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Edward J, Al-Shakfa F, Newman N, Lavoie F. Intrafocal injection of tranexamic acid decreases early return to hospital after high tibial osteotomy. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05411-5. [PMID: 38940983 DOI: 10.1007/s00402-024-05411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION High tibial osteotomy (HTO) is a surgery performed to treat the symptoms and prevent the progression of medial osteoarthritis. Post-operative bleeding has led to early returns to hospital following surgery. Intrafocal injection of tranexamic acid (TXA) could reduce this bleeding complication. The objective of the study was to evaluate the effect of TXA during HTO on the incidence of post-operative complications and early returns to hospital. MATERIALS AND METHODS This retrospective study included 251 cases of HTO performed between May 2012 and October 2021, with the use of TXA introduced in May 2017. The experimental (n = 102) and control (n = 149) groups were compared as to the rate of post-operative early returns. The influence of confounding factors was evaluated, including age, sex, body mass index (BMI), tobacco use, grade of medial femorotibial osteoarthritis (MFTO), magnitude of angular correction (MAC), and surgery duration. RESULTS No statistically significant difference was found between the groups with regards to all variables except age. The experimental group was significantly older (54.4 years; σ = 7.5) than the control group (50.4 years; σ = 7.9; p < 0.001). We observed a decrease in emergency department (ED) visits in the experimental group (15.7%) compared to the control (30.2%; p = 0.008) and a decrease in early returns in the experimental group (28.4%) compared to the control (40.5%; p = 0.049). No statistically significant difference in demographic data, MFTO, or MAC was found among patients with and without an early return, in both the experimental and control groups. CONCLUSION The intrafocal injection of TXA during HTO decreases early returns to hospital.
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Affiliation(s)
- Julia Edward
- CHUM Research Centre, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, 1000, rue St- Denis, Montréal, Québec, H2X 0C1, Canada.
| | - Fidaa Al-Shakfa
- CHUM Research Centre, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, 1000, rue St- Denis, Montréal, Québec, H2X 0C1, Canada
| | - Nicholas Newman
- CHUM Research Centre, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, 1000, rue St- Denis, Montréal, Québec, H2X 0C1, Canada
| | - Frédéric Lavoie
- CHUM Research Centre, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, 1000, rue St- Denis, Montréal, Québec, H2X 0C1, Canada
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Zheng H, Han Y, Zhao G, Wang R, Wu J, Chen X, Zhao Q, Ren F, Huang J. Topical Use of Low-dose Tranexamic Acid Has no Effect on Drainage Volume after Medial Open Wedge High Tibial Osteotomy: A Case Control Study. Orthop Surg 2024; 16:894-901. [PMID: 38444379 PMCID: PMC10984820 DOI: 10.1111/os.14014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Many studies reported that tranexamic acid (TXA) was effective in reducing surgical blood loss in the perioperative period of medial open wedge high tibial osteotomy (MOWHTO). However, few studies focused on the simple topical use of TXA in MOWHTO, and the modality and dosage of topical use of TXA varied. The purpose of this study was to observe the effect of topical use of low-dose TXA on drainage volume after MOWHTO, and to analyze the related influencing factors. METHODS Data of patients who underwent MOWHTO combined with arthroscopic knee surgery in our department from January 2019 to September 2021 were retrospectively analyzed. A total of 105 patients (38 males and 67 females, aged 57.7 ± 7.5 years) were included in this study who received topical TXA or no TXA. The patients were divided into three groups: control group (39 cases), 0.5 g TXA group (40 cases), 1 g TXA group (26 cases). Postoperative drainage volume, wound healing, incidence of hematoma and deep venous thrombosis (DVT) were observed and analyzed in the three groups. The effects of gender, hypertension and diabetes on postoperative drainage volume were analyzed using a t-test. The correlation between age, body mass index (BMI), osteotomy gap and postoperative drainage volume were analyzed using the Pearson correlation coefficient. RESULTS The average postoperative drainage volume of the control group was 259.54 ± 226.33 mL, that of the 0.5 g TXA group was 277.18 ± 177.68 mL, and that of the 1 g TXA group was 229.15 ± 219.93 mL. There was no statistically significant difference in postoperative drainage volume among the three groups (F = 0.423, p = 0.656). There was no local hematoma and wound infection in the three groups. The wound fat liquefaction was found in one patient of the control group. The incidence of DVT was 38.9% (7/18) and 57.1% (8/14) in the control group and 0.5 TXA group, respectively. There was no significant difference in the incidence of DVT between the above two groups (p = 0.476). The average postoperative drainage volume of male patients in the three groups was higher than that of female patients, and the differences were statistically significant (p < 0.05). There was no correlation between age, BMI, osteotomy gap and postoperative drainage volume in the three groups (p > 0.05). CONCLUSION Topical use of low-dose TXA has no significant effect on drainage volume after MOWHTO. The drainage volume after MOWHTO in male patients was more than that in female patients. Topical administration of low-dose TXA does not increase postoperative complications, such as DVT and hematoma.
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Affiliation(s)
- Huifeng Zheng
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Yuqin Han
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Guangjuan Zhao
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Rui Wang
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Jiang Wu
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Xiao Chen
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Qian Zhao
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Fuji Ren
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Jingmin Huang
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
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Xu Z, Li L, Xie P, Gu J, Kang K, Zheng X. Clinical Use of Tranexamic Acid in High Tibial Osteotomy: A Systematic Review and Meta-analysis. Orthop J Sports Med 2024; 12:23259671241231761. [PMID: 38455151 PMCID: PMC10919141 DOI: 10.1177/23259671241231761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/16/2023] [Indexed: 03/09/2024] Open
Abstract
Background High tibial osteotomy (HTO) can cause postoperative hemorrhage. The use of tranexamic acid to reduce the hemorrhage is still controversial. Purpose To investigate the efficacy and safety of tranexamic acid in HTO. Study Design Systematic review; Level of evidence, 4. Methods Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors conducted a comprehensive search of the Embase, Cochrane Library, PubMed, Web of Science, MEDLINE, and Foreign Medical Literature Retrieval Service databases between their inception and January 1, 2023. All clinical studies comparing the use of tranexamic acid versus no tranexamic acid during HTO were collected. The primary outcome measures were hemoglobin decrease, drainage volume, and blood loss, and the secondary outcome measures were wound complications, blood transfusion, and postoperative thrombosis. All indicators were analyzed using meta-analysis software. Results were reported as mean differences or risk ratios with 95% confidence intervals. Results Of 152 initial results, 9 studies involving 908 patients were included. The tranexamic acid group had lower indicators for total blood loss, hemoglobin decrease, and total drainage volume (P < .00001 for all). There were no differences between patients with versus without tranexamic acid in wound complications, including hematoma (P = .21) or infection (P = .18), nor were there any group differences in the prevalence of blood transfusion (P = .21) or postoperative thrombosis (P = .36). Conclusion Tranexamic acid was able to effectively reduce postoperative hemorrhage in patients undergoing HTO without affecting the rates of wound complications, blood transfusion, or postoperative thrombosis.
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Affiliation(s)
- Zheshu Xu
- Department of Orthopedics, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Lixun Li
- Department of Orthopedics, Hebei Province Special Care Hospital, Shijiazhuang, Hebei, China
| | - Peng Xie
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
- Department of Nuclear Medicine, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Juyuan Gu
- Department of Orthopedics, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Kai Kang
- Department of Orthopedics, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Xiaozuo Zheng
- Department of Orthopedics, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
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O'Donnell CE, Dadah H, Bin Abd Razak HR, Wilson A, Khakha R. Clinical Outcomes Following Use of Tranexamic Acid in High Tibial Osteotomy: A Systematic Review. Cureus 2023; 15:e49556. [PMID: 38156174 PMCID: PMC10753147 DOI: 10.7759/cureus.49556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
This study aimed to evaluate the clinical outcomes following administration of tranexamic acid (TXA) in patients undergoing high tibial osteotomy (HTO) through a systematic review of current available evidence. A systematic database search of PubMed, Embase and Cumulative Index of Nursing and Allied Health Literature (CINAHL) was performed from inception up to December 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Inclusion criteria were (i) randomised control trials, cohort studies or case-control studies that had more than 10 patients; (ii) studies reporting outcomes after TXA administration, of any route, before or after HTO, compared to placebo, control and different doses or routes; and (iii) studies reporting blood loss, including haemoglobin (Hb) drop, estimated blood loss, transfusion requirement and complications. Case reports, reviews, abstracts, non-HTO studies, non-human studies and duplicates were excluded. A synthesized comparison of drain output, wound complications, transfusion requirement and pooled analyses of blood loss and Hb drop was performed. Eleven studies involving 974 patients were included. Nine studies had placebo comparison, and two used single-dose TXA versus multiple doses. All studies reported on postoperative hemoglobin and nine on blood loss. In the six TXA versus placebo studies reporting on total blood loss, the TXA group had a pooled, estimated standardised mean difference (SMD) in blood loss of -2.37 (95% confidence interval (CI) -3.67, -1.07; P = 0.0004). For the Hb drop, on postoperative days (PODs) one, two, and five, the SMDs were -0.97 (95% CI -1.19, -0.75; P < 0.00001) for POD1, -0.74 (95% CI -1.03, -0.46; P < 0.00001) for POD2 and -0.87 (95% CI -1.10, -0.64; P < 0.00001) for POD5. TXA administration in HTO significantly reduces perioperative blood loss. This can greatly improve recovery, reduce complications and shorten length of stay. This is especially pertinent given supply shortages of NHS blood resources.
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Affiliation(s)
- Ciara E O'Donnell
- Medicine, King's College London, London, GBR
- General Surgery, Whipps Cross University Hospital, London, GBR
| | - Hashim Dadah
- General Surgery, King's College London, London, GBR
| | - Hamid Rahmatullah Bin Abd Razak
- Musculoskeletal Sciences, Duke-NUS Medical School, Singapore, SGP
- Orthopaedic Surgery, Sengkang General Hospital, Singapore, SGP
| | - Adrian Wilson
- Department of Sports and Exercise, University of Winchester, Winchester, GBR
| | - Raghbir Khakha
- Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, GBR
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Iseki T, Iseki T, Kanto R, Onishi S, Yoshiya S, Tachibana T, Nakayama H. Efficacy of intravenous tranexamic acid administration in medial opening-wedge distal tibial tuberosity osteotomy (MOWDTO) for varus knee osteoarthritis: a randomized control trial. J Orthop Surg Res 2023; 18:178. [PMID: 36890541 PMCID: PMC9996975 DOI: 10.1186/s13018-023-03666-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/01/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND This randomized controlled study was undertaken to investigate the efficacy of intravenous tranexamic acid (TXA) administration in reducing perioperative blood loss in patients undergoing medial opening-wedge distal tibial tuberosity osteotomy (MOWDTO). It was hypothesized that TXA would reduce perioperative blood loss in MOWDTO. METHODS A total of 61 knees in 59 patients who underwent MOWDTO during the study period were randomly assigned to either of the groups with intravenous TXA administration (TXA group) or without TXA administration (control group). In the TXA group, patients received 1000 mg of TXA intravenously before skin incision and 6 h after the first dose. The primary outcomes was the volume of perioperative total blood loss which calculated using the blood volume and hemoglobin (Hb) drop. The Hb drop was calculated as the difference between preoperative Hb and postoperative Hb at days 1, 3, and 7. RESULTS The perioperative total blood loss was significantly lower in the TXA group (543 ± 219 ml vs. 880 ± 268 ml, P < 0.001). The Hb drop was significantly lower at postoperative days 1, 3 and 7 in the TXA group than in the control group (day 1: 1.28 ± 0.68 g/dl vs. 1.91 ± 0.69 g/dl, P = 0.001; day 3: 1.54 ± 0.66 g/dl vs. 2.69 ± 1.00 g/dl, P < 0.001; day 7: 1.74 ± 0.66 g/dl vs. 2.83 ± 0.91 g/dl, P < 0.001). CONCLUSION Intravenous TXA administration in MOWDTO could reduce the perioperative blood loss. Trial registration The study was approved by the institutional review board. (Registered on 26/02/2019 Registration Number 3136). Level of Evidence Level I, randomized controlled trial.
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Affiliation(s)
- Takuya Iseki
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya City, Hyogo, 663-8501, Japan.
| | - Tomoya Iseki
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Ryo Kanto
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Shintaro Onishi
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, 1-4 Ohama-Cho, Nishinomiya City, Hyogo, 662-0957, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, 1-4 Ohama-Cho, Nishinomiya City, Hyogo, 662-0957, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Hiroshi Nakayama
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya City, Hyogo, 663-8501, Japan
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