Opening-Wedge Proximal Tibial Osteotomy

O’Malley, Michael; Reardon, Patrick J.; Pareek, Ayoosh; Krych, Aaron J.; Stuart, Michael J.

doi:10.1016/j.eats.2016.03.005

“…OWHTO is an accepted and reliable procedure for the treatment of medial compartmental osteoarthritis in young, active individuals with varus deformity [ 8 , 9 , 11 – 13 , 30 ]. However, during OWHTO surgery, extensive soft tissue destruction and osteotomy gap creating induce intraoperative and postoperative bleeding, which prolong recovery time and enhance the risk of infection [ 12 – 14 ]. In our previous study, we confirmed that the blood loss was 383.3 ± 181.3 ml in patients undergoing OWHTO [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Open-wedge high tibial osteotomy (OWHTO) is a reliable option for knee osteoarthritis with varus malalignment in young, active people [ 8 – 11 ]. This technique is easy to learn and allows precise correction during the surgical procedure; however, it creates an osteotomy gap and increases the risk of bleeding theoretically [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Tranexamic Acid Is Beneficial to Patients Undergoing Open-Wedge High Tibial Osteotomy

Chen

¹

,

Wang

²

,

Zhu

³

et al. 2020

BioMed Research International

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The purpose of this study was to investigate the efficacy of tranexamic acid (TXA) in patients undergoing open-wedge high tibial osteotomy (OWHTO). Patients from August 2018 to May 2020 were retrospectively studied. Clinical data were obtained including gender, age, height, weight, body mass index (BMI), smoking, alcohol consumption, hypertension, diabetes, history of aspirin, prepostoperative hematocrit (Hct) and hemoglobin (Hb), thrombotic events, blood transfusion requirement, hospital length of stay, size of osteotomy gap, and wound complications such as wound hematoma and infection. 52 patients were enrolled in the tranexamic acid group (TA group), and 48 patients were enrolled in the nontranexamic acid group (NTA group); there were no significant differences between both groups in terms of gender, age, BMI, preoperative Hb, size of osteotomy gap, incidence of smoking, alcohol consumption, hypertension, diabetes, history of aspirin, thrombotic events, blood transfusion requirement, and wound hematoma and infection. The mean hospital length of stay was 9.4 ± 1.0 days in the TA group and 11.0 ± 1.2 days in the NTA group ( P < 0.001 ), the blood loss was 296.0 ± 128.7 ml in the TA group and 383.3 ± 181.3 ml in the NTA group ( P < 0.05 ), and the postoperative Hb level was 120.8 ± 15.0 g/l in the TA group and 109.5 ± 13.8 g/l in the NTA group ( P < 0.001 ). In conclusion, the administration of TXA is beneficial to patients undergoing OWHTO via decreasing hospital length of stay, reducing blood loss, and maintaining higher postoperative Hb levels.

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“…Using the fixed-effects model, no significant difference was found in the drainage amount on POD2 between the TXA and NTXA groups (WMD = 4.17, 95% CI [À7. 48,15.83], P = 0.48) (Fig. 7B, Fig.…”

Section: Drainage Amount On Pod2mentioning

confidence: 94%

“…[11][12][13][14] However, perioperative blood loss is theoretically high during HTO, with bone bleeding from the osteotomy gap. 15 This can increase the incidence of wound complications, anemia, transfusions, and bone non-union, affecting patients both physically and mentally. Some studies have reported total blood loss of more than 800 mL, 16,17 delayed wound healing of 1.9%, and superficial wound infection of 1%.…”

Section: Introductionmentioning

confidence: 99%

Effect of Tranexamic Acid on Blood Management during a High Tibial Osteotomy: A Systematic Review and Meta‐analysis

Fang

¹

,

Zhang

²

,

Wang

³

et al. 2022

Orthopaedic Surgery

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This study aimed to evaluate the efficiency and safety of tranexamic acid for blood management during high tibial osteotomy (HTO). A systematic search was conducted in Medline, Embase, and the Cochrane library database. Six studies and 208 patients were included in this meta‐analysis using Review Manager V.5.3 and Stata 15.1 software. For primary outcomes, tranexamic acid lowered the total blood loss (WMD = –219.47, 95% CI [−355.61, −83.33], P = 0.002). For secondary outcomes, a significant reduction was found for decreased hemoglobin (POD1: WMD = –9.86, 95% CI [−13.45, −6.28], P < 0.05; POD2: WMD = –8.41, 95% CI [−11.50, −5.32], P < 0.05; POD5: WMD = –11.48, 95% CI [−14.56, −8.39], P < 0.05) and drainage (total: WMD = –105.93, 95% CI [−187.08, −24.78], P < 0.05; POD1: WMD = –122.195, 95% CI [−168.902, −75.488], P < 0.05). The sex difference (male/female ratio) was determined (total blood loss: P = 0.025; total drainage amount: p = 0.018) using meta‐regression analysis. Females benefited more from tranexamic acid in terms of total blood loss (M/F > 40%: WMD = –53.11, 95% CI [−100.16, −6.05], P = 0.03; 40% ≥ M/F ≥ 20%: WMD = –362.20, 95% CI [−423.96, −300.45], P < 0.05; M/F < 20%: WMD = –263.00, 95% CI [−277.17, −248.83], P < 0.05) and total drainage (M/F > 40%: WMD = –7.11, 95% CI [−10.75, −3.47], P < 0.05; 40% ≥ M/F ≥ 20%: WMD = –104.72, 95% CI [−155.36, −54.08], P < 0.05; M/F < 20%: WMD = –222.00, 95% CI [−297.42, −146.58], P < 0.05). No significant differences were found for drainage on POD2 and POD3, wound complications, orthromboembolic events. In conclusion, tranexamic acid is effective and safe for blood management during HTO. Females appeared to benefit more from it, and an additional postoperative dose is suggested fora better effect.

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“…Recently, opening-wedge HTO has attracted much interest due to its advantages over closing-wedge HTO, in-cluding not violating the proximal tibiofibular joint, no alteration in the length of fibular collateral ligament and providing the opportunity for a precise intraoperative correction. However, it is also reported to increase the posterior tibial slope (PTS) more than closing-wedge HTO (7). Thus, several investigations have aimed at evaluating the change of PTS following opening-and closing-wedge HTO.…”

mentioning

confidence: 99%

The Effect of Opening-Wedge High Tibial Osteotomy on the Posterior Tibial Slope Assessed by Three Different Evaluation Methods

Bagherifard

¹

,

Rezazadeh

²

,

Askari

³

et al. 2018

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Background: Recently, opening-wedge high tibial osteotomy (HTO) has attracted much interest due to its advantages over closingwedge HTO. However, it has been reported to influence the posterior tibial slope (PTS), potentiating the knee for subsequent complications.Objectives: This study aimed at evaluating: 1. How open-wedge HTO changes the PTS, and 2. how the PTS evaluation method influences the extent of the PTS change. Methods: Patients with genu varum deformity, who underwent HTO at the center of the current study were included. Tomofix plate or Podo plate with or without bone graft were used for fixation purposes. The pre-and post-operative assessment of the PTS was performed using three different evaluation methods, including tibial anatomical axis (TAA), fibular anatomical axis (FAA) and posterior tibial cortex (PTC).Results: A total of 119 knees from 83 patients, with mean age of 31.32 ± 10.1 years and mean follow-up of 3.1 ± 1.9 years, were included in this study. Medial compartmental osteoarthritis was the most frequent type of etiology. The pre-operative PTS was 13.16, 13.81 and 11.55 using the TAA, FAA and PTC method, respectively. The post-operative PTS was 12.59, 12.95 and 10.77 using the TAA, FAA and PTC method, respectively. The change of PTS was not statistically significant using either methods. Conclusions: A negligible reduction of less than 1º was observed in the PTS of patients following opening-wedge HTO. The PTS assessment was not affected by the choice of evaluation method.

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Opening-Wedge Proximal Tibial Osteotomy

Cited by 4 publications

References 6 publications

Tranexamic Acid Is Beneficial to Patients Undergoing Open-Wedge High Tibial Osteotomy

Tranexamic Acid Is Beneficial to Patients Undergoing Open-Wedge High Tibial Osteotomy

Effect of Tranexamic Acid on Blood Management during a High Tibial Osteotomy: A Systematic Review and Meta‐analysis

The Effect of Opening-Wedge High Tibial Osteotomy on the Posterior Tibial Slope Assessed by Three Different Evaluation Methods

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