Table 1.

Complications related to patient selection

Error	Clinical effect	Prevention	Detection	Remedy
Performing a HTO on a patient with significant lateral and/or patellofemoral DJD [1]	Decreased chance of success as pain and functional compromise may continue despite addressing medial compartment.	Thorough preoperative evaluation using radiographic, clinical, and possibly arthroscopic information	Radiographs (standing films, stress films), physical examination	Consider more definitive intervention (ie, arthroplasty) or continued conservative management
Performing a HTO on a patient with valgus limb alignment and isolated lateral compartment OA [5]	Correcting valgus angulation on the tibial side has been criticized because it produces obliquity of the joint line, whereas the preferred treatment is a varus-producing distal femoral osteotomy, which does not alter the joint line.	Thorough preoperative evaluation using radiographic, clinical, and possibly arthroscopic information	Radiographs (standing films, stress films), physical examination	DFO for treatment of the much less common entity of isolated lateral compartment OA in patients with valgus limb alignment
Performing a HTO on a patient with medial compartment tibial bone loss greater than 2 or 3 mm [3]	Excessive bone loss from the medial tibial plateau prevents weightbearing on both plateaus after HTO is performed and results in instability of the knee in the coronal plane.	Thorough preoperative radiographic evaluation and intraoperative evaluation (ie, arthroscopy)	Radiographs (standing films, stress films), Arthroscopy (if being performed for another reason like meniscal tear)	Consider more definitive intervention (ie, arthroplasty) or continued conservative management
Performing a DFO on a patient with significant medial and/or patellofemoral DJD [5]	Decreased chance of success as pain and functional compromise may continue despite addressing lateral compartment.	Thorough preoperative evaluation using radiographic, clinical, and possibly arthroscopic information	Radiographs (standing films, stress films), physical examination	Consider more definitive intervention (ie, arthroplasty) or continued conservative management
Performing a HTO on a patient with lateral tibial subluxation greater than 1 cm [6]	Abnormal patellofemoral tracking may be exacerbated if the tibia is brought into further valgus.	Thorough preoperative radiographic and clinical evaluations	Radiographs, physical examination	May consider addressing tibial subluxation surgically
Performing an osteotomy on a patient with knee ROM less than 90° [1]	Poor rehabilitation potential	Thorough preoperative clinical evaluation	Physical examination	Consider more definitive intervention (ie, arthroplasty) or continued conservative management
Performing an osteotomy on a patient with knee flexion contracture greater than 15° [2]	Poor rehabilitation potential	Thorough preoperative clinical evaluation	Physical examination	Consider more definitive intervention (ie, arthroplasty) or continued conservative management
Performing an osteotomy on a patient with greater than 20° correction needed [5]	Poor prognosis with such severe deformity. Also may have residual collateral ligament laxity.	Thorough preoperative radiographic and clinical evaluations	Radiographs (standing films, stress films), physical examination	Consider more definitive intervention (ie, arthroplasty) or continued conservative management
Performing an osteotomy on a patient with ligamentous instability resulting in worsened instability after bone cuts [5]	Deformity may persist because although the bony defect has been addressed, ligamentous laxity and or stiffness may continue to cause symptoms, including instability of the knee	Thorough preoperative clinical evaluation	Physical examination	Consider more definitive intervention (ie, arthroplasty) or continued conservative management
Performing HTO on patients with ≥ 30% ideal body weight [4]	Two most predictive causes of failure (recurrent pain/loss of correction) are undercorrection of the angular deformity and relative weight of patient. Coventry et al. [4] reported that patients with ≥ 30% ideal body weight had a significantly greater risk for failure.	Careful patient selection. Preoperative weight loss to maximize possible surgical benefit.	Physical examination, radiographs	Revision osteotomy, total arthroplasty, bracing.
Performing an osteotomy on a patient with inflammatory arthritis	Inflammatory arthritis will likely affect other compartments and inflammation may play a larger role in pain and functional compromise. Osteotomy does not address inflammation directly.	Thorough preoperative radiographic, clinical, and laboratory evaluations	Radiographs, physical examination, rheumatoid factor, C-reactive protein	Antirheumatic drugs, total arthroplasty

HTO = high tibial osteotomy; DJD = degenerative joint disease; OA = osteoarthritis; DFO = distal femoral osteotomy.