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Incidence of and risk factors for deep vein thrombosis in patients undergoing osteotomies around the knee: comparative analysis of different osteotomy types

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To examine the incidence of and risk factors for deep vein thrombosis (DVT) among different types of osteotomies around the knee. It was hypothesized that DVT would be detected at a substantial rate after the osteotomy, and there would be differences in the incidences among the different osteotomy procedures.

Methods

Consecutive patients who underwent knee osteotomies for varus osteoarthritis and met the inclusion criteria were included in the study. Ultrasonographic evaluation was performed to detect DVT on bilateral whole leg at 1 month before and 7 days after surgery. Statistical comparison of the demographic and clinical parameters between the patients with and without DVT as well as multivariate analysis using logistic regression was conducted to identify risk factors related to the incidence of postoperative DVT.

Results

The study subjects comprised 159 knees in 135 patients with medial opening wedge high tibial osteotomy (MOW-HTO), 93 knees in 78 patients with lateral closed wedge high tibial osteotomy (LCW-HTO), and 74 knees in 54 patients with double level osteotomy (DLO). In the postoperative evaluation, DVT was detected in 19 of 159 knees (11.9%) in MOW-HTO, 21 of 93 knees (22.6%) in LCW-HTO, and 5 of 74 knees (6.8%) in DLO. The incidence of DVT was significantly higher after LCW-HTO than after MOW-HTO and DLO (p < 0.01). DVT at a level above the knee was noted in one case after MOW-HTO, while DVT in the remaining cases developed at a level below the knee. No cases of symptomatic pulmonary embolism were encountered during the study period. Among the potential risk factors assessed for correlation with the incidence of DVT, LCW-HTO was identified as a significant risk factor (odds ratio: 2.54; 95% CI 1.334–4.836; p < 0.01).

Conclusions

This study demonstrated that DVT occurred at a substantial rate (overall incidence of 13.8%) after osteotomy around the knee even with the use of prophylactic anticoagulant. Among the different osteotomy types, the DVT rate was significantly higher after LCW-HTO than after MOW-HTO and DLO.

Level of evidence

Prospectively designed observational cohort study, Level III.

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References

  1. Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD et al (2012) Diagnosis of DVT: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e351S-e418S

    Article  CAS  Google Scholar 

  2. Erickson BJ, Tilton A, Frank RM, Park W, Cole BJ (2017) Rates of deep vein thrombosis occurring after osteotomy about the knee. Am J Orthop (Belle Mead NJ) 46:E23–E27

    Google Scholar 

  3. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S et al (2012) Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e278S-e325S

    Article  CAS  Google Scholar 

  4. Fuji T, Fujita S, Kawai Y, Nakamura M, Kimura T, Fukuzawa M et al (2015) Efficacy and safety of edoxaban versus enoxaparin for the prevention of venous thromboembolism following total hip arthroplasty: STARS J-V. Thromb J 13:27

    Article  Google Scholar 

  5. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 133:381–453

    Article  Google Scholar 

  6. Haas SB, Insall JN, Scuderi GR, Windsor RE, Ghelman B (1990) Pneumatic sequential-compression boots compared with aspirin prophylaxis of deep-vein thrombosis after total knee arthroplasty. J Bone Joint Surg Am 72:27–31

    Article  CAS  Google Scholar 

  7. Ho VB, van Geertruyden PH, Yucel EK, Rybicki FJ, Baum RA, Desjardins B et al (2011) ACR Appropriateness Criteria(®) on suspected lower extremity deep vein thrombosis. J Am Coll Radiol 8:383–387

    Article  Google Scholar 

  8. Ishimatsu T, Takeuchi R, Ishikawa H, Yamaguchi Y, Maeyama A, Osawa K et al (2019) Hybrid closed wedge high tibial osteotomy improves patellofemoral joint congruity compared with open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27:1299–1309

    Article  Google Scholar 

  9. Izumi M, Migita K, Nakamura M, Jiuchi Y, Sakai T, Yamaguchi T et al (2015) Risk of venous thromboembolism after total knee arthroplasty in patients with rheumatoid arthritis. J Rheumatol 42:928–934

    Article  Google Scholar 

  10. Jacobs JJ, Mont MA, Bozic KJ, Della Valle CJ, Goodman SB, Lewis CG et al (2012) American Academy of Orthopaedic Surgeons clinical practice guideline on: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Bone Joint Surg Am 94:746–747

    Article  Google Scholar 

  11. Kearon C, Julian JA, Newman TE, Ginsberg JS (1998) Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging Practice Guidelines Initiative. Ann Intern Med 128:663–677

    Article  CAS  Google Scholar 

  12. Kim KI, Kim GB, Lee MG, Song SJ (2020) Do we need chemoprophylaxis to prevent venous thromboembolism following medial open-wedge high tibial osteotomy? J Knee Surg. https://doi.org/10.1055/s-0039-1700976

    Article  PubMed  Google Scholar 

  13. Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Ishigatsubo R, Mitsuhashi S et al (2017) The use of factor Xa inhibitors following opening-wedge high tibial osteotomy for venous thromboembolism prophylaxis. Knee Surg Sports Traumatol Arthrosc 25:2929–2935

    Article  Google Scholar 

  14. Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Okuyama H, Hirotomi K et al (2017) Edoxaban is effective in reducing the incidence of asymptomatic phlebographic events following closed-wedge high tibial osteotomy. Orthop Traumatol Surg Res 103:1193–1196

    Article  CAS  Google Scholar 

  15. Lee WS, Kim KI, Lee HJ, Kyung HS, Seo SS (2013) The incidence of pulmonary embolism and deep vein thrombosis after knee arthroplasty in Asians remains low: a meta-analysis. Clin Orthop Relat Res 471:1523–1532

    Article  Google Scholar 

  16. Lieberman JR, Pensak MJ (2013) Prevention of venous thromboembolic disease after total hip and knee arthroplasty. J Bone Joint Surg Am 95:1801–1811

    Article  Google Scholar 

  17. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    Article  Google Scholar 

  18. Martin R, Birmingham TB, Willits K, Litchfield R, Lebel ME, Giffin JR (2014) Adverse event rates and classifications in medial opening wedge high tibial osteotomy. Am J Sports Med 42:1118–1126

    Article  Google Scholar 

  19. Nagashima M, Otani T, Takeshima K, Seki H, Nakayama M, Origuchi N et al (2020) Unexpectedly high incidence of venous thromboembolism after arthroscopic anterior cruciate ligament reconstruction: prospective, observational study. J ISAKOS 5:80–82

    Article  Google Scholar 

  20. Nakayama H, Iseki T, Kanto R, Kambara S, Kanto M, Yoshiya S et al (2020) Physiologic knee joint alignment and orientation can be restored by the minimally invasive double level osteotomy for osteoarthritic knees with severe varus deformity. Knee Surg Sports Traumatol Arthrosc 28:742–750

    Article  Google Scholar 

  21. Otsuki S, Murakami T, Okamoto Y, Nakagawa K, Okuno N, Wakama H et al (2019) Hybrid high tibial osteotomy is superior to medial opening high tibial osteotomy for the treatment of varus knee with patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 27:1332–1338

    Article  Google Scholar 

  22. Schroter S, Nakayama H, Yoshiya S, Stockle U, Ateschrang A, Gruhn J (2019) Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg 139:519–527

    Article  CAS  Google Scholar 

  23. Sun Y, Chen D, Xu Z, Shi D, Dai J, Qin J et al (2014) Incidence of symptomatic and asymptomatic venous thromboembolism after elective knee arthroscopic surgery: a retrospective study with routinely applied venography. Arthroscopy 30:818–822

    Article  Google Scholar 

  24. Takeuchi R, Ishikawa H, Miyasaka Y, Sasaki Y, Kuniya T, Tsukahara S (2014) A novel closed-wedge high tibial osteotomy procedure to treat osteoarthritis of the knee: hybrid technique and rehabilitation measures. Arthrosc Tech 3:e431-437

    Article  Google Scholar 

  25. Turner RS, Griffiths H, Heatley FW (1993) The incidence of deep-vein thrombosis after upper tibial osteotomy. A venographic study. J Bone Joint Surg Br 75:942–944

    Article  CAS  Google Scholar 

  26. van der Woude JA, Spruijt S, van Ginneken BT, van Heerwaarden RJ (2016) Distal femoral valgus osteotomy: bone healing time in single plane and biplanar technique. Strategies Trauma Limb Reconstr 11:177–186

    Article  Google Scholar 

  27. Venker BT, Ganti BR, Lin H, Lee ED, Nunley RM, Gage BF (2017) Safety and efficacy of new anticoagulants for the prevention of venous thromboembolism after hip and knee arthroplasty: a meta-analysis. J Arthroplasty 32:645–652

    Article  Google Scholar 

  28. Wang CJ, Huang CC, Yu PC, Chen HH (2004) Diagnosis of deep venous thrombosis after total knee arthroplasty: a comparison of ultrasound and venography studies. Chang Gung Med J 27:16–21

    PubMed  Google Scholar 

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Funding

There was no outside fundings or grants that received in this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hyogo College of Medicine, Hyogo, Japan

    Shintaro Onishi, Tomoya Iseki, Ryo Kanto, Makoto Kanto, Toshiya Tachibana & Hiroshi Nakayama

  2. Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan

    Shunichiro Kambara & Shinichi Yoshiya

Authors
  1. Shintaro Onishi
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  2. Tomoya Iseki
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  3. Ryo Kanto
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  7. Toshiya Tachibana
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  8. Hiroshi Nakayama
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Correspondence to Tomoya Iseki.

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The authors declare that they have no conflict of interests.

Ethical approval

This study was approved by our ethics institutional review board (No. 2218), and written informed consent was obtained from all patients.

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Onishi, S., Iseki, T., Kanto, R. et al. Incidence of and risk factors for deep vein thrombosis in patients undergoing osteotomies around the knee: comparative analysis of different osteotomy types. Knee Surg Sports Traumatol Arthrosc 29, 3488–3494 (2021). https://doi.org/10.1007/s00167-020-06326-5

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  • DOI: https://doi.org/10.1007/s00167-020-06326-5

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