Clinical Applications and Emerging Roles of Bone Wax in Orthopaedic Surgery: A Scoping Review

Area of Science:

• Orthopaedic Surgery
• Surgical Hemostasis

Background:

• Perioperative bleeding from cancellous bone is a persistent challenge in orthopaedic procedures.
• Bone wax is a widely used, cost-effective mechanical hemostatic agent.
• Existing reviews often focus narrowly on joint arthroplasty or material science, lacking a broad clinical evidence map across orthopaedic subspecialties.

Purpose of the Study:

• To comprehensively map the existing clinical evidence for bone wax use across various orthopaedic subspecialties.
• To identify the strength of evidence and reported outcomes associated with bone wax in different surgical applications.
• To highlight gaps in knowledge and areas for future research regarding bone wax and its alternatives.

Main Methods:

• A scoping review was conducted following the Arksey and O'Malley framework with PRISMA-ScR reporting.
• Searches included five electronic databases and grey literature up to May 2025.
• Eligible studies were clinical evaluations of bone wax in orthopaedics; preclinical or material-only studies were excluded.

Main Results:

• Fifteen studies met inclusion criteria, covering joint replacement (8), spinal surgery (2), bone excisions (3), and sealing (2).
• Strongest evidence from arthroplasty suggests bone wax reduces blood loss without clear adverse effects on early recovery.
• Spinal and other applications showed heterogeneous, limited evidence from observational studies and case reports; complications like foreign-body reactions were noted with retained wax.

Conclusions:

• Bone wax remains a valuable, inexpensive tool for orthopaedic hemostasis.
• Clinical evidence is most robust for arthroplasty; spinal and non-traditional uses require more data.
• Future research should focus on indication-specific benefits/risks and evaluate bioresorbable alternatives in rigorous clinical trials.