Use of Fibrin Sealant to Reduce Bloody Drainage and Hemoglobin Loss After Total Knee Arthroplasty : A Brief Note on a Randomized Prospective Trial

• Published in: Journal of bone and joint surgery. American volume Vol. 83; no. 10; pp. 1503 - 1505
• Main Authors: Wang, G J, Hungerford, D S, Savory, C G, Rosenberg, A G, Mont, M A, Burks, S G, Mayers, S L, Spotnitz, W D
• Format: Journal Article
• Language: English
• Published: Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01-10-2001; Journal of Bone and Joint Surgery Incorporated; Journal of Bone and Joint Surgery AMERICAN VOLUME
• Edition: American volume
• Subjects: Arthroplasty, Replacement, Knee - adverse effects; Biological and medical sciences; Blood Loss, Surgical - prevention & control; Drainage; Fibrin Tissue Adhesive - therapeutic use; Hemoglobins - deficiency; Hemostatics - therapeutic use; Humans; Medical sciences; Orthopedic surgery; Prospective Studies; Single-Blind Method; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Phase III trial; Knee; Human; Prevention; Fibrin; Prosthesis; Treatment efficiency; Blood loss; Total; Hemostatic adhesive; Combined treatment; Technique
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200110000-00007

BackgroundA phase-III trial that included fifty-three patients undergoing unilateral primary total knee arthroplasty with cement was conducted to investigate the hemostatic efficacy of fibrin sealant.MethodsFollowing cementing of the joint, 10 mL of fibrin sealant was sprayed onto the wound before tourniquet deflation and wound closure. No placebo was used in the control group. All patients received drains.ResultsWithin twelve hours after the surgery, the amount of bloody drainage was 184.5 ± 28.9 mL (mean and standard error) in the fibrin-sealant group (information available for twenty-three patients) and 408.3 ± 54.6 mL in the control group (information available for twenty-three patients) (p = 0.002, after adjustment for variance in the time that the drainage was measured). On the first postoperative day, the hemoglobin level had decreased by 20.1 ± 2.1 g/L in the fibrin-sealant group (information available for twenty-two patients) and by 27.3 ± 2.1 g/L in the control group (information available for twenty-four patients). After adjustment for baseline values, the decrease in the hemoglobin level was 28.9% less in the fibrin-sealant group than in the control group (p = 0.005, 95% confidence limits = 10.2, 43.7). There were no seroconversions in the fibrin-sealant group.ConclusionThese results suggest that fibrin sealant can safely reduce bloody drainage following total knee arthroplasty while maintaining higher hemoglobin levels.