Abstract
Knee osteotomies show efficacy in slowing knee osteoarthritis progression and delaying
the need for total knee arthroplasty in younger patients. Despite evolutions in indications,
techniques, and hardware that have improved outcomes, longitudinal trends demonstrate
a decline in high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) use. Unfortunately,
knowledge of the current usage and complications associated with HTO and DFO is limited.
The purpose of this study was to compare the preoperative demographics and early complication
rates of HTO and DFO. We analyzed the HTOs and DFOs performed between 2006 and 2017
using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement
Program) database. We compared both groups for preoperative patient demographics (sex,
age, race, body mass index [BMI]) and health status variables including functional
scores, ASA (American Society of Anesthesiologists) scores, smoking status, and other
comorbidities. Emergency and elective status of the patient case, length of hospital
stay, operation time, and 30-day postoperative complications were also analyzed. After
the exclusion criteria were applied, 321 HTO and 295 DFO patients were included in
the final analysis. The HTO group had higher proportions of younger (p < 0.001) and male (p < 0.001) patients with higher BMI (p = 0.007). Racial profiles were similar between the two groups (p = 0.575). Preoperatively, those in the HTO group had more functional independence,
better physical status scores, and fewer chronic conditions (p < 0.05). There were no statistically significant differences between HTO and DFO in
operative time, postoperative complications, readmission, and reoperation. HTO patients,
however, had shorter hospital stays (p < 0.001). Although there are differences in preoperative and operative characteristics
of HTO and DFO, early postoperative complications are similar for both groups. Therefore,
HTO and DFO can be considered safe and effective treatment options for younger patients
with symptomatic unicompartmental knee osteoarthritis.
Keywords high tibial osteotomy - distal femoral osteotomy - NSQIP - complications - outcomes
