Abstract
ObjectiveThe present meta-analysis was conducted to evaluate the efficacy and safety of the application of tranexamic acid (TXA) in patients undergoing high tibial osteotomy (HTO).MethodsPubMed (MEDLINE), EMBASE, and Cochrane Library were systematically searched for relevant literature from inception until 1 February 2021. A combined searching strategy of subject words and random words was adopted. After testing for potential publication bias and/or heterogeneity, we aggregated variables by using the random-effect model. The primary comparison outcome measures were total blood loss, hemoglobin decrease, drain output, wound complications, thrombotic events, and blood transfusion rate of the TXA group versus control. The meta-analysis was performed using the RevMan 5.3 software.ResultsA total of 5 studies were included involving 532 patients. The results showed that there were significant differences in the two groups concerning total blood loss (95% confidence interval [CI] − 332.74 to − 146.46, P < 0.00001), hemoglobin decrease on postoperative day (POD) 1, 2, and 5 (POD 1 95% CI − 1.34 to − 0.63, P < 0.00001; POD 2 95% CI − 1.07 to − 0.68, P < 0.00001; POD 5 95% CI − 1.46 to − 0.84, P < 0.00001), drain output (POD total 95% CI − 195.86 to − 69.41, P < 0.00001) and wound complications (RR = 0.34, 95% CI 0.12 to 0.97, P = 0.04). Nonsignificant differences were found in the incidence of thromboembolic events (RR = 0.46, 95% CI 0.09 to 2.41, P = 0.36) and blood transfusion rate (RR = 0.25, 95% CI 0.03 to 2.27, P = 0.22).ConclusionsThis meta-analysis of the available evidence demonstrated that TXA could reduce total blood loss, hemoglobin decrease, drain output, and wound complications without increasing the incidence of thromboembolic events in patients undergoing HTO. But there is no obvious evidence that TXA could reduce blood transfusion rates. Further studies, including more large-scale and well-designed randomized controlled trials, are warranted to assess the efficacy and safety issues of routine TXA use in HTO patients.
Highlights
High tibial osteotomy (HTO) is a widely used and wellestablished effective surgical treatment which aims to correct the varus malalignment or deformation with compartmental osteoarthritis or osteonecrosis of the knee in both young and elderly patients [1]
5 studies [6, 19–22] consisting of 532 patients, 258 patients in Tranexamic acid (TXA) group, and 274 in the control group were included in this meta-analysis
Based on the outcomes of pool of 5 studies, the most important finding of this meta-analysis was that the administration of TXA could significantly reduce total blood loss (MD = − 239.60, 95% confidence interval (CI) − 332.74 to − 146.46, P < 0.00001) and wound complications (RR = 0.34, 95% CI 0.12 to 0.97, P = 0.04)
Summary
High tibial osteotomy (HTO) is a widely used and wellestablished effective surgical treatment which aims to correct the varus malalignment or deformation with compartmental osteoarthritis or osteonecrosis of the knee in both young and elderly patients [1]. HTO can be implemented to delay the urgent need for a total or partial knee replacement procedure by preserving the damaged tissue in the knee joint. This surgical procedure can cause extensive bleeding due to bone gap and release of blood vessels as well as extensive soft tissues in and around the damaged site [5, 6], that may lead to soft tissue complications, such as wound hematoma, superficial skin infections, delayed union, and even compartment syndrome [7–9]. TXA is a synthetic lysine analog that competitively blocks the lysine binding site on fibrinolysin and plasminogen, inhibiting the activation of plasminogen to plasmin, and promotes clot formation by regulating the platelet dispersions [15, 16]
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