Elhalag RH, Dean YE, Hamdy A, Hadhoud AM, Chébl P, Shah J, Gawad M, Motawea KR. Comparison of the effect of open-box versus closed-box prostheses on blood loss following total knee arthroplasty: a meta-analysis.
Ann Med Surg (Lond) 2024;
86:1021-1028. [PMID:
38333267 PMCID:
PMC10849461 DOI:
10.1097/ms9.0000000000001657]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
Purpose
Postoperative blood loss is a common complication following total knee arthroplasty (TKA). The authors aimed to analyze the significance of open versus closed-box prostheses in reducing blood loss after TKA.
Methods
PubMed, Cochrane, Scopus, and Web of Science were searched. Observational studies and clinical trials comparing the effect of open-box versus closed-box prostheses on blood loss following TKA were included. The primary outcome was total blood loss following TKA. Secondary outcomes included average transfused units and total operation time. Continuous data were represented as mean difference (MD) and CI, while dichotomous data were presented as odds ratio (OR) and CI. RevMan software version 5.4 was used to conduct the analysis.
Results
Four studies with a total number of 687 patients were included. The pooled analysis showed a statistically significant association between closed-box and decreased total blood loss following TKA compared with open-box (MD=173.19, 95% CI=88.77-257.61, P value <0.0001). Similar findings were reported in unilateral TKA (MD=190.63, 95% CI=70.91-310.35, P value=0.002), and bilateral TKA (MD=160.79, 95% CI=61.70-359.86, P value=0.001). There was no significant difference between open and closed-box regarding average transfused units (MD=0.02, 95% CI=-0.07-0.11, P value=0.68), blood transfusion rate (OR=1.38, 95% CI=0.85-2.26, P value=0.20), length of stay (MD=0.06, 95% CI=-0.27 to 0.38, P value=0.74), and total operation time (MD=1.08, 95% CI=-4.62 to 6.79, P value=0.71).
Conclusion
Closed-box reduces the total blood loss following unilateral and bilateral TKA. More studies are warranted to explore the benefits of Closed-box in patients with high bleeding susceptibility.
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