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Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy

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Does the correction angle affect hidden blood loss in HTO?

Zheng Li¹, Yannong Wang², Guanglei Cao³

¹Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street, Xicheng District, Beijing, 100053, China.

Journal of Orthopaedic Surgery and Research

|November 12, 2020

Summary

Hidden blood loss (HBL) after biplanar open wedge high tibial osteotomy (BOWHTO) is significant and increases with larger correction angles. This finding highlights the need to account for HBL in patient blood volume calculations following this knee osteoarthritis surgery.

Keywords:

Correction angle Hidden blood loss High tibial osteotomy Knee arthroscopic surgery Tourniquet Tranexamic acid

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Area of Science:

Orthopedic Surgery
Knee Osteoarthritis Treatment
Surgical Blood Loss Analysis

Background:

Biplanar open wedge high tibial osteotomy (BOWHTO) is a common treatment for knee osteoarthritis.
Previous studies noted discrepancies between observed bleeding and hemoglobin decrease after HTO.
Hidden blood loss (HBL) is suspected but not well quantified in BOWHTO.

Purpose of the Study:

To investigate perioperative hidden blood loss (HBL) following BOWHTO.
To determine the correlation between the correction angle and HBL in BOWHTO patients.

Main Methods:

Retrospective analysis of 21 patients undergoing BOWHTO.
Calculation of total blood loss (TBL) and HBL using the Gross equation.
Measurement of the actual correction angle via postoperative radiographs.
Correlation analysis between HBL and correction angle.

Main Results:

Total blood loss (TBL) was 823.5 ± 348.7 mL; hidden blood loss (HBL) was 601.6 ± 297.3 mL.
Mean HBL as a proportion of patient's blood volume (H/P) was 13.19 ± 5.56%.
A statistically significant positive correlation was found between correction angle and H/P (|r| = 0.678, P = 0.001).

Conclusions:

Actual blood loss after BOWHTO is significantly higher than observed, with substantial HBL.
HBL is an objective occurrence following BOWHTO.
The degree of knee joint correction achieved in BOWHTO is directly related to the proportion of HBL.