Sealing of the intramedullar femoral canal in a TKA does not reduce postoperative blood loss: A randomized prospective study

Torres-Claramunt, Raúl; Hinarejos, Pedro; Pérez-Prieto, Daniel; Gil-Gónzalez, Sergi; Pelfort, Xavier; Leal, Joan; Puig, Lluís

doi:10.1016/j.knee.2014.03.010

Cited by 15 publications

(28 citation statements)

References 24 publications

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“…None of the previous studies referred to the effect of sealing the femoral hole on HBL in TKA. [5,6,15] In the present studies, sealing the femoral hole significantly decreased HBL (511.4 mL vs 703.7 mL, P < .05).…”

Section: Discussionsupporting

confidence: 47%

Effects of sealing the intramedullary femoral canal in total knee arthroplasty

Han³

et al. 2017

Medicine

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Background:This study investigates the clinical effects of sealing the femoral canal by intramedullary alignment instrumentation in total knee arthroplasty (TKA).Methods:One hundred twenty consecutive patients with knee osteoarthritis, who underwent unilateral TKA, were enrolled in the study and equally randomized into 2 groups: the sealing group and the control group. In the sealing group, the femoral canal was sealed with autogenous bone and cement using intramedullary alignment instrumentation, while the femoral hole was left open for patients in the control group. Blood loss, hemoglobin (Hb) reduction, and other parameters were recorded, as well as the duration of hospital stay and complications. The Hospital for Special Surgery (HSS) knee score was used to assess knee function at the final follow-up appointment.Results:The calculated blood loss, hidden blood loss, transfusion requirements, drainage volume, and Hb reduction measurements were significantly different (P < .05) between the 2 groups. There were no significant differences in the surgery time, intraoperative blood loss, length of hospital stay, HSS score or complications between the 2 groups (P > .05).Conclusions:Sealing the intramedullary canal with autologous bone and a cement plug is an effective method for reducing blood loss and decreasing blood transfusion requirements during TKA procedures that have increasing complication rates.

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Section: Discussionsupporting

confidence: 47%

Effects of sealing the intramedullary femoral canal in total knee arthroplasty

Han³

et al. 2017

Medicine

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“…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. Protzman et al 14 also found that the drop in serum Hb levels and the percentage of blood transfusions were similar for the sealed and unsealed patients following unilateral TKA.…”

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confidence: 91%

“…the femoral canal to the joint space, resulting in a significant increase in postoperative blood loss and blood transfusion rate. Thus, some surgeons seal the femoral hole in TKA intramedullary alignment and some studies [6][7][8][9][10][11][12][13] have reported that sealing the femoral hole in TKA can prevent hemoglobin (Hb) reduction, postoperative drainage, or blood transfusions.…”

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confidence: 99%

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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“…Total knee arthroplasty (TKA) can result in significant blood loss [1, 2]. One study estimated the average blood loos in TKA to be 1500 mL [3].…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, several studies comparing ABTD and CSD have reported conflicting outcomes [1, 22–24]. Whether the benefits of ABTD are limited to the reduction of the blood transfusion rate is unclear.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of autologous blood transfusion drainage in patients undergoing total knee arthroplasty: a meta-analysis of 16 randomized controlled trials

Pan

Hong

Xie

et al. 2016

BMC Musculoskelet Disord

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BackgroundAutologous blood transfusion drainage (ABTD) has been used for many years to reduce blood loss in total knee arthroplasty (TKA). We evaluate the current evidence concerning the efficiency and safety of ABTD used in TKA compared with conventional suction drainage (CSD).MethodsWe performed a systematic literature search of the PubMed, Embase, Cochrane Library and four Chinese databases. All randomized controlled trials (RCTs) that compared the effects of ABTD versus CSD in TKA were included in the meta-analysis.ResultsSixteen RCTs involving 1534 patients who compared the effects of ABTD versus CSD were included. Five of the RCTs were performed in Asia, ten in Europe, and one in North America. Patients in the ABTD group had a lower blood transfusion rate (OR: 0.25 [0.13, 0.47]; Z = 4.27, P < 0.0001) and fewer units transfused per patient (WMD: −0.68 [−0.98, −0.39]; Z = 4. 52, P < 0.00001) than did patients in the CSD group. Wound complications, deep vein thrombosis, febrile complications, post-operative hemoglobin days 5–8, drainage volume, and length of hospital stay did not differ significantly between the two types of drainage systems.ConclusionThis meta-analysis suggests that ABTD is a safe and effective method that yields a lower blood transfusion rate and fewer units transfused per patient in TKA compared with CSD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1301-7) contains supplementary material, which is available to authorized users.

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Sealing of the intramedullar femoral canal in a TKA does not reduce postoperative blood loss: A randomized prospective study

Cited by 15 publications

References 24 publications

Effects of sealing the intramedullary femoral canal in total knee arthroplasty

Effects of sealing the intramedullary femoral canal in total knee arthroplasty

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

The efficacy and safety of autologous blood transfusion drainage in patients undergoing total knee arthroplasty: a meta-analysis of 16 randomized controlled trials

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