Incidence of and risk factors for deep vein thrombosis in patients undergoing osteotomies around the knee: comparative analysis of different osteotomy types

Abstract

Purpose: To examine the incidence of and risk factors for deep vein thrombosis (DVT) among different types of osteotomies around the knee. It was hypothesized that DVT would be detected at a substantial rate after the osteotomy, and there would be differences in the incidences among the different osteotomy procedures.

Methods: Consecutive patients who underwent knee osteotomies for varus osteoarthritis and met the inclusion criteria were included in the study. Ultrasonographic evaluation was performed to detect DVT on bilateral whole leg at 1 month before and 7 days after surgery. Statistical comparison of the demographic and clinical parameters between the patients with and without DVT as well as multivariate analysis using logistic regression was conducted to identify risk factors related to the incidence of postoperative DVT.

Results: The study subjects comprised 159 knees in 135 patients with medial opening wedge high tibial osteotomy (MOW-HTO), 93 knees in 78 patients with lateral closed wedge high tibial osteotomy (LCW-HTO), and 74 knees in 54 patients with double level osteotomy (DLO). In the postoperative evaluation, DVT was detected in 19 of 159 knees (11.9%) in MOW-HTO, 21 of 93 knees (22.6%) in LCW-HTO, and 5 of 74 knees (6.8%) in DLO. The incidence of DVT was significantly higher after LCW-HTO than after MOW-HTO and DLO (p < 0.01). DVT at a level above the knee was noted in one case after MOW-HTO, while DVT in the remaining cases developed at a level below the knee. No cases of symptomatic pulmonary embolism were encountered during the study period. Among the potential risk factors assessed for correlation with the incidence of DVT, LCW-HTO was identified as a significant risk factor (odds ratio: 2.54; 95% CI 1.334-4.836; p < 0.01).

Conclusions: This study demonstrated that DVT occurred at a substantial rate (overall incidence of 13.8%) after osteotomy around the knee even with the use of prophylactic anticoagulant. Among the different osteotomy types, the DVT rate was significantly higher after LCW-HTO than after MOW-HTO and DLO.

Level of evidence: Prospectively designed observational cohort study, Level III.

Keywords: Deep vein thrombosis (DVT); Knee; Osteotomy.