Purpose: Postoperative hemorrhage in high tibial osteotomy (HTO) may elevate compartment pressure significantly. The amount of hemorrhage was prospectively measured to investigate the safety of current surgical procedure. Methods: Forty-two consecutive patients who had 47 early primary knee osteoarthritis with varus deformity were treated by Maquet dome osteotomy with staple and long leg cast stabilization. Postoperatively, hemorrhage in the osteotomy site was drained and recorded for 3 days. Results: The average amount at first 24 hours was 247 ± 87 ml and at next 24 hours, 33 ± 13 ml; 48-72 hours, 12 ± 7 ml (p < 0.001). There was no peroneal nerve palsy or clinical compartment syndrome noted. Conclusion: Within postoperative 24 hours, there is a highest risk to elevate compartment pressure due to a large amount of bleeding. The drain therefore should be inserted to lower compartment pressure. The drain may be safely removed after 24 hours.
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