Impact of tourniquet on short-term outcomes in opening wedge high tibial osteotomy with modern tranexamic acid protocols: a retrospective cohort study

Abstract

Background The use of a tourniquet during high tibial osteotomy (HTO) is a routine procedure, but there is currently no research on the benefits and potential risks of tourniquet use during HTO. The aim of this study was to investigate the impact of tourniquet on perioperative blood loss, early functional recovery and complications in opening wedge HTO with modern tranexamic acid protocols. Methods This was a retrospective cohort study of patients who underwent unilateral opening wedge HTO between January 2019 and September 2020. All patients were divided into two groups according to whether a tourniquet was applied during HTO. Patients in both groups received the same surgical procedures, tranexamic acid protocols and other perioperative treatments. Preoperative baseline data, intraoperative data, early postoperative recovery and all complications during the 3-month follow-up were collected and compared between the two groups. Results A total of 62 patients were enrolled in this study, including 32 in the tourniquet group and 30 in the non-tourniquet group. There was no significant difference in preoperative baseline data between the two groups (P > 0.05 in all). Intraoperative blood loss in the tourniquet group was significantly lower than that in the non-tourniquet group (80.22 ml versus 94.00 ml, P < 0.001), but there was no difference in total blood loss (187.39 ml versus 193.31 ml, P = 0.714). And no patient in either group required blood transfusion. In terms of early postoperative recovery, tourniquet use significantly increased pain scores and reduced knee range of motion on the first and second postoperative days, but there was no significant difference between the two groups at postoperative third day and third month. Furthermore, there was no significant difference between the two groups in terms of lower limb force line correction, length of stay, Knee Society Score or the incidence of complications during the 3-month follow-up (P > 0.05 in all). Conclusions In opening wedge HTO with modern tranexamic acid protocols, not using a tourniquet does not increase perioperative total blood loss or the risk of complications, but facilitates early postoperative recovery by reducing pain and increasing range of motion.

Application of Different Doses of Tranexamic Acid Plus Traditional Chinese Medicine in Hip Arthroplasty in Patients with Diabetes and Its Influence on Intraoperative Blood Loss and Postoperative Drainage

“…It has been found that the application of TXA in intra-articular cavity injection can further enhance the hemostatic effect because intra-articular TXA targets active bleeding sites and increases the stability of the fibrin clot, thereby avoiding blood loss from the tissue surface [ 24 ]. It has been reported that intra-articular injection did not increase the incidence of VTE [ 25 ]; however, uncertainties remain on the risk of complications associated with intravenous injection. In the present study, both intravenous and intra-articular injections were performed, and no significant differences were found between the two groups in terms of postoperative coagulation indexes ( P > 0.05), serological examination showed no statistical differences in D-D levels between the two groups, and the absence of VTE in both groups was confirmed by imaging, indicating no increase in the probability of thrombosis in diabetic patients with intravenous high-dose TXA.…”

Ankle-Angle-Adjusting Fibular Osteotomy in Closed Wedge High Tibial Osteotomy

“…These strict bleeding-control procedures help to minimize postoperative swelling due to hemorrhage, without an indwelling drain ( Table 2 ). As for OWHTO 10 or TKA, 11 the safe nontourniquet procedure may decrease the intraoperative/perioperative risks of complications such as bleeding, hematoma, or infection and may enhance postoperative recovery.…”

Double level osteotomy for medial osteoarthritis and bifocal varus malalignment has excellent short-term results while maintaining physiologic radiographic joint parameters

“…The use of tranexamic acid reduces postoperative bleeding and hematoma [4, 15]. No tourniquet was used and minimally‐invasive surgical techniques were applied, which might be beneficial with regard to wound complications and infections [13, 35]. Additionally, all surgeries were performed by high‐volume osteotomy specialists.…”