Use of fibrin sealant to reduce bloody drainage and hemoglobin loss after total knee arthroplasty - A brief note on a randomized prospective trial

Background: A phase-III trial that included fifty-three patients undergoing unilateral primary total knee arthroplasty with cement was conducted to in vestigate the hemostatic efficacy of fibrin sealant. Methods: Following cementing of the joint, 10 mL of fibrin sealant was spra yed onto the wound before tourniquet deflation and wound closure. No placeb o was used in the control group. All patients received drains. Results: Within twelve hours after the surgery, the amount of bloody draina ge was 184.5 +/- 28.9 mL (mean and standard error) in the fibrin-sealant gr oup (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 me asured). 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 (informa tion available for twenty-four patients). After adjustment for baseline val ues, the decrease in the hemoglobin level was 28.9% less in the fibrin-seal ant 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 blo ody drainage following total knee arthroplasty while maintaining higher hem oglobin levels.