No effect of fibrin sealant on drain output or functional recovery following simultaneous bilateral total knee arthroplasty: a randomized, double-blind, placebo-controlled study.
OBJECTIVE
Blood loss after total knee arthroplasty (TKA) may lead to anemia, blood transfusions, and increased total costs. Also, bleeding into the periarticular tissue may cause swelling and a reduction in quadriceps strength, thus impairing early functional recovery. In this randomized, double-blind, placebo-controlled study, we analyzed the possible effect of fibrin sealant on blood loss and early functional recovery in a fast-track setting.


METHODS
24 consecutive patients undergoing bilateral simultaneous TKA were included. 10 mL of fibrin sealant (Evicel) was sprayed onto one knee whereas the contralateral knee had saline. Drain output, the primary outcome, was measured from knee drains removed exactly 24 h after surgery. Secondary outcomes (knee swelling, pain, strength of knee extension, and range of movement (ROM)) were evaluated up to 21 days after surgery.


RESULTS
The drain output in knees treated with fibrin sealant and placebo was similar (582 mL and 576 mL, respectively). Likewise, no statistically significant differences were found between groups regarding swelling, pain, strength of knee extension, and ROM.


CONCLUSIONS
Fibrin sealant as a local hemostatic in TKA showed no benefit in reducing drain output or in facilitating early functional recovery when used with a tourniquet, tranexamic acid, and a femoral bone plug.
Department of Orthopaedic Surgery, Hvidovre Hospital, Denmark. christianskovgaard@dadlnet.dk
Christian
C
Skovgaard
Bente
B
Holm
Anders
A
Troelsen
Troels H
TH
Lunn
Lissi
L
Gaarn-Larsen
Henrik
H
Kehlet
Henrik
H
Husted
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D004311:Double-Blind Method; D004322:Drainage; D004487:Edema; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006488:Hemostasis, Surgical / Q000379:methods*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D014111:Tourniquets; D014148:Tranexamic Acid / Q000627:therapeutic use; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents; D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D014148:Tranexamic Acid