Fibrin sealant before wound closure in total knee arthroplasty reduced blood loss: a meta-analysis.
ABSTRACT Fibrin sealant (FS) comprises a mixture of fibrinogen and thrombin that controls bleeding, reduces blood transfusions, improves tissue healing and shortens postoperative recovery time after various surgical procedures. However, no single study has been large enough to definitively determine whether fibrin sealant is safe and effective. We report a meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy and safety of fibrin sealant in total knee arthroplasty.
Articles published before August, 2012 were identified from PubMed, Embase, The Cochrane Library and other internet databases. Relevant journals and the recommendations of expert panels were also searched manually. We included only high-quality RCTs. Two independent reviewers searched and assessed the literature. Relevant data were analysed using RevMan 5.0.
Seven RCTs met the inclusion criteria. Use of fibrin sealant significantly reduced haemoglobin decline mean difference (MD = -0.72), 95 % confidence interval [95 % CI (-0.83, -0.62), p < 0.00001], postoperative drainage volume [MD = -354.53, 95 % CI (-482.43, -226.63), p < 0.00001], the proportion of patients requiring blood transfusion risk differences [RD = -0.27, 95 % CI (-0.45, -0.08), p = 0.006] and the incidence of wound haematoma [RD = -0.11, 95 % CI (-0.22, -0.00), p = 0.04]. There were no significant differences in deep vein thrombosis, pulmonary embolism, infection rate or other complications between groups.
Use of fibrin sealant in total knee arthroplasty was effective and safe, reduced haemoglobin decline, postoperative drainage volume, incidence of haematoma and need for blood transfusion, and did not increase the risk of complications. Due to the limited quality of the evidence currently available, more high-quality RCTs are required. LEVEL OF EVIDENCE: II.
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ABSTRACT: One hundred fifteen consecutive patients undergoing TKR were divided into two groups to determine whether blood loss and transfusion in total knee replacement (TKR) using adrenaline with saline infiltration would be less than TKR with tourniquet and drain. Group 1, composed of 60 patients, received 2.5 mg of 1:1000 adrenaline diluted in 500 mL of normal saline, which was infiltrated into the skin, subcutaneous tissues, and capsule before surgical incision. No tourniquets or postoperative drains were used. Group 2, composed of 55 patients, had a tourniquet and postoperative drain. Thromboprophylaxis with low molecular weight heparin also was used. Pre- and postoperative hemoglobin, blood loss, hematocrit, and transfusion requirements were studied in both groups; in group 2, blood loss in the drains also was noted. Average preoperative hemoglobin and hematocrit in the two groups were 13.7 g/dL and 39.3 g/dL, respectively, and 13.5% and 39%, respectively. Average intraoperative blood loss was 290 mL in group 1 and 377.7 mL in group 2 (P<.005). Postoperative blood loss in group 1 was <50 mL based on dressing soakage and 297.7 mL in group 2 (P<.005). Average postoperative hemoglobin and hematocrit in the two groups were 10.6 g/dL and 8.4 g/dL, respectively, and 35.4% and 31.1%, respectively. Transfusion rates were 3.3% and 23.6%, respectively (P<.005). The average volume transfused was 1.2 U. Adrenaline and saline infiltration is safe and helps reduce intraoperative blood loss. Suction drain use for surgical wounds after primary, uncomplicated TKR is questionable.The journal of knee surgery 01/2004; 17(1):24-7.
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ABSTRACT: We performed a randomised, controlled trial involving 150 patients with a pre-operative level of haemoglobin of 13.0 g/dl or less, to compare the effect of either topical fibrin spray or intravenous tranexamic acid on blood loss after total knee replacement. A total of 50 patients in the topical fibrin spray group had 10 ml of the reconstituted product applied intra-operatively to the operation site. The 50 patients in the tranexamic acid group received 500 mg of tranexamic acid intravenously five minutes before deflation of the tourniquet and a repeat dose three hours later, and a control group of 50 patients received no pharmacological intervention. There was a significant reduction in the total calculated blood loss for those in the topical fibrin spray group (p = 0.016) and tranexamic acid group (p = 0.041) compared with the control group, with mean losses of 1190 ml (708 to 2067), 1225 ml (580 to 2027), and 1415 ml (801 to 2319), respectively. The reduction in blood loss in the topical fibrin spray group was not significantly different from that achieved in the tranexamic acid group (p = 0.72).The Bone & Joint Journal 04/2007; 89(3):306-9. DOI:10.1302/0301-620X.89B3.17565 · 2.80 Impact Factor
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ABSTRACT: In this study we describe the potential role of autologous platelet gel and fibrin sealant in unilateral total knee arthroplasty to improve the postoperative range of motion and to reduce the incidence of arthrofibrosis. Total knee arthroplasty is often associated with a considerable amount of post-operative blood loss. Persistent limited motion directly after surgery may ultimately result in arthrofibrosis. To counteract these effects we investigated whether the use of autologous derived platelet gel and fibrin sealant would reduce postoperative blood loss, decrease the impaired range of motion and the incidence of arthrofibrosis. All patients were consecutively operated and assigned to the study or control groups. Study group patients (n = 85) were treated with the application of autologous platelet gel and fibrin sealant at the end of surgery. Eighty patients were operated without the use of platelet gel and fibrin sealant, and served as the control group. The postoperative hemoglobin decrease, range of motion and length of hospitalization were recorded. During a 5-month postoperative period patients were followed to observe the incidence of arthrofibrosis. In patients in the treatment group the hemoglobin concentration in blood decreased significantly less when compared to the control group. They also showed a superior postoperative range of motion when compared to those of the control group (P < 0.001). The incidence of arthrofibrosis and subsequent forced manipulation was significantly less (P < 0.001) in patients managed with platelet gel and fibrin sealant. We conclude that peri-operatively applied platelet gel and fibrin sealant may improve the range of motion after total knee arthroplasty, decreases the length of stay and may reduce the incidence of arthrofibrosis.Knee Surgery Sports Traumatology Arthroscopy 07/2007; 15(7):888-94. DOI:10.1007/s00167-007-0296-x · 2.84 Impact Factor