Abstract
Several methods were introduced to limit perioperative blood loss in total knee arthroplasty
(TKA). By transcollation of soft tissues below 100°C, bipolar sealers intend to reduce
bleeding and tissue damage, compared with conventional electrocautery. Existing studies
report contradictory findings about the performance of bipolar sealers. The purpose
of this study was to evaluate the effect of a bipolar sealer on blood loss, transfusions,
hospital length of stay (LOS), and functional scores in primary TKA. In this single-center
prospective study, 101 patients, undergoing primary TKA in a fast-track setting without
tourniquet use, were randomly assigned to either (1) the study group which was operated
with a bipolar sealer or (2) the control group operated with conventional electrocautery.
The study cohort comprised 49 men and 52 women, aged 71.1 ± 8.8 years. There was no
significant difference between the bipolar sealer group and the control group in terms
of blood loss at day 3 (1,240 ± 547.4 vs. 1,376 ± 584.4 mL; p = ns [not significant]), transfusion rate (10 vs. 4%; p = ns), surgery time (48.2 ± 10.8 vs. 46.6 ± 9.1 minute; p = ns) or LOS (4.1 ± 2.7 vs 4.3 ± 2.0 days; p = ns). At a mean follow-up of 63.3 ± 4.9 days, there was no significant difference
between the bipolar sealer group and the control group in terms of net improvement
of Knee Society Score (KSS) knee (26.0 ± 16.7 vs. 23.7 ± 12.3; p = ns) and KSS function (20.4 ± 19.3 vs. 20.8 ± 19.9; p = ns). Compared with the use of conventional electrocautery in primary TKA without
tourniquet, we found no effect of bipolar sealer use on blood loss, transfusion rates,
LOS, or functional recovery. This is a Level II, prospective cohort study.
Keywords
bipolar sealer - blood loss - hospital length of stay - primary TKA - fast-track setting
