa, the overall incidence of major complications following knee osteotomy surgery was 18%. Twenty nine percent of the patients had minor complications. However, it was interesting to note that the complication rate was not statistically different between patients undergoing isolated realignment surgery vs. combined procedures, or with HTO compared with DFO. The most common major complication in this cohort of patients was failure of hardware 5% (Table 7.1).1 Out of 79 cases, there were two cases of intra-articular fracture (2.5%), and failure of proper correction in two cases (2.5%). This complication rate seems to be consistent with other studies published in the literature. © 2009 Springer-Verlag London.
