A new bipolar blood sealing system embedded in perioperative strategies vs. a conventional regimen for total knee arthroplasty: results of a matched-pair study

Michael Pfeiffer, Heike Bräutigam, Detlev Draws, Andreas Sigg, Michael Pfeiffer, Heike Bräutigam, Detlev Draws, Andreas Sigg

Abstract

From a prospective matched-pair study in 40 patients it can be concluded that the use of a new bipolar sealer system for electrocoagulation is effective in Total Knee Arthroplasty in reducing the visible total blood loss until drain removal on day two after surgery by more than 28% as compared to a conventional regimen. Together with shed blood autotransfusion, it reduced homologous blood transfusions by a factor of five. No complications occurred. The system can be recommended for use in knee surgery during, after opening, and without use of a tourniquet. It bears additional potential for further applications in orthopaedic surgery.

Keywords: blood transfusion; electrocoagulation; surgical hemostasis; total knee replacement.

Figures

Table 1. Paired T-Test results for total…
Table 1. Paired T-Test results for total visible blood loss (TVBL) with BPS vs. control group
Figure 1. The Bipolar Sealer: principles of…
Figure 1. The Bipolar Sealer: principles of design (1a) and action (1b)
Figure 2. Mean visible blood loss in…
Figure 2. Mean visible blood loss in BPS vs. control group over time intraoperatively, on Intermediate Care Unit (IMC), on regular ward at time of drain removal (left from vertical line), and cumulated (TVBL, right from vertical line).
Group differences after IMC and cumulated differences as shown were highly significant. Bars represent 95% confidence intervals of mean values.
Figure 3. Hemoglobin concentrations for the two…
Figure 3. Hemoglobin concentrations for the two groups preoperatively and at discharge, bars depict 95% confidence intervals of mean values.

References

    1. Callaghan J. An analysis of current transfusion practice in patients undergoing total hip and knee replacement. In: Brown A, editor. Analyst interviews & surgeon interviews, re: cost of blood. 1999.
    1. Hay SN, Monk TG, Brecher ME. Intraoperative blood salvage: a mathematical perspective. Transfusion. 2002;42(4):451–455.
    1. Levy O, Martinowitz U, Oran A, Tauber C, Horoszowski H. The use of fibrin tissue adhesive to reduce blood loss and the need for blood transfusion after total knee arthroplasty. A prospective, randomized, multicenter study. J Bone Joint Surg Am. 1999;81(11):1580–1588.
    1. Martin A, Prenn M, Spiegel T, Sukopp C, von Strempel A. Die Bedeutung der Wunddrainage in der Knieendoprothetik - eine prospektive Vergleichsstudie [Relevance of wound drainage in total knee arthroplasty--a prospective comparative study] Z Orthop Ihre Grenzgeb. 2004;142(1):46–50.
    1. Mengal B, Aebi J, Rodriguez A, Lemaire R. Drainage ou non-drainage postopératoire dans les arthroplasties totales primaires de hanche et de genou : étude prospective randomisée [A prospective randomized study of wound drainage versus non-drainage in primary total hip or knee arthroplasty] Rev Chir Orthop Reparatrice Appar Mot. 2001;87(1):29–39.
    1. Parker MJ, Roberts CP, Hay D. Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2004;86-A(6):1146–1152.
    1. Pfeiffer M, Schuler P, Wirth T, Griss P. Sekretverluste bei orthopadisch-chirurgischen Standardeingriffen unter Anwendung einer neuartigen geschlossenen Vakuumdrainage. Ein Erfahrungsbericht [Wound secretions in standard orthopedic surgery interventions using a new kind of closed vacuum drainage. A report of experiences] Unfallchirurg. 1991;94(4):194–197.
    1. Rosolski T. Autologe Direkt-Retransfusion (ADR)- Contra Diskussion [Autologous transfusion -- from euphoria to reason: clinical practice based on scientific knowledge (Part II). Autologous direct re-transfusion -- contra] Anasthesiol Intensivmed Notfallmed Schmerzther. 2004;39(11):697–700.
    1. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee. 2000;7(3):151–155.
    1. Sigg A, Grosse C, Henche HR. Fremdblutsparende Maßnahme bei knieendoprothetischen Eingriffen durch Aprotinin [Blood saving in Total Knee Arthroplasty by Aprotinin] Orthopädische Praxis. 2003;39(8):471–473.
    1. TissueLink Medical's HemoSealing technology - Procedure guide for Total Knee Arthroplasty. Dover, NH: TissueLink Medical Inc.; 2003.
    1. Waters JH, Lee JS, Karafa MT. A mathematical model of cell salvage efficiency. Anesth Analg. 2002;95(5):1312–1317.
    1. Weiskopf RB. Efficacy of acute normovolemic hemodilution assessed as a function of fraction of blood volume lost. Anesthesiology. 2001;94(3):439–446.

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