scholarly journals Perioperative pain control is important for prevention of venous thromboembolism after around the knee osteotomy

2020 ◽  
Author(s):  
Mitsuaki Kubota ◽  
Youngji Kim ◽  
Taisuke Sato ◽  
Ryuichi Ohno ◽  
Muneaki Ishijima
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Venous Thromboembolism ◽  
High Tibial Osteotomy ◽  
Logistic Regression Analysis ◽  
Pain Control ◽  
Tibial Osteotomy ◽  
Perioperative Pain ◽  
Wedge High Tibial Osteotomy ◽  
Knee Osteotomy

Abstract Background: Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE) are well-known complications after TKA. However, there are few reports about VTEs after around the knee osteotomy (AKO). Purpose: To investigate the incidence of and risk factors for VTEs after AKO. Methods: A total 108 AKO cases were assessed in this study. The procedures included open-wedge high tibial osteotomy (OWHTO; n=96), hybrid closed-wedge high tibial osteotomy (CWHTO; n=7), distal femoral osteotomy (DFO; n=2), tibial condylar valgus osteotomy (TCVO; n=2), and double level osteotomy (DLO; n=1). Ultrasonography of the lower extremities was performed for all patients at 1 week after AKO. The incidence of VTEs was investigated, and a logistic regression analysis was performed to determine which patient demographics, pre-operative clinical results and surgical factors were associated with DVT or PE after surgery. Results: Of the 108 patients who underwent AKO, 29 (26.9%) developed postoperative DVT, but no patients developed PE. The logistic regression analysis identified abrasion chondroplasty (odds ratio [OR], 3.46) and pre-operative pain visual analog scale (VAS; OR, 1.05) as independent predictors of DVT. Conclusion: The incidence of DVT after AKO is relatively high and preoperative and postoperative pain may induce DVT. Perioperative pain control is important for preventing VTEs.

scholarly journals Re-evaluating the necessity of routine laboratory tests after high tibial osteotomy surgery

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hong-bo Li ◽  
Si Nie ◽  
Min Lan ◽  
Xin-gen Liao ◽  
Zhi-ming Tang
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
High Tibial Osteotomy ◽  
Logistic Regression Analysis ◽  
Laboratory Tests ◽  
Clinical Treatment ◽  
The Body ◽  
Tibial Osteotomy ◽  
Independent Risk Factors

Abstract Background To assess the utility of routine postoperative laboratory tests for patients undergoing high tibial osteotomy (HTO) surgery. Methods The associations between clinical risk factors and postoperative clinical treatment were analyzed. Additionally, a logistic regression analysis was performed to detect independent risk factors for patients requiring postoperative clinical treatment. Results A total of 482 patients with symptomatic isolated medial compartment osteoarthritis from January 2015 to May 2020 were included in the present study and underwent examination by the full set of postoperative laboratory tests within 3 days after HTO surgery. However, only a small proportion of the patients with anemia (3.9 %), hypoalbuminemia (4.1 %), and abnormal serum potassium levels (3.5 %) required clinical intervention after surgery. Binary logistic regression analysis showed that the body mass index (BMI), preoperative hemoglobin level, estimated blood loss and operative duration were independent risk factors for postoperative blood transfusion in patients who underwent HTO surgery, and factors associated with albumin supplementation were female sex and preoperative albumin level. In addition, these results indicated that preoperative potassium was potential risk factor for patients who required potassium supplementation postoperatively. Conclusions Based on the analysis, we conclude that routinely ordering postoperative laboratory tests after HTO surgery is unnecessary. However, for patients with identified risk factors, routine postoperative laboratory tests are still needed.

scholarly journals Efficacy of flurbiprofen axetil for preventing postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Atsushi Kotera
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Postoperative Pain ◽  
Logistic Regression Analysis ◽  
Pain Control ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Postoperative Pain Control ◽  
Flurbiprofen Axetil ◽  
Postanesthetic Shivering

Abstract Background Postanesthetic shivering is an unpleasant adverse event in surgical patients. A nonsteroidal anti-inflammatory drug has been reported to be useful in preventing postanesthetic shivering in several previous studies. The aim of this study was to evaluate the efficacy of flurbiprofen axetil being a prodrug of a nonsteroidal anti-inflammatory drug for preventing postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries. Method This study is a retrospective observational study. I collected data from patients undergoing gynecologic laparotomy surgeries performed between October 1, 2019, and September 30, 2020, at Kumamoto City Hospital. All the patients were managed with general anesthesia with or without epidural analgesia. The administration of intravenous 50 mg flurbiprofen axetil for postoperative pain control at the end of the surgery was left to the individual anesthesiologist. The patients were divided into two groups: those who had received intravenous flurbiprofen axetil (flurbiprofen group) and those who had not received intravenous flurbiprofen axetil (non-flurbiprofen group), and I compared the frequency of postanesthetic shivering between the two groups. Additionally, the factors presumably associated with postanesthetic shivering were collected from the medical charts. Intergroup differences were assessed with the χ2 test with Yates’ correlation for continuity category variables. The Student’s t test was used to test for differences in continuous variables. Furthermore, a multivariate logistic regression analysis was performed to elucidate the relationship between the administration of flurbiprofen axetil and the incidence of PAS. Results I retrospectively examined the cases of 141 patients aged 49 ± 13 (range 21-84) years old. The overall postanesthetic shivering rate was 21.3% (30 of the 141 patients). The frequency of postanesthetic shivering in the flurbiprofen group (n = 31) was 6.5%, which was significantly lower than that in the non-flurbiprofen group (n = 110), 25.5% (p value = 0.022). A multivariate logistic regression analysis showed that administration of flurbiprofen axetil was independently associated with a reduced incidence of postanesthetic shivering (odds ratio 0.12; 95% confidence interval, 0.02-0.66, p value = 0.015). Conclusions My result suggests that intraoperative 50 mg flurbiprofen axetil administration for postoperative pain control is useful to prevent postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries.

Do We Need Chemoprophylaxis to Prevent Venous Thromboembolism following Medial Open-Wedge High Tibial Osteotomy?

2020 ◽  
Author(s):  
Kang-Il Kim ◽  
Gi Beom Kim ◽  
Myeong Gu Lee ◽  
Sang Jun Song
Keyword(s):  
Venous Thromboembolism ◽  
High Tibial Osteotomy ◽  
Varus Deformity ◽  
Control Group ◽  
Minor Bleeding ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Vein Thrombosis ◽  
Asian Patients ◽  
Wedge High Tibial Osteotomy

AbstractThe aim of this study was to investigate the overall incidence of venous thromboembolism (VTE) and to assess the efficacy of chemoprophylaxis to prevent VTE following medial open-wedge high tibial osteotomy (MOWHTO) in Asian patients. A total of 133 patients who consecutively underwent MOWHTO for the treatment of knee osteoarthritis with varus deformity were enrolled. All patients underwent preoperative ultrasonography and computed tomography venography on postoperative day 5 to detect deep vein thrombosis (DVT). Patients were divided into two groups: chemoprophylaxis group included patients (n = 66) who received 2.5 mg fondaparinux for 5 days postoperatively, whereas control group comprised patients (n = 67) who received placebo (67 patients). We evaluated the efficacy and safety outcomes of the treatment. We also assessed the predisposing factors that may affect the occurrence of VTE. The incidence of overall DVT was 14.9% in the control group and 10.6% in the chemoprophylaxis group (p > 0.05). Proximal DVT occurred in one patient in the control group. There was no symptomatic DVT or pulmonary embolism in either group. The patients with DVT had significantly higher mean body mass index (BMI) than the patients without DVT. Multivariate logistic regression showed BMI > 30 kg/m2 that was significantly correlated with the development of DVT (odds ratio = 0.8; p = 0.017). There were no cases of major bleeding; however, minor bleeding episodes occurred in four patients in the chemoprophylaxis group. The current study showed that the overall incidence of VTE following MOWHTO was low in Asian patients even without chemoprophylaxis. Therefore, routine chemoprophylaxis following MOWHTO seems to be not necessary in a population with low-VTE incidence. However, selective chemoprophylaxis should be considered in patients with BMI > 30 kg/m2.

scholarly journals Progression of pelvic retroversion is a critical factor for clinical outcome after Opening-wedge high tibial osteotomy among elderly patients

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Shuhei Otsuki ◽  
Hitoshi Wakama ◽  
Kuniaki Ikeda ◽  
Nobuhiro Okuno ◽  
Yoshinori Okamoto ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Clinical Outcome ◽  
High Tibial Osteotomy ◽  
Knee Extension ◽  
Lysholm Score ◽  
Compensatory Mechanism ◽  
Tibial Osteotomy ◽  
Critical Factors ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy

Abstract Purpose To evaluate the clinical outcome after opening-wedge high tibial osteotomy (OWHTO) and to determine the critical factors for a poor clinical outcome after OWHTO in patients aged over 65 years. Methods Our retrospective analysis was based on the data from 233 patients who underwent OWHTO for medial compartment knee OA at our institution between January 2013 and December 2018, and 88 patients (36 men and 52 women) over 65 years of age were included in this study. Radiographic parameters of weight-bearing line ratio (WBLR) and pelvic inclination (PI); the knee function, range of motion (ROM) and extension; and clinical outcome with Lysholm score were obtained preoperatively and postoperatively at the final follow-up visit. To evaluate the critical factors for the clinical outcome, univariate regression analysis was used to identify the relationship between postoperative and improved Lysholm score and pre-and post-operative essential factors. To reveal the factor having a greater impact on the clinical outcome, a p < 0.05 in univariate factors was entered into a multivariate regression analysis. Results The preoperative WBLR was significantly changed, and Lysholm score improved from 59.5 to 81.5 (p < 0.0001), whereas the PI, knee extension and ROM were not changed after OWHTO. Regarding the essential factors affecting clinical outcome after OWHTO, age and delta PI were negative, whereas preoperative WBLR, postoperative ROM, especially extension, had a positive effect (p < 0.05). Furthermore, only delta PI had affected the improvement of clinical outcome with OWHTO (p < 0.01), and postoperative knee extension was negatively correlated with the progression of pelvic retroversion (p < 0.01). Conclusion Age at surgery and progression of pelvic retroversion were the critical factors for poor postoperative clinical outcomes after OWHTO. Care should be taken for the progression of pelvic retroversion after OWHTO because it deteriorates the clinical outcome by inducing the knee flexion contracture as the compensatory mechanism for the balance of sagittal alignment.

scholarly journals Prognostic Factors for Open-Wedge High Tibial Osteotomy with Spacer Implantation in Patients with Medial Compartmental Knee Osteoarthritis

2021 ◽  
Author(s):  
Fengkun Wang ◽  
Wenru Ma ◽  
Jinli Chen ◽  
Wenbin Cong ◽  
Yingze Zhang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Prognostic Factors ◽  
High Tibial Osteotomy ◽  
Univariate Analysis ◽  
Womac Score ◽  
Neutral Position ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Duration Of Symptoms ◽  
Wedge High Tibial Osteotomy

Abstract Background: To identify the medial open-wedge high tibial osteotomy (MOWHTO) prognostic factors with wedge-shaped spacer implantation (spacer-type MOWHTO) for varus medial compartment knee osteoarthritis.Methods: Patients who underwent spacer-type MOWHTO between August 2018 and September 2019 were prospectively enrolled in this study. Patients were divided into two groups based on Western Ontario and McMasters University Osteoarthritis Index (WOMAC) scores of 40 points at 1 year postoperatively: the effective group (n=88, 84.6%), with post-WOMAC scores 40 or less, and the invalid group (n=16, 15.4%), with post-WOMAC scores more than 40. The variables assessed at baseline and 1 year postoperatively including age, sex, body mass index (BMI), Kellgren-Lawrence (K-L) grade, hip-knee-ankle angle (HKAA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), Blackburn-Peel index (BPI), duration of symptoms and WOMAC score, were compared. Prognostic factors were analyzed using logistic regression, and the corresponding odds ratios were also calculated.Results: A total of 104 patients were enrolled in the study protocol at 1 year postoperatively. The WOMAC score decreased from 72.39±12.95 at baseline to 20.06±12.96 at 1 year postoperatively. The preoperative varus was corrected to a neutral position or to mild valgus. In addition, the PTSA was decreased. At the same time, the patellar height was not significantly changed postoperatively. Univariate analysis revealed that the significant predictors of the WOMAC score were age >70 years, BMI >30 kg/m², K-L grade IV, and pre-HKAA >10° (P<0.1 for all). Multivariable logistic regression analysis revealed that age>70 (OR=4.861) and K-L grade IV (OR=6.590) were significantly associated with the WOMAC score at 1 year postoperatively.Conclusion: Spacer-type MOWHTO is an effective treatment for osteoarthritis with varus deformity. The prognostic factors for spacer-type MOWHTO were age and K-L grade.Level of evidence: III

scholarly journals Was femoral nerve block effective for pain control of medial opening-wedge high tibial osteotomy?

Medicine ◽  
2021 ◽  
Vol 100 (3) ◽  
pp. e23978
Author(s):  
Yi-Ming Ren ◽  
Meng-Qiang Tian ◽  
Yuan-Hui Duan ◽  
Yun-Bo Sun ◽  
Tao Yang ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Nerve Block ◽  
Pain Control ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy

Effect of Medial Open-Wedge High Tibial Osteotomy on the Patellofemoral Joint According to Postoperative Realignment

2019 ◽  
Vol 47 (8) ◽  
pp. 1863-1873 ◽  
Author(s):  
Tae-Hwan Yoon ◽  
Chong Hyuk Choi ◽  
Sung-Jae Kim ◽  
Sung-Hwan Kim ◽  
Nam-Hoo Kim ◽  
...  
Keyword(s):  
Regression Analysis ◽  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Characteristic Curve ◽  
Cutoff Point ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Level Of Evidence ◽  
Femoral Trochlea ◽  
Wedge High Tibial Osteotomy

Background: No study has yet assessed the effect of medial open-wedge high tibial osteotomy (MOWHTO) on the patellofemoral joint according to postoperative alignment. Purpose: To evaluate the effect of MOWHTO on the patellofemoral joint according to postoperative alignment by comparing the cartilage status before and after surgery and assessing the clinical and radiological outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 135 patients who underwent MOWHTO were retrospectively investigated. The patients were divided into 3 groups according to the postoperative weightbearing line ratio (WBLR): undercorrection (WBLR <58.3%, lowest quartile), acceptable correction (WBLR of 58.3%-66.3%, middle 2 quartiles), and overcorrection (WBLR >66.3%, highest quartile). The postoperative change in the cartilage status was assessed arthroscopically during implant removal at 2 years after MOWHTO. The clinical and radiological outcomes were evaluated at a mean follow-up of 52.1 months. A regression analysis was performed to identify the factors affecting the deterioration of the patellofemoral joint cartilage status. A receiver operating characteristic curve was employed to identify the cutoff point for the postoperative WBLR associated with the deterioration of the cartilage status in the patellofemoral joint. Results: Of all patients, progression of cartilage degeneration was noted in 39.3% for femoral trochlea and 23.7% for patella. The incidence of cartilage progression was significantly higher in the overcorrection group than in the undercorrection and acceptable correction groups (femoral trochlea: undercorrection group = 30.3%, acceptable correction group = 32.4%, and overcorrection group = 61.8% [ P = .008]; patella: undercorrection group = 15.2%, acceptable correction group = 17.7%, and overcorrection group = 44.1% [ P = .005]). The functional outcomes, including Lysholm knee score, Knee injury and Osteoarthritis Outcome Score (Pain, Symptoms, and Activities of Daily Living subscales), and Shelbourne and Trumper score, were significantly worse in the overcorrection group. The regression analysis showed that only the postoperative WBLR had a significant effect on cartilage deterioration. The cutoff point for the postoperative WBLR associated with progression of the International Cartilage Repair Society grade was 62.1% for the femoral trochlea (sensitivity = 61.5%, specificity = 62.7%, accuracy = 66.2%) and 62.2% for the patella (sensitivity = 59.4%, specificity = 60.2%, accuracy = 67.8%). Conclusion: The patellofemoral joint was adversely affected by MOWHTO. Overcorrection causing excessive valgus alignment led to further progression of degenerative changes in the patellofemoral joint and inferior clinical outcomes. The postoperative WBLR can be used as a predictive factor for deterioration of the cartilage status in the patellofemoral joint after MOWHTO.

scholarly journals Association between obesity and venous thromboembolism

2020 ◽  
Author(s):  
Cristina Hotoleanu
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Body Mass ◽  
Logistic Regression Analysis ◽  
The Body ◽  
Increased Risk

Background and aims. Obesity is associated with numerous pathological conditions, including venous thromboembolism (VTE). VTE is a multifactorial disease; more than half of the hospitalized patients are at risk for VTE. We aimed to assess the risk of VTE associated with obesity, taking into account the class of obesity (according to the body mass index), gender, age and the intervention of other acquired risk factors. Method. A case-control study including 732 patients was designed. Collected data included: age, gender, body mass index, pregnancy/ postpartum state, use of hormonal therapy, personal and family history of VTE, smoking, prolonged immobilization and the presence of comorbidities- acquired risk factors for VTE. The risk of VTE was expressed as odds ratio (OR) with 95% confidence interval. Multiple logistic regression analysis was used to detect the independent risk factors. P value < 0.05 was considered significant statistic. Results. Obesity was associated with a 6.2- fold increased risk for VTE. The risk of VTE associated with obesity was highest in patients aged >50 years and in cases included in classes II and III of obesity. The interaction between obesity and another acquired risk factor has almost doubled the risk of VTE. Multivariate logistic regression analysis showed obesity as an independent risk factor for VTE for both female and male patients. Conclusion. Obesity is an independent and moderate risk factor for VTE. The risk increases with body mass index, age and the presence of other acquired risk factors.

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