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Development and validation of a nomogram for predicting the risk of immediate postoperative deep vein thrombosis after open wedge high tibial osteotomy

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to identify independent risk factors for immediate postoperative deep vein thrombosis (DVT) in patients with open wedge high tibial osteotomy (OWHTO) and to develop and validate a predictive nomogram.

Methods

Patients who underwent OWHTO for knee osteoarthritis (KOA) from June 2017 to December 2021 were retrospectively analyzed. Baseline data and laboratory test results were collected, and the occurrence of DVT in the immediate postoperative period was regarded as the study outcome event. Multivariable logistic regression identified independent risk factors associated with a higher incidence of immediate postoperative DVT. The predictive nomogram was constructed based on the analysis results. The stability of the model was further assessed in this study using patients from January to September 2022 as an external validation set.

Results

741 patients were enrolled in the study, of which 547 were used in the training cohort and the other 194 for the validation cohort. Multivariate analysis revealed a higher Kellgren–Lawrence (K–L) grade (III vs. I–II OR 3.09, 95% CI 0.93–10.23. IV vs. I–II OR 5.23, 95% CI 1.27–21.48.), platelet to hemoglobin ratio (PHR) > 2.25 (OR 6.10, 95% CI 2.43–15.33), Low levels of albumin (ALB) (OR 0.79, 95% CI 0.70–0.90), LDL-C > 3.40 (OR 3.06, 95% CI 1.22–7.65), d-dimer > 1.26 (OR 2.83, 95% CI 1.16–6.87) and BMI ≥ 28 (OR 2.57, 95% CI 1.02–6.50) were the independent risk factors of immediate postoperative DVT. The concordance index (C-index) and Brier score of the nomogram were 0.832 and 0.036 in the training set, and the corrected values after internal validation were 0.795 and 0.038, respectively. The receiver-operating characteristic (ROC) curve, the calibration curve, the Hosmer–Lemeshow test, and the decision curve analysis (DCA) performed well in both the training and validation cohorts.

Conclusion

This study developed a personalized predictive nomogram with six predictors, which allows surgeons to stratify risk and recommended immediate ultrasound scans for patients with any of these factors.

Level of evidence

III.

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Data availability

All data in this study can be obtained from the authors based on reasonable demand.

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Acknowledgements

We sincerely thank all the patients in this study.

Funding

The research was supported by the Hebei Department of Science and Technology High-Level Talent Team Construction Project (No. 225A7703D) and the Hebei Provincial Key Research and Development Program (No. 192777113D).

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Authors and Affiliations

  1. Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Haichuan Guo, Tianyu Wang, Chengsi Li, Jiahao Yu, Ruoxuan Zhu, Maolin Wang, Yanbin Zhu & Juan Wang

  2. Orthopedic Research Institute of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Yanbin Zhu & Juan Wang

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  1. Haichuan Guo
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Contributions

JW designed the study; HCG, RXZ, and MLW searched for relevant studies and abstracted the data; TYW, CSL, and JHY analyzed and interpreted the data; HCG wrote the manuscript, and JW and YBZ approved the final version of the manuscript. All authors reviewed the manuscript before submitting it.

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Correspondence to Yanbin Zhu or Juan Wang.

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This study was accepted by our institutional ethics committee.

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Guo, H., Wang, T., Li, C. et al. Development and validation of a nomogram for predicting the risk of immediate postoperative deep vein thrombosis after open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 31, 4724–4734 (2023). https://doi.org/10.1007/s00167-023-07488-8

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