Bone Wax Is Effective in Reducing Blood Loss After Total Knee Arthroplasty

Moo, Ing How; Chen, Jerry; Pagkaliwaga, Eric H.; Tan, See Wei; Poon, Kein Boon

doi:10.1016/j.arth.2016.12.028

Cited by 31 publications

(51 citation statements)

References 19 publications

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“…The modalities to reduce the intra-articular blood loss that should be considered include increasing the dose, as well as altering the delivery method (IV vs. topical) of TXA, and the application of bone wax to seal exposed areas of cancellous bone not covered by the implant as has been shown to be effective in cemented TKA. 31 Our study has several limitations. It is possible that the relatively small number of knees in our study (78 cemented, 76 cementless) limited the variability of our observations.…”

Section: Discussionmentioning

confidence: 91%

Greater Blood Loss in Contemporary Cementless Total Knee Arthroplasty than Cemented Total Knee Arthroplasty despite Tranexamic Acid Use: A Match-Controlled Retrospective Study

et al. 2019

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The purpose of this retrospective study was to assess whether tranexamic acid (TXA) reduces blood loss in cementless total knee arthroplasty (TKA) comparable to levels observed with cemented fixation. After exclusions from 109 consecutive TKAs, 76 cementless knees were matched to 78 cemented knees of identical implant and surgeon. Blood loss with and without TXA was compared. There was no difference between cohorts in sex, age, body mass index, American Society of Anesthesiologists Physical Status classification, or preoperative hemoglobin (p ≥ 0.119). Use of TXA reduced median drain output by only 205 mL in cementless knees compared to 470 mL in cemented knees (p < 0.001). Median drain output per hour was highest in cementless knees without TXA (39.5 mL) followed by cemented knees without TXA (38.2 mL), cementless knees with TXA (28.5 mL), and cemented knees with TXA (12.7 mL; p < 0.001). Hemoglobin drop and total blood loss did not differ between cohorts regardless of TXA use. Cementless fixation in TKA resulted in greater intra-articular blood loss as measured by drain output, despite the use of TXA. Further research is warranted to examine whether a higher TXA dose, TXA delivery method, or the application of bone wax sealant would mitigate blood loss in cementless TKA, and subsequently whether intra-articular blood accumulation resulting in postoperative hemarthrosis affects recovery, function, and clinical outcomes.

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Section: Discussionmentioning

confidence: 91%

Greater Blood Loss in Contemporary Cementless Total Knee Arthroplasty than Cemented Total Knee Arthroplasty despite Tranexamic Acid Use: A Match-Controlled Retrospective Study

et al. 2019

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“…It consists of a mixture of beeswax, paraffin and isopropyl palmitate[138]. Although its use in elective orthopaedic surgery hasn’t been well-demonstrated, Moo et al[139] suggest bone wax’s application in TKA for reducing total blood loss and maintaining higher hemoglobin levels.…”

Section: Intra-operativementioning

confidence: 99%

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Themistoklis¹,

Vogiatzaki²,

Kazakos³

et al. 2017

WJO

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Total knee replacement (TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions (ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.

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“…After discarding at title or abstract level, 11 studies met the prespecified inclusion criteria for further analysis. Finally, a total of eight randomized controlled trials [6][7][8][9][10][11][12][13] were finally included in the meta-analysis (►Fig. 1).…”

Section: Search Resultsmentioning

confidence: 99%

“…Another important issue is the complications with the use of autologous bone plugs. Four studies [9][10][11][12] reported the incidence of infection, deep vein thrombosis, redness of incision, and hematoma. Our results demonstrated that the sealed group decreased the rate of hematoma than control group.…”

Section: Discussionmentioning

confidence: 99%

“…In a prospective randomized controlled trial (RCT) that included 100 patients undergoing TKA, Moo et al 9 demonstrated that the drop in serum Hb levels and total blood loss in sealed group were significantly lower than the control groups. On the other hand, Torres-Claramunt et al 10 reported no statistical differences were obtained with regard to blood drainage at 12 and 24 hours, the Hb value decreases at 72 hours and the number of blood transfusions between bone graft sealing and control groups.…”

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confidence: 99%

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Sealing the Intramedullary Femoral Canal for Blood Loss in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials

Wang

Yuan

et al. 2019

J Knee Surg

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Blood loss after total knee arthroplasty (TKA) is a potentially serious medical problem since it leads to anemia, increased need for transfusion, and prolonged hospitalization. Some studies have reported that sealing of the intramedullary femoral canal during TKA may decrease postoperative blood loss. The purpose of this study is to determine the effects of sealing of the intramedullary femoral canal during TKA on blood loss and transfusion rate. Electronic databases, PubMed, EMBASE, the Cochrane Library, Web of Science, and Chinese Biomedical Database, were systematically searched. Only randomized controlled trials (RCTs) that compared the sealing group with the control group during TKA were included up to March 2019. Two reviewers independently extracted data and assessed the quality of included studies. The statistical analysis was performed by using Review Manager 5.3 software. Cochrane Risk of Bias tool was used for quality assessment. Overall, eight RCTs involving 996 patients met our criteria and were analyzed. The results of meta-analysis showed that patients in the sealed group had less total blood loss, less total drain output and less hidden blood loss, less transfusion rates, a lower drop of hemoglobin level at day 1 postoperatively, and less hematoma than the control group. On the other hand, there were no significant differences in infection, deep vein thrombosis, and redness of incision between sealed and control group. Current meta-analysis found that sealing the femoral canal during TKA was an effective method for the control of blood loss.

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Bone Wax Is Effective in Reducing Blood Loss After Total Knee Arthroplasty

Cited by 31 publications

References 19 publications

Greater Blood Loss in Contemporary Cementless Total Knee Arthroplasty than Cemented Total Knee Arthroplasty despite Tranexamic Acid Use: A Match-Controlled Retrospective Study

Greater Blood Loss in Contemporary Cementless Total Knee Arthroplasty than Cemented Total Knee Arthroplasty despite Tranexamic Acid Use: A Match-Controlled Retrospective Study

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Sealing the Intramedullary Femoral Canal for Blood Loss in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials

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