Complications associated with opening wedge high tibial osteotomy — A review of the literature and of 15 years of experience

• We assess the complications associated with opening wedge high tibial osteotomy.
• We compare 15 years of experience with a literature review of previously reported complications.
• Opening wedge high tibial osteotomy can potentially be used in patients with a much higher BMI than commonly advocated.
• Serious complications are rare, minor complications appear much higher than previously reported.

BackgroundComplication rates following opening wedge high tibial osteotomy (OWHTO) is an issue that has not been comprehensively addressed in current literature.MethodsWe performed a retrospective study of local patients who underwent OWHTO for isolated medial compartment knee osteoarthritis from 1997 to 2013. We analysed survivorship and complication rates and compared this to a literature review of previously reported data.ResultsOne hundred and fifteen patients met the inclusion criteria. Mean follow-up = 8.4 years. Mean age = 47 (range 32 to 62). Mean Body Mass Index (BMI) = 29.1 (range 20.3 to 40.2). Devices used consisted of Tomofix (72%), Puddu plate (21%) and Orthofix (seven percent) (no significant differences in age/sex/BMI). Wedge defects were filled with autologous graft (30%), Chronos (35%) or left empty (35%).Five years survival rate (without requiring conversion to arthroplasty) = 80%. Overall complication rate = 31%. Twenty five percent of patients suffered 36 complications including minor wound infections (9.6%), major wound infections (3.5%), metalwork irritation necessitating plate removal (seven percent), non-union requiring revision (4.3%), vascular injury (1.7%), compartment syndrome (0.9%), and other minor complications (four percent). No thromboembolic complications were observed.ConclusionNo significant differences existed in complication rates following OWHTO relative to BMI, implant type, type of bone graft used or patient age at surgery.When the complications from OWHTO were analysed closely they appear higher than previously reported in the literature; however serious complications appear rare.Level of Evidence 3Retrospective cohort study