Comparison of three methods for sealing of the intramedullary femoral canal during total knee arthroplasty; a randomized controlled trial

Dikmen, İsmail; Köse, Özkan; Cakar, Albert; Taşatan, Ersin; Ertan, Mehmet Baris; Yapar, Dilek

doi:10.1007/s00402-022-04596-x

Cited by 3 publications

(6 citation statements)

References 26 publications

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“…In our review of previous similar articles, we found that the ndings of Li X et al [7] were similar to the present experiment, with signi cant differences in total and hidden blood loss between the two groups of patients. Dikmen İ et al [4] also illustrated a difference in total blood loss between the empty tube and bone cement groups. The bone cement blocking of the femoral medullary canal in this experiment did reduce blood loss, probably because more gaps remained around the block after it was blocked.…”

Section: Discussionmentioning

confidence: 94%

“…There are also inconsistent results in terms of transfusion rates and drainage in previous articles, with [3][4][5], which may be related to whether tranexamic acid was used intraoperatively. Tranexamic acid reduces bleeding and transfusion requirements in the perioperative period [23,24].The transfusion rate in the study by Dikmen İ et al [4] was partly due to a decrease in the use of tranexamic acid.In addition,there is a difference in the results of drainage ow between Dikmen İ et al and Batmaz AG et al [3,5]. We compared them and found that the time of drainage tube removal was different, and since drainage ow increases with time, it is closely related to the time of removal and also to the use of perioperative anticoagulants [25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Batmaz et al found that sealing the intramedullary canal with autologous bone graft reduced postoperative blood loss [3]. İsmail Dikmen found the same effect with bone cement, but in his study he found that sealing the canal with autologous bone had no effect on blood loss [4], while other authors have concluded that none of these methods reduced postoperative blood loss [5]. in addition to the con icting results on postoperative drainage and transfusion rates in related articles [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Effect of bone cement sealing of the intramedullary femoral canal on coagulation status after total knee arthroplasty: a retrospective thromboelastography study

Wang

Zhang

Sun

et al. 2023

Preprint

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Background: The main objective of this study was to investigate whether the use of bone cement in total knee arthroplasty (TKA) has an effect on postoperative coagulation status and bleeding METHODS: 148 patients who underwent unilateral TKA between September 2019 and February 2023 were collected and divided into Bone and Cement&Bone groups according to whether bone cement was used to seal the bone medullary canal intraoperatively. Routine blood and thromboelastography(TEG) examinations were performed on the day before, the first day and the seventh day after surgery; postoperative bleeding, drainage, transfusion rate and the number of people suffering from deep venous thrombosis (DVT) were recorded. RESULTS: There were no significant differences between the two groups in terms of baseline clinical characteristics before surgery（p>0.05）。In terms of TEG indicators, the CI of the Bone&Cement group was lower than that of the Bone group on the first postoperative day and on the seventh postoperative day (p<0.005). The CI of patients in the Bone group on the first postoperative day was lower than that of the preoperative day (p<0.05); In terms of blood loss, the total blood loss and occult blood loss were lower in the Bone&Cement group than in the Bone group (p< 0.05). In addition, there was no significant difference in the incidence of postoperative drainage (p:0.255), transfusion rate (p:0.286) and DVT (p:0.576) between the two groups CONCLUSION: Blocking the intramedullary canal of the femur with bone cement during TKA improves relative postoperative hypocoagulation and reduces postoperative blood loss, although there is no significant effect on transfusion rates, drainage and DVT, but the use of bone cement is clinically beneficial to patients. TRIAL REGISTRATION: ChiCTR2100051502, 2021/09/24

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of bone cement sealing of the intramedullary femoral canal on coagulation status after total knee arthroplasty: a retrospective thromboelastography study

Wang

Zhang

Sun

et al. 2023

Preprint

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“…In our review of previous similar articles, we found that the findings of Li et al [ 7 ] were similar to the present experiment, with significant differences in total and hidden blood loss between the two groups of patients. Dikmen et al [ 4 ] also illustrated a difference in total blood loss between the empty tube and bone cement groups. The bone cement blocking of the femoral medullary canal in this experiment did reduce blood loss, probably because more gaps remained around the block after it was blocked.…”

Section: Discussionmentioning

confidence: 99%

“…Batmaz et al found that sealing the intramedullary canal with autologous bone graft reduced postoperative blood loss [ 3 ]. İsmail Dikmen found the same effect with bone cement, but in his study he found that sealing the canal with autologous bone had no effect on blood loss [ 4 ], while other authors have concluded that none of these methods reduced postoperative blood loss [ 5 ] in addition to the conflicting results on postoperative drainage and transfusion rates in related articles [ 4 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of bone cement sealing of the intramedullary femoral canal on coagulation status after total knee arthroplasty: a retrospective thromboelastography study

Chen,

Zhang,

Wang

et al. 2023

J Orthop Surg Res

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Background The main objective of this study was to investigate whether the use of bone cement in total knee arthroplasty (TKA) has an effect on postoperative coagulation status and bleeding. Methods 153 patients who underwent unilateral TKA between September 2019 and February 2023 were collected and divided into Bone and Cement&Bone groups according to whether bone cement was used to seal the bone medullary canal intraoperatively. Routine blood and thromboelastography (TEG) examinations were performed on the day before, the first day and the seventh day after surgery; postoperative bleeding, drainage, transfusion rate and the number of people suffering from deep venous thrombosis (DVT) were recorded. Results There were no significant differences between the two groups in terms of baseline clinical characteristics before surgery (P > 0.05). In terms of TEG indicators, the coagulation index (CI) of the Bone&Cement group was lower than that of the Bone group on the first postoperative day and on the seventh postoperative day (P < 0.05). The CI of patients in the Bone group on the first postoperative day was lower than that of the preoperative day (P < 0.05); in terms of blood loss, the total blood loss and occult blood loss were lower in the Bone&Cement group than in the Bone group (P < 0.05). In addition, there was no significant difference in postoperative drainage,transfusion rate and the incidence of DVT between the two groups. Conclusion Blocking the intramedullary canal of the femur with bone cement during TKA improves relative postoperative hypocoagulation and reduces postoperative blood loss, although there is no significant effect on transfusion rates, drainage and DVT.

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Efficacy and Safety of Bone Wax Application at Different Time Points to Reduce Postoperative Blood Loss in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Ye,

Gan,

et al. 2024

Orthopaedic Surgery

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ObjectiveIn addition to the surface hemorrhage of cancellous bone after large‐area osteotomy, the intramedullary hemorrhage after the reamed knee joint is also a major cause of postoperative bleeding after total knee arthroplasty (TKA). This study evaluated the efficacy and safety of bone wax application at different time points of prone hemorrhage to reduce perioperative blood loss.MethodsFrom August 2023 to December 2023, 150 patients undergoing primary unilateral TKA were included in this prospective, randomized controlled trial, patients were randomly divided into three groups: group A, after autogenous osteotomy plug was used to fill the femoral medullary cavity, the residual space was sealed with bone wax and the exposed cancellous bone surface around the prosthesis was coated with bone wax after the prosthesis adhesion; group B, only the exposed cancellous bone surface around the prosthesis was coated with bone wax; and group C, no bone wax was used. The primary outcome was total perioperative blood loss. Secondary outcomes included occult blood loss, postoperative hemoglobin reduction, blood transfusion rate, lower limb diameter, and knee function, while length of hospital stay was recorded. Tertiary outcomes included the incidence of postoperative related adverse events.ResultsThe total blood loss in group A (551.5 ± 224.5 mL) and group B (656.3 ± 267.7 mL) was significantly lower than that in group C (755.3 ± 248.3 ml, p < 0.001), and the total blood loss in group A was also lower than that in group B (p < 0.05). There were also significant differences in the reduction of hemoglobin level and hidden blood loss among the three groups (p < 0.05). However, there was no significant improvement in postoperative lower limb swelling, knee joint activity and hospitalization time; there was no significant difference in the incidence of complications such as thromboembolism.ConclusionThe use of bone wax in TKA can safely and effectively reduce perioperative blood loss and hemoglobin drop rate, and multiple use at time points during the operation when blood loss is prone to occur can produce more significant hemostatic effect.

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Comparison of three methods for sealing of the intramedullary femoral canal during total knee arthroplasty; a randomized controlled trial

Cited by 3 publications

References 26 publications

Effect of bone cement sealing of the intramedullary femoral canal on coagulation status after total knee arthroplasty: a retrospective thromboelastography study

Effect of bone cement sealing of the intramedullary femoral canal on coagulation status after total knee arthroplasty: a retrospective thromboelastography study

Effect of bone cement sealing of the intramedullary femoral canal on coagulation status after total knee arthroplasty: a retrospective thromboelastography study

Efficacy and Safety of Bone Wax Application at Different Time Points to Reduce Postoperative Blood Loss in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

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