Introduction:
High tibial osteotomy (HTO) is an adequate procedure for the treatment of medial unicompartmental knee arthritis in the varus knee. It is technically demanding and has a significant complication rate. Although rare, vascular injury is potentially the most serious complication.
Case report:
We present the case of a 50-year-old male who developed a popliteal artery pseudoaneurysm needing surgical intervention following closing wedge (CWHTO). The patient presented with worsening pain and progressive neurological symptoms. The osteotomy healed normally but the neurological symptoms showed only minor improvement over the 2-year follow-up period.
Conclusions:
Even with proper surgical technique, CWHTO presents a small inherent risk of injury to the popliteal neurovascular structures. Prompt recognition and treatment of this injury are of paramount importance for a good long-term outcome. Further studies are necessary to determine if open wedge HTO would be a safer surgical option.