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The Journal of Bone and Joint Surgery (American) 83:1503-1505 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Use of Fibrin Sealant to Reduce Bloody Drainage and Hemoglobin Loss After Total Knee Arthroplasty

A Brief Note on a Randomized Prospective Trial

G. J. Wang, MD, D. S. Hungerford, MD, C. G. Savory, MD, A. G. Rosenberg, MD, M. A. Mont, MD, S. G. Burks, BSN, S. L. Mayers, PhD and W. D. Spotnitz, MD

Investigation performed at University of Virginia Health System, Charlottesville, Virginia; Good Samaritan Hospital, Baltimore, Maryland; Hughston Sports Medicine Clinic, Columbus, Georgia; and Midwest Orthopaedics, Chicago, Illinois
G.J. Wang, MD
S.G. Burks, BSN
S.L. Mayers, PhD
W.D. Spotnitz, MD
Tissue Adhesive Center, University of Virginia Health System, MR4 Building, Room 3122, Charlottesville, VA 22908. E-mail address for G.W. Wang: uvatac{at}virginia.edu

D.S. Hungerford, MD
M.A. Mont, MD
Department of Orthopaedic Surgery, Johns Hopkins University, Professional Office Building, Suite G1, 5601 Loch Raven Boulevard, Baltimore, MD 21239

C.G. Savory, MD
Hughston Sports Medicine Clinic, 6262 Veterans Parkway, P.O. Box 9517, Columbus, GA 31908

A.G. Rosenberg, MD
Department of Orthopaedic Surgery, Rush-Presbyterian-St. Luke’s Medical Center, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612

Although none of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article, benefits have been or will be received, but are directed solely to a research fund, foundation, educational institution, or other nonprofit organization with which one or more of the authors is associated. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was Omrix Biopharmaceuticals.

Background: A phase-III trial that included fifty-three patients undergoing unilateral primary total knee arthroplasty with cement was conducted to investigate the hemostatic efficacy of fibrin sealant.

Methods: Following cementing of the joint, 10 mL of fibrin sealant was sprayed onto the wound before tourniquet deflation and wound closure. No placebo was used in the control group. All patients received drains.

Results: Within twelve hours after the surgery, the amount of bloody drainage was 184.5 ± 28.9 mL (mean and standard error) in the fibrin-sealant group (information available for twenty-three patients) and 408.3 ± 54.6 mL in the control group (information available for twenty-three patients) (p = 0.002, after adjustment for variance in the time that the drainage was measured). On the first postoperative day, the hemoglobin level had decreased by 20.1 ± 2.1 g/L in the fibrin-sealant group (information available for twenty-two patients) and by 27.3 ± 2.1 g/L in the control group (information available for twenty-four patients). After adjustment for baseline values, the decrease in the hemoglobin level was 28.9% less in the fibrin-sealant group than in the control group (p = 0.005, 95% confidence limits = 10.2, 43.7). There were no seroconversions in the fibrin-sealant group.

Conclusion: These results suggest that fibrin sealant can safely reduce bloody drainage following total knee arthroplasty while maintaining higher hemoglobin levels.


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