Is fibrin sealant effective and safe in total knee arthroplasty? A meta-analysis of randomized trials

Wang, Hongsheng; Shan, Liancheng; Zeng, Hui; Sun, Mengxiong; Hua, Yingqi; Cai, Zhengdong

doi:10.1186/1749-799x-9-36

Cited by 33 publications

(24 citation statements)

References 26 publications

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“…Hb decrease can be associated with medical short-and long-term complications and numerous strategies were developed to reduce blood loss during TKA. 2,[4][5][6][7][8][9][10][11][12] Violation of the medullary canal may increase the risk of perioperative blood loss and embolization of medullary content. PSI overcomes this need, making reasonable to expect a reduction in blood loss.…”

Section: Discussionmentioning

confidence: 99%

Patient-Specific Instrumentation Affects Perioperative Blood Loss in Total Knee Arthroplasty

et al. 2018

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Patient-specific instrumentation (PSI) may contribute to reduced blood loss related to total knee arthroplasty (TKA). The purpose of this study was to compare the estimated hemoglobin (Hb) and red blood cell volume (RBC) losses in two groups of patients undergoing TKA with PSI and conventional instrumentation. Pre- and postoperative blood samples were collected from 22 patients randomly assigned to receive a PSI-assisted or conventional TKA. Post- to preoperative Hb difference was calculated and RBC loss was estimated according to Sehat et al. A significant difference in Hb reduction in favor of the PSI group was registered on the last day of stay ( = 0.0084) and significant treatment effect ( = 0.027) on Hb reduction after intervention was found with a regression model for longitudinal measurements. This study demonstrated that PSI leads to a significant trend in earlier Hb regain. These promising results suggest a beneficial effect of PSI in blood loss reduction.

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Section: Discussionmentioning

confidence: 99%

Patient-Specific Instrumentation Affects Perioperative Blood Loss in Total Knee Arthroplasty

et al. 2018

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“…Many studies have proved their efficacy without increasing the risk of DVT, PE, hematoma, wound infection or other complications for patients undergoing TKA[101,102]. However, their main disadvantage is the high cost compared to other blood management methods (like TXA)[103,104].…”

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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“…Clinically, fibrinogen is applied together with thrombin as fibrin hydrogels that are used as biological adhesives [15]. Beyond their well-known haemostatic and sealant properties, alternative applications in tissue engineering have been tested, combining fibrin with ceramics, cells or other proteins [16e20].…”

Section: Introductionmentioning

confidence: 99%

Fibrinogen scaffolds with immunomodulatory properties promote in vivo bone regeneration

et al. 2016

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The hypothesis behind this work is that fibrinogen (Fg), classically considered a pro-inflammatory protein, can promote bone repair/regeneration. Injury and biomaterial implantation naturally lead to an inflammatory response, which should be under control, but not necessarily minimized. Herein, porous scaffolds entirely constituted of Fg (Fg-3D) were implanted in a femoral rat bone defect and investigated at two important time points, addressing the bone regenerative process and the local and systemic immune responses, both crucial to elucidate the mechanisms of tissue remodelling. Fg-3D led to early infiltration of granulation tissue (6 days post-implantation), followed by bone defect closure, including periosteum repair (8 weeks post-injury). In the acute inflammatory phase (6 days) local gene expression analysis revealed significant increases of pro-inflammatory cytokines IL-6 and IL-8, when compared with non-operated animals. This correlated with modified proportions of systemic immune cell populations, namely increased T cells and decreased B, NK and NKT lymphocytes and myeloid cell, including the Mac-1+ (CD18+/CD11b+) subpopulation. At 8 weeks, Fg-3D led to decreased plasma levels of IL-1β and increased TGF-β1. Thus, our data supports the hypothesis, establishing a link between bone repair induced by Fg-3D and the immune response. In this sense, Fg-3D scaffolds may be considered immunomodulatory biomaterials.

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Is fibrin sealant effective and safe in total knee arthroplasty? A meta-analysis of randomized trials

Cited by 33 publications

References 26 publications

Patient-Specific Instrumentation Affects Perioperative Blood Loss in Total Knee Arthroplasty

Patient-Specific Instrumentation Affects Perioperative Blood Loss in Total Knee Arthroplasty

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

Fibrinogen scaffolds with immunomodulatory properties promote in vivo bone regeneration

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