Hemostatic matrix effects on blood loss after total knee arthroplasty: A randomized controlled trial

Abstract

Background:Total knee arthroplasty (TKA) can result in major postoperative blood loss which can impact on the recovery and rehabilitation of patients. It also requires expensive transfusions. The purpose of the study was to investigate whether a hemostatic matrix, composed of cross-linked gelatin and a thrombin solution, would reduce blood loss in patients following TKA.Materials and Methods:This was a prospective, randomized, controlled study (Trial registration: Hospital S. Salvatore L’Aquila ADJ00843) conducted in 93 patients. Criteria for participation were unilateral TKA for osteoarthritis, and a preoperative hemoglobin level >13 g/dL. The outcomes measured were postoperative hemoglobin and hematocrit levels measured at 24h, 72 h, and 7 days. The mean total postoperative blood loss was calculated from drainage volume, patient blood volume, hematocrit, and red blood cell volume. In addition, the drain output within 24 h following surgery and any transfusion requirements were determined.Results:Hemostatic matrix-treated patients (n = 51) showed significant reductions in calculated postoperative blood loss of 32.3% and 28.7% versus control in men and women, respectively (P < 0.01). Postoperative blood loss after 24 h in drain was significantly less with the hemostatic matrix versus control, as were decreases in hemoglobin levels 7 days post-surgery (each P < 0.01). Three patients in the control group required blood transfusion, whereas no blood transfusions were necessary in the hemostatic matrix group.Conclusion:The use of a hemostatic matrix provides a safe and effective means to reduce blood loss and blood transfusion requirements in TKA.

Thrombin-Based Hemostatic Agent in Primary Total Knee Arthroplasty

“…No additional studies were obtained after the reference review. Finally, four independent RCTs 11,13,15,16 were eligible for data extraction and meta-analysis, as indicated by the flowchart in ►Fig. 1.…”

“…In each study, Floseal was administered intra-articularly before suturing, though the dosages varied (5-10 mL). Three studies 11,13,16 reported a transfusion trigger. Cemented prostheses were reported in three studies, 11,15,16 while the remaining study incorporated uncemented prostheses.…”

“…The quality of the included studies according to the Cochrane Handbook for Systematic Review of Interventions is reported in ►Table 2. Three of the four included studies 13,15,16 described computer-generated random numbers and adequate concealment of allocation, and two studies employed 15,16 a double-blind method (participants and personnel blinding). All the included studies did not have an unclear bias due to incomplete outcome data or selective outcome reporting.…”

Efficacy, Security, and Manageability of Gelified Hemostatic Matrix in Bleeding Control during Thoracic and Lumbar Spine Surgery: FloSeal versus Surgiflo

“…This prospective study compares and evaluates two hemostatic gel matrixes: FloSeal (Baxter Healthcare, Deerfield, Illinois, United States) and Surgiflo (Ethicon, Somerville, New Jersey, United States) for hemostatic control during spine surgery. Many different studies have been published about the efficacy of those agents during general and vascular surgery procedures [6][7][8][9][10][11][12][13][14][15][16][17][18] and their eventual complications. [19][20][21] For neurosurgical procedures, only studies that evaluate their efficacy during both brain and spine surgery have been published.…”

Continuous intraarticular and periarticular levobupivacaine for management of pain relief after total knee arthroplasty: A prospective randomized, double-blind pilot study

“…Second, our recent study suggests that the use of hemostatic matrix in TKA not only reduces blood loss by drainage suction, but also by extravasation of blood into the tissues, and for this reason we decided to clamp the drainage for the first 3 h, allowing us to minimize the loss of local anesthetic. 6 The potential benefits of effective hemostasis using hemostatic matrix include a decrease of total blood loss while maintaining higher hemoglobin levels reducing the rate of blood transfusion, faster functional rehabilitation, and lower rates of wound infection and finally decreasing the cost of each patient. 4,10 Also, it is not recommended not to use the drain, because it increases the hemarthrosis, joint stiffness, and infection.…”