title: Bone Wax Is Effective in Reducing Blood Loss After Total Knee Arthroplasty.
abstract: Total knee arthroplasty (TKA) is associated with major blood loss and blood transfusion is often required. This study aimed to evaluate the efficacy of bone wax in reducing blood loss and transfusion rates after TKA.
  
  
  
  A prospective randomized controlled study that included 100 patients undergoing primary unilateral TKA with cement was conducted in a tertiary center between March 2014 and June 2014. The bone wax group received 2.5 g of bone wax, applied onto the uncovered bone around the prostheses and the nail holes before the tourniquet was released, whereas the control group had hemostasis achieved using electrocautery only. Total blood loss was calculated using the hemoglobin balance method.
  
  
  
  There were no demographic differences between the 2 groups. The preoperative serum hemoglobin levels were comparable between the 2 groups. The drop in serum hemoglobin levels at 24 h post-TKA was 1.6 ± 0.9 and 2.1 ± 1.1 g/dL in the bone wax and control groups respectively (P = .021), while the drop in serum hemoglobin levels at 72 h post-TKA was 2.7 ± 1.1 and 3.6 ± 1.2 g/dL respectively (P = .013). Total blood loss at 72 h post-TKA was 987.9 and 1183.5 mL for the bone wax and control groups respectively (P = .017). There was no adverse event associated with the use of bone wax at the 3-month follow-up.
  
  
  
  The application of bone wax in TKA was safe and effective for reducing total blood loss and maintaining higher hemoglobin levels.
authors.affiliation: Department of Orthopaedics Surgery, Changi General Hospital, Singapore.
authors.forename: Ing H
authors.initials: IH
authors.lastname: Moo
authors.affiliation: Department of Orthopaedics Surgery, Changi General Hospital, Singapore.
authors.forename: Jerry Y Q
authors.initials: JYQ
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics Surgery, Changi General Hospital, Singapore.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Pagkaliwaga
authors.affiliation: Department of Orthopaedics Surgery, Changi General Hospital, Singapore.
authors.forename: See W
authors.initials: SW
authors.lastname: Tan
authors.affiliation: Department of Orthopaedics Surgery, Changi General Hospital, Singapore.
authors.forename: Kein B
authors.initials: KB
authors.lastname: Poon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D015992:Body Mass Index; D001843:Bone Cements; D004564:Electrocoagulation; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010168:Palmitates / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011446:Prospective Studies; D014111:Tourniquets; D016896:Treatment Outcome; D014885:Waxes / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D001843:Bone Cements; D006454:Hemoglobins; D010168:Palmitates; D014885:Waxes; C055480:bone wax
keywords: bleeding; blood loss; bone wax; knee arthroplasty