title: Polysaccharide hemostatic system reduces blood loss in high-body-mass-index patients undergoing simultaneous bilateral total knee arthroplasty.
abstract: BACKGROUND
  To investigate the efficacy of a topically applied hemostatic agent used to reduce blood loss in patients undergoing simultaneous bilateral total knee arthroplasty (TKA).
  
  
  METHODS
  Thirty-two patients (5 male, 27 female) mean age 65 ± 9.3 (46-80) undergoing single-stage bilateral TKA were enrolled in the study and divided in two groups. Groups 1 and 2 consisted of patients with body mass index (BMI) <30 and >30, respectively. Polysaccharide hemostatic agent (PHA; 3 g) was applied topically to the right knees of each patient intraoperatively. The left knees were used as controls. A negative suction drain was used and the effect of PHA and BMI on postoperative bleeding was evaluated.
  
  
  RESULTS
  Blood loss was significantly higher (p = 0.027, r = 0.397) for patients with higher BMI. Treatment by local application of PHA to potential bleeding sites significantly reduced blood loss-314 ± 151 ml (50-600) for the right knees versus 468 ± 140 ml (150-700) for the left knees (p = 0.007) in group 1; 420 ± 251 ml (100-900) for the right knees versus 620 ± 229 ml (350-1125) for the left knees (p = 0.036) in group 2. Blood loss reduction between the right and left knees was no different between the two groups (p = 0.173).
  
  
  CONCLUSIONS
  By reducing blood loss and the need for postoperative blood transfusion in patients with high BMI, PHA can be of value as adjuvant therapy in new blood-management procedures in major joint-replacement surgery.
authors.affiliation: Department of Orthopaedics, Ankara Onkoloji Training and Research Hospital, 2. Ortopedi Klinigi, Demetevler, Ankara, Turkey. drerdem2007@gmail.com
authors.forename: Erdem
authors.initials: E
authors.lastname: Aktas
authors.forename: Ali Volkan
authors.initials: AV
authors.lastname: Kaya
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Deveci
authors.forename: Kenan
authors.initials: K
authors.lastname: Ozler
authors.forename: Halil
authors.initials: H
authors.lastname: Akdeniz
authors.forename: Hasan
authors.initials: H
authors.lastname: Yildirim
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015992:Body Mass Index; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013213:Starch / Q000008:administration & dosage*; D018709:Statistics, Nonparametric
chemical_list: D006490:Hemostatics; D013213:Starch