Does the correction angle affect hidden blood loss in HTO?

Abstract

BACKGROUND:

High tibial osteotomy (HTO) has a history of nearly 60 years and has been widely used in clinical practice. Biplanar open wedge high tibial osteotomy (BOWHTO), which evolved from HTO, is an important therapy for the knee osteoarthritis. In our previous research, we found that the decrease of hemoglobin levels after high tibial osteotomy ranges from between 17 to 41 g/L, but this is highly inconsistent with the intraoperative bleeding and postoperative drainage observed in clinical practice. The purpose of this study was to investigate the perioperative hidden blood loss (HBL) after biplanar open wedge high tibial osteotomy (BOWHTO), as well as to study the effect of the actual correction angle on blood loss.

METHODS:

A retrospective analysis was performed on 21 patients who underwent BOWHTO for osteoarthritis of the knee due to proximal tibia deformity. Gross equation was used to calculate the perioperative total blood loss (TBL) and HBL. The actual correction angle was measured by postoperative anteroposterior radiograph. The correlation between HBL and correction angle was determined through correlation analysis.

RESULTS:

The TBL was 823.5 ± 348.7 mL and the HBL was 601.6 ± 297.3 mL, total hemoglobin loss was 25.0 ± 10.7 g/L, and the mean HBL/patient's blood volume (H/P) was 13.19 ± 5.56% for 21 patients. The correlation coefficient of correction angle and H/P is statistically significant (|r| = 0.678, P = 0.001).

CONCLUSIONS:

The actual total blood loss after BOWHTO was significantly higher than the observed, and the HBL was objective existent after BOWHTO. The proportion of H/P is positively correlated with the correction angle.

• Authors: Zheng Li, Yannong Wang, Guanglei Cao, Shuai An, Mingli Feng, Liwei Wang, Xi Wang, Guangzhong Yang, Guanghan Gao, Shuai Wang, Xufeng Jiao, Lei Ding
• Journal: Journal of orthopaedic surgery and research (J Orthop Surg Res) Vol. 15 Issue 1 Pg. 528 (Nov 11 2020) ISSN: 1749-799X [Electronic] England
• PMID: 33176816 (Publication Type: Journal Article)

Chemical References

• Tranexamic Acid

Topics

• Aged
• Blood Loss, Surgical (prevention & control)
• Female
• Humans
• Knee Joint (surgery)
• Male
• Middle Aged
• Osteoarthritis, Knee (etiology, surgery)
• Osteotomy (adverse effects, methods)
• Radiography
• Retrospective Studies
• Tibia (abnormalities, diagnostic imaging, surgery)
• Tourniquets
• Tranexamic Acid (administration & dosage)