Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a prospective randomized controlled study

Li, Songlin; Yang, Jianling; Watson, Christiaan; Lu, Qiong; Zhang, Meng; Miao, Zhimin; Luo, Desu; Liu, Peilai

doi:10.1007/s00264-020-04530-z

Cited by 13 publications

(16 citation statements)

References 21 publications

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“…Li et al 8 observed that the combined intravenous and local TXA protocol did not effectively improve knee HSS and VAS scores in patients after surgery (with the 6th month as the observation point). A recent study demonstrated that the use of a drainage tube does not increase the extra blood loss when TXA is used intravenously, and the VAS score and calf swelling in the early postoperative period are lower than those in the control group, which can effectively reduce the incidence of incision complications 10 . The TXA multiple-dose regimen has been con rmed in the current study.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, it is considered one of the most effective methods for the treatment of KOA [5][6][7] . However, owing to the use of tourniquets, exfoliation of soft tissues, and exposure of the cancellous bone surface during osteotomy, intraoperative and postoperative bleeding is inevitable and may lead to signi cant bleeding [8][9][10] . Postoperative bleeding can cause hematomas around the incision, delayed incision healing, deep infections, and anemia 11 .…”

Section: Introductionmentioning

confidence: 99%

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Multiple Intravenous Tranexamic Acid Doses After Open Wedge-high Tibial Osteotomy(OW-HTO) Further Reduce Perioperative Blood Loss and Drainage Volume: A Retrospective Study

Wang

Liu

et al. 2021

Preprint

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Background Studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in opening wedge high tibial osteotomy(OW-HTO). However, a consensus has not been established regarding the best dosing regimen and timing. In the present study, we aimed to compare three different dosages of intravenous (IV) TXA in OW-HTO.Material and methods A retrospective analysis of the clinical data obtained from patients administered with OW-HTO treatment for knee osteoarthritis from February 2016 to December 2019 was conducted. All operations were performed under general anaesthesia. TXA1 group (18 patients) received 1g of IV TXA administered 15 to 30 minutes pre-operation. TXA2 group (18 patients) received an additional dose of IV TXA (1g) 3 h after incision and the TXA3 group (18 patients) received an additional (third) dose 6 h later(1g). The blood loss and adverse events were compared between the three groups. Functional analysis, quality of life (QoL), and pain assessment were performed based on their corresponding scoring system.Results Baseline data were comparable for all groups. The postoperative drainage volume was calculated for the TXA3 group and the estimated blood loss was significantly reduced (p-value <0.05). The treatment effectively maintained postoperative Hb at a high level (p-value <0.05). In addition, a faster recovery, better QoL, reduced postoperative pain, and no complications were observed in patients belonging to the group TXA3.Conclusion Based on our results, three doses of IV TXA can effectively and safely reduce estimated blood loss and postoperative drainage volume in patients undergoing OW-HTO with additional associated benefits.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multiple Intravenous Tranexamic Acid Doses After Open Wedge-high Tibial Osteotomy(OW-HTO) Further Reduce Perioperative Blood Loss and Drainage Volume: A Retrospective Study

Wang

Liu

et al. 2021

Preprint

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“…Rajesh and Prashant et al proved that the presence of drainage signi cantly reduces opioid consumption during the rst 6 hours after total knee arthroplasty [26]. Li S et al randomly divided the patients undergoing high tibial osteotomy(HTO) into a drainage group and a no drainage group and the results showed that there was improvement of visual analogue scale (VAS) pain score in the non-drainage group until postoperative 5 days [27]. This is supported the fact that suction drainage can decrease immediate postoperative pain by draining hematoma production that results in increased pressure at the surgical site.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Bilateral Simultaneous Total Hip Arthroplasty With and Without Drainage; a Retrospective Cohort Study

Kim¹,

Yoon²,

Park³

2021

Preprint

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BackgroundThere are many reports staged bilateral THA without drainage is a better method than with drainage in many ways. However, there is little report regarding bilateral simultaneous THA (BSTHA) without drainage. This study aimed to evaluate the differences in the clinical outcomes and complication rate of BSTHA with drainage and without drainage.MethodsBetween October 2015 and April 2019, a retrospective cohort study was conducted with modified minimally invasive two-incision method and a consecutive series of 41 BSTHA performed with drainage were compared to 37 BSTHA performed without drainage. It was assessed clinically and radiographically for a mean of 2.1 ± 0.8 years (range, 1.0-4.8 years). Postoperative hematologic values (Hgb drop, Hct drop, total blood loss, transfusion rate), pain susceptibility, functional outcome, and complication were compared in the drained group and the non-drained group. All patients preoperatively received intravenous tranexamic acid (TXA) and intraoperatively received intra-articular TXA on each hip. Statistical analyses were performed using the independent t tests, Chi-squared or Fisher’s exact tests. A significance level of ≤ 0.05 was used for all statistical tests.Results Mean postoperative Hgb (g/dL, p < 0.001) & Hct drop (%, p < 0.001), mean total blood loss (ml, p < 0.001) and mean transfusion unit (IU, p < 0.001) were significantly lower in the BSTHA without drainage than in the BSTHA with drainage group. But the mean dose of morphine equivalent (mg, p < 0.001) was significantly larger in BSTHA without drainage.ConclusionBSTHA without drainage can reduce postoperative blood loss and the requirement for transfusion without increasing other complication. But BSTHA without drainage is more painful method than BSTHA with drainage. Therefore, BSTHA without drainage will be a good option to reduce the burden on the patient by reducing postoperative bleeding if it can control pain well after surgery.

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“…However, with the concept of clinical practice guidelines for enhanced recovery after surgery was gradually introduced and promoted to the eld of HTO surgery, orthopedic surgeons are increasingly encouraged to minimizing invasive surgery technique, improving perioperative blood management, and improving patient comfort and satisfaction. Particularly the widespread use of tranexamic acid is a successful milestone of perioperative blood management and perioperative care pathways in HTO surgery eld [4,5].…”

Section: Introductionmentioning

confidence: 99%

Are Routine Postoperative Laboratory Tests Really Necessary after High Tibial Osteotomy surgery?

Nie

Lan

et al. 2021

Preprint

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Background: The purpose of this study was to assess the necessity and cost-effectiveness of routine postoperative laboratory tests for patients undergoing high tibial osteotomy (HTO) surgery.Methods: A prospective study was conducted and 513 patients with symptomatic isolated medial compartment osteoarthritis received HTO surgery from January 2015 to May 2020 were included in this study. The associations between different clinical factors and postoperative clinical treatment were analyzed. Finally, A logistic regression analysis was performed to detect independent risk factors for patients requiring postoperative clinical treatment. Results: In this study, 482 patients had completed the full set of postoperative laboratory studies within 3 days after surgery were included in the present study. However, only a small proportion of the patients with anemia (3.9%), hypoalbuminemia (4.1%), and abnormal serum potassium levels (3.5%) required clinical intervention after surgery. Binary logistic regression model analysis showed that body mass index (BMI), preoperative hemoglobin level, estimated blood loss and operative time were the independent risk factors correlated with postoperative blood transfusion in patients with HTO surgery. Female gender and preoperative albumin level were independent risk factors for patients who had requiring albumin supplementation after HTO surgery. Finally, preoperative potassium was the independent risk factors for patients required potassium supplementation postoperatively.Conclusions: based on the analysis, we conclude that routinely ordering postoperative laboratory studies after HTO surgery are both unnecessary and cost inefficient. However, for patients with identified risk factors, routine postoperative laboratory tests are still needed.

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Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a prospective randomized controlled study

Cited by 13 publications

References 21 publications

Multiple Intravenous Tranexamic Acid Doses After Open Wedge-high Tibial Osteotomy(OW-HTO) Further Reduce Perioperative Blood Loss and Drainage Volume: A Retrospective Study

Multiple Intravenous Tranexamic Acid Doses After Open Wedge-high Tibial Osteotomy(OW-HTO) Further Reduce Perioperative Blood Loss and Drainage Volume: A Retrospective Study

Comparison Between Bilateral Simultaneous Total Hip Arthroplasty With and Without Drainage; a Retrospective Cohort Study

Are Routine Postoperative Laboratory Tests Really Necessary after High Tibial Osteotomy surgery?

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