Effect of no Drainage Tube on Blood Loss and Recovery After High Tibial Osteotomy

• ClinicalTrials.gov Identifier: NCT03954860
• Recruitment Status: Completed
• First Posted: May 17, 2019
• Last Update Posted: February 19, 2020
• Sponsor: Qilu Hospital of Shandong University
• Information provided by (Responsible Party): Qilu Hospital of Shandong University

Study Description

Brief Summary:

The objective of this study was to evaluate the safety and efficacy of topical combined with intravenous tranexamic acid for high tibial osteotomy without placement of a drainage tube The clinical scores of patients and their possible risks were tracked. The investigators hypothesized that a combination of tranexamic acid and no drainage tube could reduce blood loss and facilitate early recovery. The implementation of the study will provide a new perioperative blood loss control program for High Tibial Osteotomy, reduce the cost of hospitalization, promote patients to get out of bed early, reduce the number of days in hospital.

Condition or disease	Intervention/treatment	Phase
Osteoarthritis, Knee	Other: Drainage Tube; Drug: Tranexamic Acid; Drug: Sodium Chloride 0.9%	Not Applicable

Detailed Description:

The condition of the patients was evaluated, and the total length of both lower limbs, anteroposterior position of knee and Mri of knee were included. The preoperative dose of tranexamic acid was calculated according to body weight of 20 mg / kg, 100 ml of tranexamic acid sodium chloride solution was dripped 30 minutes before operation, and after incision closure, 30 ml of normal saline solution containing 2 g of tranexamic acid was injected through drainage tube or subcutaneously. Postoperative intravenous drip of 100 ML sodium chloride solution containing 20 mg / kg tranexamic acid. Arthroscopy was first used to further confirm the cartilage defect, and a new type of lower limb alignment meter and a customized precise osteotomy template were used to perform the osteotomy according to the preoperative plan. One group was not placed drainage tube, the other group was placed drainage tube. Visual analogue pain score (Vas) and American Special Surgical Hospital (HSS) knee function score were recorded 3 month after surgery. Throughout the trial, the investigators will carefully observe and manage your complications and the outcome of your surgery.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 80 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Effect of no Drainage Tube on Blood Loss and Recovery After High Tibial Osteotomy
• Actual Study Start Date: August 1, 2018
• Actual Primary Completion Date: September 1, 2019
• Actual Study Completion Date: September 1, 2019

Arms and Interventions

Arm	Intervention/treatment
Experimental: No Drainage; The preoperative dose of tranexamic acid was calculated according to 20 mg / kg body weight, 100 ml of tranexamic acid sodium chloride solution was dripped 30 minutes before operation, and 30 ml saline containing 2 g tranexamic acid was applied to the local area before loosening the tourniquet.Postoperative intravenous drip of 100 ML sodium chloride solution containing 20 mg / kg tranexamic acid. No drainage tube was placed after operation.	Drug: Tranexamic Acid; Tranexamic acid (TXA) is an anti-fibrinolytic drugcan，which can increase the stability of fibrin clots and achieve hemostasis for High tibial osteotomy'patients.; Other Name: TXA; Drug: Sodium Chloride 0.9%; Sodium Chloride 0.9% is a solution of sodium chloride, which has the same osmotic pressure as animal or human plasma in physiological experiments or clinics, and can be used to dilute Tranexamic Acid .; Other Name: sodium chloride solution
Active Comparator: Drainage; The preoperative dose of tranexamic acid was calculated according to 20 mg / kg body weight, 100 ml of tranexamic acid sodium chloride solution was dripped 30 minutes before operation, and 30 ml saline containing 2 g tranexamic acid was applied to the local area before loosening the tourniquet.Postoperative intravenous drip of 100 ML sodium chloride solution containing 20 mg / kg tranexamic acid. Drainage tube should be placed after operation.	Other: Drainage Tube; The drainage tube drainage to guide the pus, blood and liquid accumulated between human tissues or in body cavity outside the body of High tibial osteotomy'patients.; Drug: Tranexamic Acid; Tranexamic acid (TXA) is an anti-fibrinolytic drugcan，which can increase the stability of fibrin clots and achieve hemostasis for High tibial osteotomy'patients.; Other Name: TXA; Drug: Sodium Chloride 0.9%; Sodium Chloride 0.9% is a solution of sodium chloride, which has the same osmotic pressure as animal or human plasma in physiological experiments or clinics, and can be used to dilute Tranexamic Acid .; Other Name: sodium chloride solution

Outcome Measures

Primary Outcome Measures :

1. Postoperative blood loss [ Time Frame: The third day after operation ]
   Total blood loss preoperative blood volume =(preoperative hematocrit-postoperative Hematocrit) + transfusion volume.
2. Haemoglobin [ Time Frame: The third day after operation ]
   Reactive blood loss
3. Hematocrit [ Time Frame: The third day after operation ]
   Reactive blood loss
4. Hospital for special surgery knee score [ Time Frame: postoperative 3 month ]
   HSS is a knee function scoring system with a full score of 100. 0 means the loss of knee function, 100 means the best knee function, and the greater the value, the better knee function.
5. Visual Analogue Scale Postoperative Day One [ Time Frame: Postoperative Day One ]
   Draw a 10 cm horizontal line on the paper. One end of the line is 0, indicating no pain; the other end is 10, indicating severe pain; and the middle part indicates varying degrees of pain. The patient selects a point from the horizontal line and the length from 0 to this point is the Visual Analogue Scale score.
6. Visual Analogue Scale Postoperative Day Three [ Time Frame: Postoperative Day Three ]
   Draw a 10 cm horizontal line on the paper. One end of the line is 0, indicating no pain; the other end is 10, indicating severe pain; and the middle part indicates varying degrees of pain. The patient selects a point from the horizontal line and the length from 0 to this point is the Visual Analogue Scale score.
7. Visual Analogue Scale Postoperative Day Five [ Time Frame: Postoperative Day Five ]
   Draw a 10 cm horizontal line on the paper. One end of the line is 0, indicating no pain; the other end is 10, indicating severe pain; and the middle part indicates varying degrees of pain. The patient selects a point from the horizontal line and the length from 0 to this point is the Visual Analogue Scale score.
8. Circumference of shank Postoperative Day One [ Time Frame: Postoperative Day One ]
   indirectly reflects the latent blood loss
9. Circumference of shank Postoperative Day Three [ Time Frame: Postoperative Day Three ]
   indirectly reflects the latent blood loss
10. Circumference of shank Postoperative Day Five [ Time Frame: Postoperative Day Five ]
    indirectly reflects the latent blood loss
11. Number of blood transfusions [ Time Frame: Postoperative Day Three ]
    If the hemoglobin was <80 g/l, allogeneic blood was transfused, and the number of blood transfusions were recorded.0 means no blood transfusion, and the larger the number is, the more blood transfusion.The maximum number does not exceed the total number of patients
12. Number of Incision infection [ Time Frame: postoperative 3 month ]
    The incision was red, swollen, hot and painful, and the blood routine showed that the leukocyte was increased.
13. Number of hematoma formation [ Time Frame: postoperative 3 month ]
    After operation, the incision is swollen and has wave motion, but it is not hot or painful, and there will be blood outflow during puncture.
14. Number of delayed healing of the incision. [ Time Frame: On the 14th day after operation ]
    On the 14th day after operation, the incision did not heal.
15. Volume of drainage [ Time Frame: Postoperative Day One ]
    Reactive blood loss

Secondary Outcome Measures :

1. Activated partial thromboplastin time [ Time Frame: The third day after operation ]
   Assessment of coagulation function in patients
2. Prothrombin time [ Time Frame: The third day after operation ]
   Assessment of exogenous coagulation system
3. Concentration of D-dimer [ Time Frame: The third day after operation ]
   Assessment of thrombotic diseases
4. Concentration of Fibrinogen [ Time Frame: The third day after operation ]
   Assessment of coagulation function in patients

Eligibility Criteria

• Ages Eligible for Study: Child, Adult, Older Adult
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Simple knee medial compartment osteoarthritis High tibial osteotomy.
2. With varus deformity, medial proximal tibia angle <85°
3. Unilateral High tibial osteotomy
4. informed consent: Participants must be able to understand and voluntarily sign a written informed consent and follow the research protocol and interview process

Exclusion Criteria:

1. patients who underwent other knee surgery within 6 months
2. Preoperative combined anemia (Hb<100g/l)
3. Patients with severe cardiovascular, hepatic, renal and hematopoietic diseases
4. Patient with preoperative coagulation abnormalities 5. Patients with allergies and patients allergic to TXA.

Contacts and Locations

Locations

China, Shandong

Qilu hospital of Shandong University

Jinan, Shandong, China, 250014

Sponsors and Collaborators

Qilu Hospital of Shandong University

Investigators

• Study Chair: Peilai Liu, Ph.D; Qilu Hospital of Shandong University

More Information

Publications:

Kim KI, Kim HJ, Kim GB, Bae SH. Tranexamic acid is effective for blood management in open-wedge high tibial osteotomy. Orthop Traumatol Surg Res. 2018 Nov;104(7):1003-1007. doi: 10.1016/j.otsr.2018.07.019. Epub 2018 Sep 20.

Palanisamy JV, Das S, Moon KH, Kim DH, Kim TK. Intravenous Tranexamic Acid Reduces Postoperative Blood Loss After High Tibial Osteotomy. Clin Orthop Relat Res. 2018 Nov;476(11):2148-2154. doi: 10.1097/CORR.0000000000000378.

Suh DW, Kyung BS, Han SB, Cheong K, Lee WH. Efficacy of Tranexamic Acid for Hemostasis in Patients Undergoing High Tibial Osteotomy. J Knee Surg. 2018 Jan;31(1):50-55. doi: 10.1055/s-0037-1600091. Epub 2017 Mar 29.

Zhang Q, Zhang Q, Guo W, Liu Z, Cheng L, Zhu G. No need for use of drainage after minimally invasive unicompartmental knee arthroplasty: a prospective randomized, controlled trial. Arch Orthop Trauma Surg. 2015 May;135(5):709-13. doi: 10.1007/s00402-015-2192-z. Epub 2015 Mar 8.

Huang Z, Xie X, Li L, Huang Q, Ma J, Shen B, Kraus VB, Pei F. Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial. J Bone Joint Surg Am. 2017 Dec 20;99(24):2053-2061. doi: 10.2106/JBJS.16.01525.

Chan JJ, Cirino CM, Huang HH, Poeran J, Mazumdar M, Parsons BO, Anthony SG, Galatz LM, Cagle PJ Jr. Drain Use is Associated with Increased Odds of Blood Transfusion in Total Shoulder Arthroplasty: A Population-Based Study. Clin Orthop Relat Res. 2019 Jul;477(7):1700-1711. doi: 10.1097/CORR.0000000000000728.

Legnani C, Oriani G, Parente F, Ventura A. Reducing transfusion requirements following total knee arthroplasty: effectiveness of a double infusion of tranexamic acid. Eur Rev Med Pharmacol Sci. 2019 Mar;23(5):2253-2256. doi: 10.26355/eurrev_201903_17273.

Nishitani K, Kuriyama S, Nakamura S, Ito H, Matsuda S. A Multivariate Analysis on the Effect of No Closed Suction Drain on the Length of Hospital Stay in Total Knee Arthroplasty. Knee Surg Relat Res. 2019 Mar 1;31(1):25-30. doi: 10.5792/ksrr.18.013.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Li S, Yang J, Watson C, Lu Q, Zhang M, Miao Z, Luo D, Liu P. Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a prospective randomized controlled study. Int Orthop. 2020 Jun;44(6):1037-1043. doi: 10.1007/s00264-020-04530-z. Epub 2020 Mar 14.

• Responsible Party: Qilu Hospital of Shandong University
• ClinicalTrials.gov Identifier: NCT03954860
• Other Study ID Numbers: 2019041
• First Posted: May 17, 2019
• Last Update Posted: February 19, 2020
• Last Verified: May 2019

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No
• Plan Description: The datasets used and/or analysed during the current study are available from the overall study officials on reasonable request.

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

Osteoarthritis, Knee; Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Tranexamic Acid; Antifibrinolytic Agents; Fibrin Modulating Agents; Molecular Mechanisms of Pharmacological Action; Hemostatics; Coagulants