Complications of corrective osteotomies around the knee

Abstract

Corrective osteotomies around the knee are a cost-efficient and joint-preserving treatment option for primary leg deformities. Incorrect indications, technical errors, and insufficient postoperative management may lead to severe complications. This review discusses potential complications of corrective osteotomies around the knee and treatment and prevention strategies. A selective review of the literature and a discussion of the authors' strategies for avoiding complications are presented. Major risk factors for complications are the indication for and the planning of an osteotomy. The indication should take into consideration the difference between primary (constitutional) and secondary deformity. Planning must be based on a long-leg X-ray with correct rotation of the leg. Joint space opening of the non-involved compartment must be considered to avoid over-correction. Intraoperative fractures can be avoided by the use of an optimized technique. The neurovascular structures must be protected during osteotomy of the posterior cortex. Delayed bone healing/pseudarthrosis may occur in open-wedge and in closed-wedge procedures. High-energy shock wave therapy or autologous cancellous bone grafts can be used to enable bone healing. Infection is usually associated with the implant. Early infection may be treated by debridement and antibiotics. Late infection requires removal of the implant and placement of an external fixator if the osteotomy is still unstable. Corrective osteotomies around the knee represent a safe treatment option if there is a proper indication and patient selection. Intra- and postoperative complications need to be identified quickly to maintain satisfactory postoperative results.