Complications Associated With Medial Opening-Wedge High Tibial Osteotomy Using a Locking Plate: A Multicenter Study

Abstract Background The aim of this study is to investigate complications following medial opening-wedge high tibial osteotomy using a locking plate. In addition, we aimed to compare postoperative outcomes between the complicated and the uncomplicated group. Methods This study enrolled 209 patients who underwent medial opening-wedge high tibial osteotomy between 2010 and 2015. Patients with a follow-up period of at least 2 years were enrolled. Medical records and radiologic data were retrospectively reviewed. The complications were assessed up to postoperative 2 years and categorized into major and minor complications. The preoperative and postoperative clinical statuses were assessed using the Western Ontario McMaster University Osteoarthritis Index. Results The mean patient age was 56.4 ± 5.9 years. Overall complication rate was 29.7%. Minor complications included undisplaced lateral hinge fracture (12.0%), hardware irritation (1.4%), displaced lateral hinge fracture (2.4%), delayed wound healing (1.9%), undisplaced lateral tibial plateau fracture (1%), and superficial wound infection (1%). Major complications were symptomatic hardware which needed hardware removal (4.8%), deep wound infection (1.9%), hardware failure with correction loss (1%), nonunion (0.5%), and early conversion to arthroplasty (0.5%). Most complications occurred intraoperatively (30.6%) and within 3 months postoperatively (40.3%). The major complication group showed a statistically higher Western Ontario McMaster University Osteoarthritis Index score than did other groups at postoperative 1 year ( P  = .013) and 2 years ( P  = .001). Conclusion The overall complication rate was 29.7%. Most complications were minor. The most common complication was undisplaced lateral hinge fracture. Major complications occurred in 8.6%. The major complication group showed significantly worse clinical outcomes than did the uncomplicated and minor complication groups.