The Application Of Drainage Tube In High Tibial Osteotomy:a Prospective Randomized Controlled Study

BackgroundHigh tibial osteotomy(HTO)has become an effective method for the treatment of knee single compartment osteoarthritis with varus deformity.Compared with total knee arthroplasty,HTO retains the original joint structure and aims to transfer the force line of the lower limb from the medial compartment of the knee to the lateral compartment by osteotomy at the proximal of the tibial.By correcting the weight-bearing line of the knee joint,HTO can prevent further wear and tear of cartilage,reduce pain and improve the function of the knee joint,to avoid or postpone joint replacement as much as possible.In 1958,Jackson first reported HTO in the treatment of knee osteoarthritis with varus deformity.Since then,with the continuous improvement of surgical techniques and internal fixation devices,the incidence of complications has gradually decreased,and the surgical effect has been more and more affirmed.Tranexamic acid(TXA)is a plasminogen inhibitor,which can strongly adsorb to the exposed plasminogen lysine binding site on the wound surface,making it saturated,thus breaking the effective binding of plasminogen with fibrin-containing lysine residues.Fibrin can not be degraded,so as to achieve the purpose of hemostasis.Previous studies have found that intravenous and topical administration of TXA can reduce bleeding after HTO.Gelatin sponge is a kind of absorbable hemostatic material,which has water absorption and can inhale blood several times its own weight,and achieve the purpose of hemostasis through its coagulation in the sponge,which is widely used in HTO.The main function of the drainage tube is to drain the fluid gathered in the cavity of the human body,so it can reduce the formation of wound hematoma and incision complications,but with the improvement of minimally invasive surgical techniques and the administration of TXA,the use of drainage tube in total knee arthroplasty(TKA),total hip arthroplasty(THA),unicompartmental knee arthroplasty(UKA),and spinal surgery is controversial.Some scholars think that the placement of drainage tube will increase the postoperative blood loss of patients and it is not conducive to the early recovery of patients after the operation and may become the source of postoperative bacterial infection.The placement of drainage tube after HTO is a routine operation,but there are few studies on it.ObjectiveThe purpose of this study was to evaluate the effect of drainage after HTO on postoperative blood loss,the incidence of complications and early functional exercise of the affected limb.In view of the following points,we assume that it is necessary to place a drainage tube after HTO:1.Relieve postoperative swelling and pain;2.It is beneficial to the early functional recovery;3.It will not increase the total blood loss after the operation.MethodsA randomized parallel controlled study was conducted in 90 patients with knee osteoarthritis who underwent HTO in the same hospital from 2018.12 to 2020.6.They were randomly divided into drainage group(n;=45)and control group(n=45).The same type of drainage tube was placed on the inside of the osteotomy in the drainage group,while no drainage tube was placed in the control group.The following data were recorded:general population,distraction angle,operation time,length of hospital stay,total blood loss,amount of drainage and dressing infiltration on the first day after the operation,hemoglobin,number of cases,and volume of blood transfusion on the 3rd day after the operation,visual analogue scale(VAS)and the thickest circumference of the crus on the 1 st,3rd and 5th day after operation,knee joint range of motion(ROM)on the 3rd day after the operation,incision infection,incision hematoma,delayed wound healing and other complications.VAS and Hospital for special surgery(HSS)knee joint score were also recorded during follow-up 3 months after surgery.ResultsA total of 82 patients were followed up,41 cases in the drainage group and 41 cases in the control group.The follow-up time was(3-5)months,with an average of(3.3±0.2)months.There was no significant difference in perioperative general condition between the two groups(p>0.05).The average postoperative blood loss in the drainage tube group was higher than that in the control group,but there was no significant difference between the two groups(p>0.05).There was no blood transfusion in both groups.There was no significant difference in hemoglobin and hematocrit between the two groups on the third day after operation(p>0.05).In terms of postoperative pain,the VAS of the drainage group was lower than that of the control group on the first day,the third day and the fifth day after operation,and the difference was statistically significant(p<0.05).The pain in both groups was the most severe on the first day after operation and gradually relieved on the third and fifth day after operation.At the 3rd month after operation,there was no significant difference in VAS between the two groups(p>0.05).In terms of postoperative crus circumference,the thickest crus circumference of the drainage group was smaller than that of the control group on the first day,the third day and the fifth day after operation,and the difference was statistically significant(p<0.05).The ROM of knee joint in the drainage group was higher than that in the control group on the third day after operation,and the difference was statistically significant(p<0.05).At the third month after operation,there was no significant difference in HSS knee joint score between the two groups(p>0.05).There were 6 cases of incision complications in the control group,including 5 cases of delayed healing and 1 case of subcutaneous hematoma.Delayed healing of incision occurred in 1 case in drainage group.There was significant difference between the two groups(p<0.05).Within 24 hours after operation,there were 8 cases of dressing infiltration in the control group and only 2 case in the drainage tube group,the difference was statistically significant(p<0.05).ConclusionThis study shows that the absence of drainage tube after HTO will significantly increase the postoperative crus swelling and pain,increase the incidence of incision complications,which is not conducive to the early functional exercise of patients.Moreover,due to the use of TXA and gelatin sponge,the placement of drainage tube did not increase the total blood loss after HTO.Therefore,we believe that it is necessary to place a drainage tube after HTO.