Blood Loss Associated with Uncemented Total Hip Replacement: Hypotension Does not Affect Blood Loss

The Aquamantys system--an alternative to reduce blood loss in primary total hip arthroplasty?

To evaluate the effectiveness of the Bipolar Sealer 6.0-VT (BPS 6.0-VT) (Tissue Link Medical, Inc, Dover, NH) in reducing blood loss compared with a conventional electrocautery (Erbe ICC 350) (Erbe ICC 350 (ERBE Elektromedizin GmbH, Tübingen, Germany). A prospective randomized trial of 105 patients with primary total hip arthroplasty (Erbe ICC 350: 50 patients; BPS 6.0-VT: 55 patients). On the basis of the calculation of the preoperative blood volume the total and postoperative blood loss were calculated. No statistically significant difference could be shown for total intraoperative and postoperative blood loss (group A 1846 mL; group B 1740 mL) (t test). Due to the lack of reduction of blood loss and the high costs of the BPS 6.0-VT, its use is not recommended in primary total hip arthroplasty.

A comparative study of closed-wound suction drainage vs. no drainage in total hip arthroplasty

One hundred consecutive primary total hip arthroplasties performed by the same surgeon over 4 years were retrospectively reviewed. In the first 50, closed-suction drains were used; the following 50 were not drained. Comparison between the two groups revealed no statistically significant differences in wound problems, postoperative pyrexias, or other short-term complications. No wound infections occurred. A mean of 2.6 units of blood per patient was transfused to the nondrained group. In the drained group, a mean of 3.4 units of blood per patient was transfused. This difference was not statistically significant. The mean postoperative fall in haemoglobin concentration was 2.4 g/dl in the nondrained group, and 1.9 g/dl in the drained group. This difference was not statistically significant. This study demonstrated no advantage to the use of suction drains in uncomplicated total hip arthroplasty, and perhaps their routine use should be questioned.

Reduction in blood loss in total hip arthroplasty using topical Colgen

Blood loss associated with uncemented total hip arthroplasty can be considerable, and any simple and safe means of reducing this loss and hence the volume of blood transfused during surgery would be valuable. The authors conducted a randomized trial using Colgen, a nondenatured collagen with hemostatic properties, in 76 patients undergoing uncemented total hip arthroplasty. Thirty-eight patients had Colgen sprinkled around the reduced hip joint after arthroplasty and 38 patients acted as controls. Analysis, using Student's t-test, showed no difference between the groups in measured blood loss at operation. However, after surgery in the Colgen group both visible measured blood loss (P less than .05) and total calculated blood loss (P less than .01) were significantly reduced. These results are particularly relevant today, when blood transfusion itself is a potential danger and should be kept to the necessary minimum.