title: Efficacy of Hybrid Plasma Scalpel in Reducing Blood Loss and Transfusions in Direct Anterior Total Hip Arthroplasty.
abstract: Allogeneic blood transfusions have inherent risk and direct cost in total hip arthroplasty. Anterior total hip arthroplasty has grown in popularity with increased utilization. This approach may offer an enhanced recovery but has been associated with increased blood loss. Several technologies have been developed including the Canady Hybrid Plasma Scalpel (CHPS) and Aquamantys Bipolar Sealer (BS) to decrease blood loss.
  
  
  
  Two hundred forty-four consecutive patients undergoing anterior supine intermuscular total hip arthroplasty were separated by intraoperative cautery device (CHPS vs BS). Exclusion criteria included blood dyscrasias and contraindication to tranexamic acid. Demographic data, blood loss, transfusion requirements, and Harris Hip Scores were obtained. Differences between groups were evaluated using the Student t-test or Wilcoxon rank-sum test for continuous variables and chi-square test for categorical variables.
  
  
  
  There were no differences in demographic data between the groups. Patients in the CHPS group had a significantly smaller decrease in postoperative hemoglobin (-2.3 mg/dL vs -2.7 mg/dL, P < .05), estimated blood loss (240.3 mL vs 384.4 mL, P < .001), and calculated actual blood loss (1.11 L vs 2.47 L, P < .001). There were 12 transfusions in the BS group and none in CHPS group (P < .001).
  
  
  
  The use of the hybrid plasma scalpel resulted in significantly less blood loss and transfusions than the BS. Additionally, patients treated with the hybrid plasma scalpel had significantly shorter operative times and reduced hospital length of stay. The hybrid scalpel shows promise in reducing blood loss in anterior total hip arthroplasty and is a valuable tool in the multimodal approach to avoiding transfusions.
authors.affiliation: Department of Orthopaedics, Emory University, Adult Hip and Knee Reconstruction, Atlanta, Georgia.
authors.forename: George N
authors.initials: GN
authors.lastname: Guild
authors.affiliation: Department of Orthopaedics, Emory University, Atlanta, Georgia.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Runner
authors.affiliation: Northside Hospital, Atlanta, Georgia.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Castilleja
authors.affiliation: Department of Orthopaedics, Emory University, Adult Hip and Knee Reconstruction, Atlanta, Georgia.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Smith
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: CatPhuong L
authors.initials: CL
authors.lastname: Vu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D002425:Cautery / Q000295:instrumentation*; D004564:Electrocoagulation / Q000295:instrumentation; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011184:Postoperative Period; D013525:Surgical Instruments; D014148:Tranexamic Acid / Q000627:therapeutic use
chemical_list: D006454:Hemoglobins; D014148:Tranexamic Acid
keywords: anterior total hip arthroplasty; blood loss; blood transfusion; electrocautery; hybrid plasma scalpel; post-operative anemia