Topical Use of Low-dose Tranexamic Acid Has no Effect on Drainage Volume after Medial Open Wedge High Tibial Osteotomy: A Case Control Study

Abstract

Objective: Many studies reported that tranexamic acid (TXA) was effective in reducing surgical blood loss in the perioperative period of medial open wedge high tibial osteotomy (MOWHTO). However, few studies focused on the simple topical use of TXA in MOWHTO, and the modality and dosage of topical use of TXA varied. The purpose of this study was to observe the effect of topical use of low-dose TXA on drainage volume after MOWHTO, and to analyze the related influencing factors.

Methods: Data of patients who underwent MOWHTO combined with arthroscopic knee surgery in our department from January 2019 to September 2021 were retrospectively analyzed. A total of 105 patients (38 males and 67 females, aged 57.7 ± 7.5 years) were included in this study who received topical TXA or no TXA. The patients were divided into three groups: control group (39 cases), 0.5 g TXA group (40 cases), 1 g TXA group (26 cases). Postoperative drainage volume, wound healing, incidence of hematoma and deep venous thrombosis (DVT) were observed and analyzed in the three groups. The effects of gender, hypertension and diabetes on postoperative drainage volume were analyzed using a t-test. The correlation between age, body mass index (BMI), osteotomy gap and postoperative drainage volume were analyzed using the Pearson correlation coefficient.

Results: The average postoperative drainage volume of the control group was 259.54 ± 226.33 mL, that of the 0.5 g TXA group was 277.18 ± 177.68 mL, and that of the 1 g TXA group was 229.15 ± 219.93 mL. There was no statistically significant difference in postoperative drainage volume among the three groups (F = 0.423, p = 0.656). There was no local hematoma and wound infection in the three groups. The wound fat liquefaction was found in one patient of the control group. The incidence of DVT was 38.9% (7/18) and 57.1% (8/14) in the control group and 0.5 TXA group, respectively. There was no significant difference in the incidence of DVT between the above two groups (p = 0.476). The average postoperative drainage volume of male patients in the three groups was higher than that of female patients, and the differences were statistically significant (p < 0.05). There was no correlation between age, BMI, osteotomy gap and postoperative drainage volume in the three groups (p > 0.05).

Conclusion: Topical use of low-dose TXA has no significant effect on drainage volume after MOWHTO. The drainage volume after MOWHTO in male patients was more than that in female patients. Topical administration of low-dose TXA does not increase postoperative complications, such as DVT and hematoma.

Keywords

Drainage / Osteotomy / Tranexamic Acid / Venous Thrombosis

References

[1] TakadaA, TakadaY. Inhibition by tranexamic acid of the conversion of single-chain tissue plasminogen activator to its two chain form by plasmin: the presence on tissue plasminogen activator of a site to bind with lysine binding sites of plasmin. Thromb Res. 1989;55(6):717–725.

[2] MiangulS, Oluwaremi T, El HaddadJ, AdraM, Pinnawala N, NakanishiH, et al. Update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2022;33:2179–2190.

[3] WangZ, LuY, WangQ, Song L, MaT, RenC, et al. Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study. BMC Musculoskelet Disord. 2020;21(1):739.

[4] PrastikaruniaR, Wahyuhadi J, SusiloRI, HaqI. Tranexamic acid to reduce operative blood loss in brain tumor surgery: a meta-analysis. Surg Neurol Int. 2021;12:345.

[5] MitraS, JainK, SinghJ, Jindal S, MehraR, SinghS. Topical vs. intravenous administration of tranexamic acid to minimize blood loss in abdominal hysterectomy perioperatively: a randomized controlled study. J Anaesthesiol Clin Pharmacol. 2022;38(2):233–239.

[6] PalijaS, Bijeljac S, ManojlovicS, JovicicZ, Jovanovic M, CvijicP, et al. Effectiveness of different doses and routes of administration of tranexamic acid for total hip replacement. Int Orthop. 2021;45(4):865–870.

[7] LeiYT, XieJW, HuangQ, Huang W, PeiFX. The antifibrinolytic and anti-inflammatory effects of a high initial-dose tranexamic acid in total knee arthroplasty: a randomized controlled trial. Int Orthop. 2020;44(3):477–486.

[8] FenwickA, Antonovska I, PfannM, MayrJ, WiedlA, NuberS, et al. Does tranexamic acid reliably reduce blood loss in proximal femur fracture surgery. Eur J Trauma Emerg Surg. 2022;49:209–216.

[9] ClohisyJ, LenkeLG, DafrawyM, Wolfe RC, FrazierE, KellyMP. Randomized, controlled trial of two tranexamic acid dosing protocols in adult spinal deformity surgery. Spine Deform. 2022;10(6):1399–1406.

[10] LevackAE, McLawhorn AS, DodwellE, DelPizzoK, NguyenJ, SinkE. Intravenous tranexamic acid reduces blood loss and transfusion requirements after periacetabular osteotomy. Bone Joint J. 2020;102-B:1151–1157.

[11] LuoW, FuX, HuangJM, Wu J, MaXL. Efficacy and safety of intravenous combined with topical administration of tranexamic acid in reducing blood loss in opening wedge high tibial osteotomy procedure: a retrospective case-control study. Acta Orthop Traumatol Turc. 2022;56(2):100–104.

[12] LobenhofferP, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2003;11(3):132–138.

[13] ScrepisD, PiovanG, BaldiniM, Amarossi A, NataliS, IaconoV, et al. Higher activity level after opening wedge high tibial osteotomy compared to medial unicompartimental knee arthroplasty in a selected cohort of advanced age: a propensity score-matched analysis. Knee. 2022;40:183–191.

[14] YoonWK, KimKI, KimJH, Lee SH, JoMG. Does degeneration of the patellofemoral joint after medial open-wedge high tibial osteotomy affect clinical outcomes. Am J Sports Med. 2022;50(11):2972–2979.

[15] KimKI, KimJH, LeeSH, Song SJ, JoMG. Mid- to long-term outcomes after medial open-wedge high tibial osteotomy in patients with radiological kissing lesion. Orthop J Sports Med. 2022;10(7):23259671221101875.

[16] PalanisamyJV, DasS, MoonKH, Kim DH, KimTK. Intravenous tranexamic acid reduces postoperative blood loss after high tibial osteotomy. Clin Orthop Relat Res. 2018;476(11):2148–2154.

[17] NiJ, LiuJ, ZhangJ, Jiang J, DangX, ShiZ. Tranexamic acid is beneficial for blood management of high tibial osteotomy: a randomized controlled study. Arch Orthop Trauma Surg. 2021;141(9):1463–1472.

[18] KimKI, KimHJ, KimGB, Bae SH. Tranexamic acid is effective for blood management in open-wedge high tibial osteotomy. Orthop Traumatol Surg Res. 2018;104(7):1003–1007.

[19] KimMS, KohIJ, SungYG, Park DC, HaWJ, InY. Intravenous tranexamic acid has benefit for reducing blood loss after open-wedge high tibial osteotomy: a randomized controlled trial. J Clin Med. 2021;10(15):3272.

[20] WangL, ZhangZ, XiongW, Fang Q, TangY, WangG. Impact of tourniquet on short-term outcomes in opening wedge high tibial osteotomy with modern tranexamic acid protocols: a retrospective cohort study. BMC Musculoskelet Disord. 2021;22(1):931.

[21] BianJ, DengB, WangZ, Yuan L, LiS, ZhaoX, et al. Comparison of topical and intravenous tranexamic acid for high tibial osteotomy: a retrospective study. Medicine (Baltimore). 2021;100(32):e26884.

[22] LiS, LuQ, GuoX, ZhangM, MiaoZ, Luo D, et al. Intravenous combined with topical tranexamic acid administration has No additional benefits compared with intravenous administration alone in high tibial osteotomy: a retrospective case-control study. Orthop Surg. 2020;12(2):515–523.

[23] ChenDS, ZhuJW, WangTF, Zhu B, FengCH. Tranexamic acid is beneficial to patients undergoing open-wedge high tibial osteotomy. Biomed Res Int. 2020;2020:2514207.

[24] SuhDW, KyungBS, HanSB, Cheong K, LeeWH. Efficacy of tranexamic acid for hemostasis in patients undergoing high tibial osteotomy. J Knee Surg. 2018;31(1):50–55.

[25] ValkeringKP, van den Bekerom MP, KappelhoffFM, AlbersGH. Complications after tomofix medial opening wedge high tibial osteotomy. J Knee Surg. 2009;22(3):218–225.

[26] MillerBS, DownieB, McDonoughEB, Wojtys EM. Complications after medial opening wedge high tibial osteotomy. Art Ther. 2009;25(6):639–646.

[27] WoodacreT, Ricketts M, EvansJT, PavlouG, Schranz P, HockingsM, et al. Complications associated with opening wedge high tibial osteotomy—A review of the literature and of 15 years of experience. Knee. 2016;23(2):276–282.

[28] MartinR, Birmingham TB, WillitsK, LitchfieldR, LebelME, et al. Adverse event rates and classifications in medial opening wedge high tibial osteotomy. Am J Sports Med. 2014;42(5):1118–1126.

[29] ParkHJ, KangSB, ParkJ, Chang MJ, KimTW, ChangCB, et al. Patterns and distribution of deep vein thrombosis and its effects on clinical outcomes after opening-wedge high tibial osteotomy. Orthop J Sports Med. 2021;9(10):23259671211030883.

[30] MaJ, LuH, ChenX, Wang D, WangQ. The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis. J Orthop Surg Res. 2021;16(1):373.

[31] SeoSS, KimOG, SeoJH, Kim DH, KimYG, LeeIS. Complications and short-term outcomes of medial opening wedge high tibial osteotomy using a locking plate for medial osteoarthritis of the knee. Knee Surg Relat Res. 2016;28(4):289–296.

[32] BrossetT, Pasquier G, MigaudH, GougeonF. Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix™) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases. Orthop Traumatol Surg Res. 2011;97(7):705–711.

[33] GuerinS, Collins C, KapoorH, McCleanI, Collins D. Blood transfusion requirement prediction in patients undergoing primary total hip and knee arthroplasty. Transfus Med. 2007;17(1):37–43.

[34] HuY, LiQ, WeiBG, Zhang XS, TorshaTT, XiaoJ, et al. Blood loss of total knee arthroplasty in osteoarthritis: an analysis of influential factors. J Orthop Surg Res. 2018;13(1):325.

[35] PrasadN, Padmanabhan V, MullajiA. Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop. 2007;31(1):39–44.

[36] JuelsgaardP, LarsenUT, SørensenJV, MadsenF, Søballe K. Hypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion. Reg Anesth Pain Med. 2001;26(2):105–110.

[37] ParkJH, Rasouli MR, MortazaviSM, TokarskiAT, Maltenfort MG, ParviziJ. Predictors of perioperative blood loss in total joint arthroplasty. J Bone Joint Surg Am. 2013;95(19):1777–1783.

[38] ZhuJW, ChenDS, WangTF, Xie Y. Patient characteristics related to blood loss in high tibial osteotomy in novel multiple linear regression analysis. Biomed Res Int. 2020;2020:8965925.

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