title: Saline-coupled bipolar sealing in simultaneous bilateral total knee arthroplasty.
abstract: BACKGROUND
  The efficacy of saline-coupled bipolar sealing devices in joint arthroplasty is uncertain, and the utility in simultaneous bilateral total knee arthroplasty (TKA) has not been reported.
  
  
  METHODS
  This study compares the use of bipolar sealing and conventional electrocautery in 71 consecutive patients. The experimental and control groups were matched for age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, and preoperative hemoglobin. Variables of interest included blood loss, transfusion requirements, and operative characteristics.
  
  
  RESULTS
  In comparison to patients treated with conventional electrocautery, those treated with the bipolar sealer were 35% less likely to require transfusion. The median number of transfusions per case was also significantly lower in the experimental group. Hemoglobin change, total blood loss, and length of stay were not significantly different between the groups. The experimental group had longer operative times.
  
  
  CONCLUSIONS
  Bipolar sealing shows promise as a blood loss reduction tool in simultaneous bilateral TKA. The marginal savings attributed to reduced transfusion rates with use of the bipolar sealer did not exceed the additional per-case expense of using the device. The decision to use the device with the goal of less blood loss must come with the additional expense associated with its use.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Atul F
authors.initials: AF
authors.lastname: Kamath
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Austin
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Derman
authors.affiliation: Department of Orthopedic Surgery, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: R Carter
authors.initials: RC
authors.lastname: Clement
authors.affiliation: Department of Orthopedic Surgery, Lankenau Institute for Medical Research and Pennsylvania Orthopedic Center, Exton, PA, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Garino
authors.affiliation: Department of Orthopedic Surgery, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Gwo-Chin
authors.initials: GC
authors.lastname: Lee
mesh_terms: D000328:Adult; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D017115:Catheter Ablation / Q000295:instrumentation; D004564:Electrocoagulation / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male
keywords: Arthroplasty; Blood transfusion; Equipment and supplies; Knee; Surgical hemostasis