The Application of Flowable Gelatin Without Thrombin in Total Joint Arthroplasty: A Propensity Score-Matched
Yi Zhang1, Jiale Yuan1, Yuanjie Zhang2
1Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Background:
Flowable gelatin (FG) without thrombin is a widely utilized intraoperative hemostatic agent, yet its efficacy in total joint arthroplasty remains debated. This study aimed to assess its clinical impact on total knee arthroplasty (TKA) and total hip arthroplasty (THA).
Methods:
We conducted a retrospective analysis of patients who underwent primary TKA and THA at a single institution from 2018 to 2024, categorizing them based on intraoperative FG usage. Patients who received FG were propensity score-matched in a 2:1 ratio to those who did not, based on demographic characteristics, comorbidities, and surgical factors. Primary outcomes included blood loss, transfusion rate, thromboembolic events, and other perioperative complications. Regression analyses were conducted to assess the impact of intraoperative FG use on total blood loss in both TKA and THA. A total of 612 TKA patients (non-FG: 233; FG: 117) and 844 THA patients (non-FG: 391; FG: 203) were included, with a mean follow-up exceeding two years (up to six years).
Result:
Both total blood loss (TKA: 899.0 versus 1,122.1 mL; THA: 1,021.8 versus 1,328.4 mL) and hidden blood loss (TKA: 789.1 versus 1,010.8 mL; THA: 858.6 versus 1,169.9 mL) were significantly reduced in the FG group, accompanied by lower transfusion rates (TKA: 4.3 versus 12.9%; THA: 8.87 versus 19.69%). The incidence of thromboembolic events, including deep vein thrombosis and pulmonary embolism, did not differ significantly between groups (P > 0.05). Multivariate analyses further identified FG use as an independent predictor of reduced total blood loss.
Conclusions:
Our study found that FG effectively reduces perioperative blood loss and transfusion rates in both TKA and THA, without increasing the risk of lower limb thrombosis or other postoperative complications.
Level Of Evidence:
Level II study.
