Effect of Tranexamic Acid on Blood Management during a High Tibial Osteotomy: A Systematic Review and Meta-analysis

Does tranexamic acid reduce transfusion requirements in children with cerebral palsy undergoing osteotomies? A systematic review and meta-analysis

Introduction

Children with cerebral palsy have postural alterations and hip displacements are common among them, for which osteotomies must be carried out, involving great blood loss. Tranexamic acid (TXA), a fibrinolysis inhibitor, has been shown to reduce bleeding in osteotomies. However, the effectiveness of TXA in children with cerebral palsy has not been well studied, so a comprehensive meta-analysis is required to evaluate its impact.

Objective

We conducted a meta-analysis to investigate the effectiveness of tranexamic acid administration in reducing blood loss and transfusions during osteotomies in children with cerebral palsy.

Methods

Databases were searched until April 17, 2024, for randomized controlled trials and observational cohort studies comparing TXA use versus a control group. The primary outcome was overall transfusion.Secondary outcomes included intraoperative transfusion, postoperative transfusion, postoperative hemoglobin (Hb), postoperative hematocrit (Hct), drop in Hct, drop in Hb, length of stay, total blood loss (TBL) and estimated blood loss (EBL). The analysis utilized pooled relative risk ratios (RR) for categorical variables, and mean difference (MD) for numerical variables. We utilized the fixed-effects model utilizing the Mantel-Haenszel method.

Results

The analysis included 7 articles, which collectively provided data on 943 patients. It was found thatTXA administration decreases overall transfusion rate (RR = 0,65, 95 % CI: 0.47 to 0,90, p = 0,008),postoperative transfusion rate (RR = 0.53, 95 % CI: 0.36 to 0,79, p = 0.002) and TBL (MD = -139,41, 95 % CI: 221,34 to -57,48, p = 0,0009). There was less length of stay in the control group (MD = 0,47, 95 % CI: 0.10 to0,84, p = 0,01). TXA doesn't demonstrate significant differences in EBL, intraoperative transfusion rate, postoperative Hb, postoperative Hct, drop in Hct or drop in Hb.

Conclusion

TXA reduces the need of transfusion and total blood loss and increased length of hospital stay. And TXA doesn't demonstrate significant differences in EBL, intraoperative transfusion rate, postoperative Hb, postoperative Hct, drop in Hct or drop in Hb.

Postoperative management following osteotomies around the knee: a narrative review

The present narrative review provides a summary of postoperative therapy modalities and their effectiveness following osteotomies around the knee. The topics that are discussed in the scientific discourse include support of cartilage cell regeneration, pain management, drainage insertion, tourniquet use, pharmacological and mechanical thromboembolism prophylaxis, weight-bearing protocols and bone consolidation. There is evidence for the use of pharmacological thromboembolism prophylaxis and weight-bearing protocols. A standardized postoperative treatment concept following osteotomies around the knee cannot be derived due to lack of evidence for the other topics in current literature.

Avoiding Compartment Syndrome, Vascular Injury, and Neurologic Deficit in Tibial Osteotomy: An Observational Study of 108 Limbs

INTRODUCTION

Tibial deformities are common, but substantial concern may be associated with corrective osteotomy regarding major complications reported in classic literature. Such studies chiefly focused on high tibial osteotomy, with relatively little investigation of other areas and types of deformity. The primary aim of this study was to identify the rate of compartment syndrome, vascular injury, nerve injury, and other major complications after elective tibial osteotomy.

METHODS

One hundred eight tibia osteotomies performed during 2019 to 2021 were evaluated, representing all tibia osteotomies except situations of existing infection. A retrospective chart review was performed to identify patient demographics, surgical indications, anatomic location of osteotomy, fixation used, and complications prompting additional surgery.

RESULTS

The most common osteotomy locations were high tibial osteotomy (35/108 = 32%, 32/35 = 91% medial opening, and 3/35 = 9% medial closing), proximal metaphysis (30/108 = 28%), and diaphysis (32/108 = 30%). The most common fixation was plate and screw (38/108 = 35%) or dynamic frame (36/108 = 33%). Tranexamic acid was administered to 107/108 = 99% of patients and aspirin chemoprophylaxis was used for 83/108 = 86%. A total of 33/34= 97% of anterior compartment prophylactic fasciotomies were performed for diaphyseal or proximal metaphysis osteotomies. No events of compartment syndrome, vascular injury, nerve injury, or pulmonary embolism occurred. One patient required débridement to address infection. Additional surgery for delayed/nonunion occurred for nine segments (8%). Additional surgery for other reasons were performed for 10 segments (9%), none resulting in reduced limb function.

CONCLUSION

Tibial osteotomy can be safely performed for a variety of indications in a diverse range of patients, without a notable risk of the most feared complications of compartment syndrome, vascular injury, and neurologic deficit. Prophylactic fasciotomy and reducing postoperative bleeding using tranexamic acid, along with location-specific safe surgical techniques, may help prevent major complications and thereby facilitate optimized deformity care.