What question did this study set out to answer?

This study aims to compare the effectiveness of the bipolar sealer system and fibrin sealant in managing blood loss during total knee arthroplasty.

March 19, 2026Prosthesis0 citationsOpen Access

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Blood Loss Management in Total Knee Arthroplasty: Bipolar Sealer System vs. Fibrin Sealant: A New Fast-Track Protocol

LMLorenzo MorettiUniversity of Bari Aldo Moro ASAntonio SpinarelliOspedale degli Infermi GCGiuseppe Danilo CassanoUniversity of Bari Aldo Moro

Key Points

This study aims to compare the effectiveness of the bipolar sealer system and fibrin sealant in managing blood loss during total knee arthroplasty.
Retrospective analysis of 480 patients who underwent total knee arthroplasty.
Cohort divided into two groups: control (TXA and fibrin sealant) and study (Aquamantys BSS and TXA).
Assessment of hematological parameters (hemoglobin, hematocrit, red blood cells) at multiple time points.
Significantly lower changes in hemoglobin levels in patients using BSS compared to fibrin sealant at all postoperative time points.
Similar trends observed in hematocrit and red blood cell values.
Statistically significant p-values: 0.0003 at T1, 0.027 at T2, and 0.0001 at T3.

Abstract

Background/Objectives: Total knee arthroplasty (TKA) is often associated with extensive bleeding and the need for intraoperative and postoperative blood transfusions. Due to concern about the risks associated with them, a push has been made in surgery toward the development of new intraoperative blood management devices and innovative postoperative care strategies. Tranexamic acid (TXA), fibrin sealant and standard electrocautery are widely used in orthopedic surgery, since several studies provided evidence about their efficacy and safety. A new device, the bipolar sealer system (BSS), provides hemostasis at lower temperature (<100°) than conventional electrocautery. It does not produce smoke, necrosis or burn tissue. Methods: In this study, we retrospectively analyzed data from 480 patients who underwent TKA between January 2017 and December 2024. The cohort was divided into two groups based on the hemostatic protocol adopted. The control group enrolled 240 patients who received the standard protocol with TXA and fibrin sealant, while the study group enrolled 240 patients who followed protocol with Aquamantys BSS and TXA. Hematological parameters, including hemoglobin (Hb), hematocrit (HCT) and red blood cells (RBCs) were analyzed preoperatively (T0) and postoperatively: immediately after surgery (T1), at day one (T2) and day three (T3). Results: Changes in hemoglobin from baseline to postoperative follow-up were significantly lower among patients who received TXA plus BSS and those receiving TXA plus fibrin sealant, with p-values of 0.0003 at T1 (immediately after surgery), 0.027 at T2 (one day post-op), and 0.0001 at T3 (three days post-op). Comparable results were observed for HCT and RBC values. Conclusions: These data demonstrate that Aquamantys is more effective than fibrin glue in controlling blood loss after knee replacement surgery, not only immediately after the procedure but also in the following days.

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Cite This Study

Moretti et al. (Tue,) studied this question.

synapsesocial.com/papers/69bb92f2496e729e62980a2b https://doi.org/https://doi.org/10.3390/prosthesis8030031

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