{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:39:29Z","timestamp":1790354369707,"version":"4.1.0"},"reference-count":39,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T00:00:00Z","timestamp":1643846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T00:00:00Z","timestamp":1643846400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T00:00:00Z","timestamp":1643846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study was to assess complications, reoperations, and their risk factors at 90\u00a0days and 2 years after high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) in a national cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The PearlDiver Mariner Dataset was queried using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes for HTO and DFO, complications, and subsequent surgery. Minimum follow\u2010up was 2 years and complications were assessed at 90\u00a0days and 2 years. Hospital readmission in the first 90\u00a0days was also assessed. Univariate and multiple logistic regression were utilized to identify risk factors for complications and re\u2010operation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 90\u2010day and 2\u2010year complication rates after HTO (<jats:italic>n<\/jats:italic>\u2009=\u20091780) were 11.6% and 31.7%, compared to 21.5% (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and 41.5% (<jats:italic>p<\/jats:italic>\u2009=\u20090.0001) after DFO (<jats:italic>n<\/jats:italic>\u2009=\u2009446). Infection was the most frequent early (90\u2010day) complication for both HTO and DFO cohorts, while hardware problems were most common at 2 years. Increasing Elixhauser Comorbidity Index (ECI) was associated with increased odds of infection, readmission, and hardware\u2010associated complications in both cohorts. Gender and tobacco use were also associated with various complications after HTO. At 2 years, 23.7% of HTO patients and 26.2% of DFO patients had undergone subsequent surgery. Hardware removal occurred in 16.4% of HTO and 18.4% of DFO patients (n.s.), while 4.5% of HTO and 5.2% of DFO patients underwent total knee arthroplasty (TKA) within 2 years (n.s.).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>HTO and DFO have substantial complication rates in the short and mid term, with a higher rate of overall complications observed after DFO as compared to the HTO cohort. After both procedures, roughly one quarter of patients will undergo subsequent surgery within 2 years. Patients with tobacco use and numerous medical co\u2010morbidities may not be optimal candidates due to increased complication rates. Elixhauser Comorbidity Index (ECI) may be an useful tool for risk assessment prior to surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Retrospective cohort study, III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-06865-z","type":"journal-article","created":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T23:40:34Z","timestamp":1643845234000},"page":"4029-4045","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Complications after high tibial osteotomy and distal femoral osteotomy are associated with increasing medical comorbidities and tobacco use"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0303-6423","authenticated-orcid":false,"given":"Natalie K.","family":"Kucirek","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> University of California, San Francisco School of Medicine 533 Parnassus Ave 94143 San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Anigwe","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> University of California, San Francisco School of Medicine 533 Parnassus Ave 94143 San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan L.","family":"Zhang","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery University of California, San Francisco 1500 Owens St 94158 San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Benjamin","family":"Ma","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery University of California, San Francisco 1500 Owens St 94158 San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian T.","family":"Feeley","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery University of California, San Francisco 1500 Owens St 94158 San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew A.","family":"Lansdown","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery University of California, San Francisco 1500 Owens St 94158 San Francisco CA 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October 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 February 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"DAL consults for Vericel, Inc., receives educational support from Arthrex\/Evolution Surgical, receives research support from AOSSM, AANA, and Arthritis Foundation, and is a committee member of AOSSM, AANA, and ORS; BTF serves on the editorial board of JSES and CRMM, holds stock options with Bioniks and Kaliber.ai, and receives research support from NIH, VA, Orthofix, and Stryker; ALZ is a consultant for Stryker and Depuy-Mitek; CBM is a consultant for Stryker, Conmed, and Tornier, receives research support from Aesculap, Samumed, Zimmer, and Conmed and receives royalties from Conmed.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}