Clinical outcome and complications after simultaneous bilateral medial opening-wedge high tibial osteotomy

The literature provides limited evidence regarding postoperative outcomes and complications following simultaneous bilateral medial opening-wedge high tibial osteotomy (MOWHTO). This study aimed to investigate the clinical outcomes and complications associated with simultaneous bilateral MOWHTO.

We retrospectively evaluated 72 knees from 36 patients (mean age, 58.6 ± 8.2 years) who underwent simultaneous bilateral MOWHTOs between December 2011 and January 2021. Locking compression plates were used for simultaneous bilateral MOWHTOs. The Oxford Knee Score (OKS) was used to assess clinical outcomes at the last follow up. Complications (lateral hinge fracture (LHF), nonunion, and loss of correction) were evaluated using postoperative serial plain radiography and computed tomography (CT).

At the last follow up (range, 2.0-11.1 years), the mean OKS for the 72 knees was 36.8 ± 10.4. According to the OKS, 42 knees (58.3%) scored 'excellent', 16 (22.2%) scored 'good', eight (11.1%) scored 'moderate', and six (8.3%) scored 'poor'. LHFs occurred in 11 of the 72 knees (15.3%). Among these, five LHFs were identified on postoperative plain radiographs and CT scans (acute LHFs), whereas six fractures were identified only on follow up plain radiographs (delayed LHFs). Loss of correction occurred in one patient with delayed LHFs. The patient required an additional surgical treatment to achieve bone healing at the osteotomy site.

Simultaneous bilateral MOWHTO is a viable treatment option for patients with bilateral medial osteoarthritis of the knee joint. Serial plain radiographs at short-term intervals are recommended to detect delayed LHFs and prevent complications such as fixation failure and loss of correction.