Patterns and Distribution of Deep Vein Thrombosis and Its Effects on Clinical Outcomes After Opening-Wedge High Tibial Osteotomy

Abstract

Background: Although a few studies have reported the incidence of deep vein thrombosis (DVT) after opening-wedge high tibial osteotomy (OWHTO), previous studies focused only on symptomatic DVT. Information is lacking regarding the overall incidence of DVT after OWHTO, thrombus location, and the relationship between DVT and clinical outcome. Purpose: To determine the overall incidence of DVT and classify the location of DVT after OWHTO. We also determined whether significant differences in clinical improvement exist in patients with and without DVT at 6 months and at 2 years after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included 46 patients (47 knees) who underwent OWHTO. All patients were instructed to perform knee range of motion exercises and partial weightbearing after drain removal. None of the patients received a chemoprophylaxis for DVT except intermittent pneumatic compression. DVT was diagnosed using 128-row multidetector computed tomography performed before discharge on the fourth postoperative day. The location was classified into 6 segments in the distal portion (muscular and axial veins) and proximal portion (popliteal, femoral, and common femoral veins and veins located above the iliac vein). International Knee Documentation Committee (IKDC) score was assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years using a linear mixed model. Results: Although the incidence of symptomatic DVT was 8.5% (n = 4), the overall incidence of early DVT was 44.7% (n = 21). All DVTs were located in the distal portion of the lower extremity vein, and 76.2% of the DVTs were located in an axial vein. The IKDC scores were 33.6 ± 7.2 and 35.3 ± 9.1 ( P = .910) preoperatively, 38.1 ± 5.6 and 40.6 ± 8.4 ( P = .531) at 6 months after surgery, and 44.8 ± 6.9 and 45.9 ± 11.4 ( P = .786) at 2 years after surgery in patients without and those with DVT, respectively. Conclusion: The overall incidence of early DVT after OWHTO was 44.7%. DVT after OWHTO was found particularly around the osteotomy site (76.2%). Patients with DVT did not have inferior short-term clinical outcomes after surgery.

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

“…The proportion of patients with muscular DVT was 95.2% (20/21), and that of axial DVT was 76.2% (16/21). In the present study, the results were comparable to those of Park et al 29 . The incidence of DVT was 38.9% (7/18) and 57.1%(8/14)in control group and 0.5 g TXA group, respectively.…”

“…Complications after MOWHTO usually include: delayed wound healing, wound infection, hematoma, loss of correction, intraoperative or postoperative lateral cortex fractures, DVT, bone delayed unions, vascular injury and so on 25–27 . The incidence of DVT of lower extremities had been reported to range from 1% to 44.7% 19,26,28,29 . Park et al 29 .…”

“…[25][26][27] The incidence of DVT of lower extremities had been reported to range from 1% to 44.7%. 19,26,28,29 Park et al 29 reported that the overall incidence of early DVT after opening-wedge HTO was 44.7%, and all DVTs were located in the distal portion of the lower extremity vein (muscular vein and axial vein). The proportion of patients with muscular DVT was 95.2% (20/21), and that of axial DVT was 76.2% (16/21).…”

Development and validation of a nomogram for predicting the risk of immediate postoperative deep vein thrombosis after open wedge high tibial osteotomy

“…A retrospective study by Onishi et al reported the incidence of DVT after osteotomies around the knee (13.8%) [28], but the study was not specific to OWHTO. Later, Park et al further reported the incidence (44.7%) and location (76.2% around the osteotomy site) of immediate postoperative DVT based on the clinical data from 46 patients with OWHTO [30], but did not analyze associated risk factors. A prospective Japanese study with 137 subjects revealed that the postoperative single‐leg standing test was the independent predictor of immediate postoperative DVT after OWHTO [19].…”

“…Immediately postoperative deep vein thrombosis (DVT) is a highly prevalent medical complication (2.4–44.7%) following open wedge high osteotomy (OWHTO) [18, 23, 26, 30], despite prophylactic anticoagulation. DVT not only causes swelling of the affected limb, interfering with local circulation and compromising the healing of the surgical site and osteotomy gap but also may extend proximally, leading to pulmonary embolism (PE) and even death [12].…”