Reducing blood loss after total knee replacement: a fibrin solution.

Area of Science:

• Orthopedic Surgery
• Surgical Hemostasis
• Transfusion Medicine

Background:

• Significant blood loss is a common complication during total knee replacement (TKR).
• Minimizing perioperative blood loss and transfusion requirements is crucial for patient outcomes.
• Adrenaline and fibrin sealants are used to control bleeding in orthopedic procedures.

Purpose of the Study:

• To compare the efficacy of a new generation fibrin sealant versus local adrenaline infiltration in reducing blood loss and transfusion rates during TKR.
• To assess the impact of these interventions on knee range of movement post-TKR.

Main Methods:

• A prospective study involving 114 patients undergoing TKR.
• Patients were randomized into two groups: one receiving intra-operative fibrin sealant, the other receiving local adrenaline infiltration.
• Comparison of mean calculated total blood volume (TBV) loss, transfusion rates, and knee range of movement between groups.

Main Results:

• Mean TBV loss was comparable between the fibrin sealant group (705 ml) and the local adrenaline group (712 ml) (p = 0.929).
• Significantly fewer blood units were transfused overall in the fibrin sealant group (7 units) compared to the local adrenaline group (15 units) (p = 0.0479).
• Patients receiving fibrin sealant required fewer units per transfusion (1.0 unit) versus the adrenaline group (1.67 units) (p = 0.027), indicating a reduced need for multiple units.

Conclusions:

• The new generation fibrin sealant is effective in reducing blood transfusion requirements during TKR compared to local adrenaline.
• While not significantly reducing total blood loss, fibrin sealant appears to decrease the incidence of multiple-unit blood transfusions.
• Knee range of movement was not adversely affected by either intervention, suggesting fibrin sealant is a safe and effective option for managing blood loss in TKR.