Tufts University School of Medicine, Boston, Massachusetts, USA.
Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA.
Am J Sports Med. 2024 Jan;52(1):258-268. doi: 10.1177/03635465221142868. Epub 2023 Feb 13.
High tibial osteotomy (HTO) is a well-recognized procedure for its effectiveness in treating symptomatic early knee arthritis and malalignment. Although there are numerous systematic reviews evaluating the management and outcomes after HTO, there are few investigations on complications of this procedure.
To systematically review the literature to determine the incidence of intraoperative and postoperative complications associated with medial opening wedge and lateral closing wedge HTOs.
Systematic review; Level of evidence, 4.
The Cochrane Database of Systematic Reviews, PubMed, Embase, and MEDLINE databases were queried for studies reporting complications associated with HTO with or without concomitant procedures. Data including patient characteristics, procedure type, concomitant procedures, follow-up time, and postoperative imaging were extracted. Rates of intra- and postoperative complications, reoperations, and conversion to arthroplasty were recorded.
A total of 71 studies were included for analysis, comprising 7836 patients. The overall intraoperative complication rate during HTO was 5.5% (range, 0%-29.3%), and the overall postoperative complication rate was 6.9% (range, 0%-26.6%). The most common intraoperative complication was lateral hinge fracture (incidence, 9.1%; range, 0%-30.4%) in medially based HTOs and peroneal nerve injury in laterally based HTOs (incidence, 3.2%; range, 0%-8.7%). The overall incidence of neurovascular injury after medially or laterally based HTOs was 1.1% (range, 0%-18.9%). The most common postoperative complication was superficial infection (incidence, 2.2%; range, 0%-13%). Of the included studies, 62 included postoperative radiographic analysis, and among those, the incidence of nonunion was 1.9% (range, 0%-15.5%), loss of correction was 1.2% (range, 0%-34.3%), and implant failure was 1.0% (range, 0%-10.2%). Among studies reporting revision surgeries, the overall reoperation rate was 15.5% (range, 0%-70.7%), with the most common type of reoperation being hardware removal (incidence, 10.0%; range, 0%-60%).
Intraoperatively, medially based HTOs are associated with a 1 in 11 risk of lateral hinge fracture and laterally based HTOs with a 1 in 30 risk of peroneal nerve injury. Postoperative complication rates in the range of 10% to 15% can be expected, including infection (2.9%), loss of correction (1.2%), and nonunion (1.9%). Patients should also be counseled that the reoperation rate is approximately 15%, with hardware removal being the most common procedure.
高位胫骨截骨术（HTO）是一种公认的治疗有症状的早期膝关节关节炎和对线不良的方法，其疗效显著。尽管有许多系统评价评估 HTO 的管理和结果，但对该手术的并发症的研究很少。
系统回顾文献，以确定内侧开放楔形和外侧闭合楔形 HTO 相关的术中及术后并发症的发生率。
系统回顾；证据水平，4 级。
检索 Cochrane 系统评价数据库、PubMed、Embase 和 MEDLINE 数据库，以查找报告与 HTO 相关的并发症的研究，包括有无伴随手术。提取患者特征、手术类型、伴随手术、随访时间和术后影像学等数据。记录术中及术后并发症、再次手术和转为关节置换的发生率。
共纳入 71 项研究进行分析，共纳入 7836 例患者。HTO 术中总的并发症发生率为 5.5%（范围，0%-29.3%），术后总的并发症发生率为 6.9%（范围，0%-26.6%）。最常见的术中并发症是内侧支撑 HTO 中的外侧铰链骨折（发生率，9.1%；范围，0%-30.4%）和外侧支撑 HTO 中的腓总神经损伤（发生率，3.2%；范围，0%-8.7%）。内侧或外侧支撑 HTO 后总的神经血管损伤发生率为 1.1%（范围，0%-18.9%）。最常见的术后并发症是浅表感染（发生率，2.2%；范围，0%-13%）。纳入的研究中，62 项研究进行了术后影像学分析，其中，不愈合的发生率为 1.9%（范围，0%-15.5%），矫正丢失的发生率为 1.2%（范围，0%-34.3%），植入物失败的发生率为 1.0%（范围，0%-10.2%）。在报告进行翻修手术的研究中，总的再手术率为 15.5%（范围，0%-70.7%），最常见的翻修手术类型是去除内固定物（发生率，10.0%；范围，0%-60%）。
术中，内侧支撑 HTO 发生外侧铰链骨折的风险为 1/11，外侧支撑 HTO 发生腓总神经损伤的风险为 1/30。预计术后并发症发生率在 10%至 15%之间，包括感染（2.9%）、矫正丢失（1.2%）和不愈合（1.9%）。还应告知患者，再手术率约为 15%，去除内固定物是最常见的手术。
