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Blood Loss Reduction with Tranexamic Acid and a Bipolar Sealer in Direct Anterior Total Hip Arthroplasty

May 15, 2018 | Surgery
Sherif Dabash, MD ; Leticia C. Barksdale, MD ; Colin A. McNamara, MD, MBA ; Preetesh D. Patel, MD ; Juan C. Suarez, MD
Author and Disclosure Information

Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.

Dr. Dabash is a Clinical Fellow, University of Texas Health Science Center, Houston, Texas. Dr. Barksdale is a Resident, University of Arkansas for Medical Sciences, Fayetteville, Arkansas. Dr. McNamara is a Resident, University of Miami/Jackson Memorial Hospital, Miami, Florida. Dr. Patel is an Orthopedic Surgeon, Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, Florida. Dr. Suarez is an Orthopaedic Surgeon, Baptist Health South Florida, Miami, Florida.

Address correspondence to: Juan C. Suarez, MD, Baptist Health South Florida, 8940 North Kendall Dr, Suite 601E, Miami, FL 33176 (email, juansu@baptisthealth.net).

Am J Orthop. 2018;47(5). Copyright Frontline Medical Communications Inc. 2018. All rights reserved.

Sherif Dabash, MD Leticia C. Barksdale, MD Colin A. McNamara, MD, MBA Preetesh D. Patel, MD Juan C. Suarez, MD . Blood Loss Reduction with Tranexamic Acid and a Bipolar Sealer in Direct Anterior Total Hip Arthroplasty. Am J Orthop.

May 15, 2018

TAKE-HOME POINTS

  • TXA reduces blood loss and transfusion requirements in THA.
  • The bipolar sealer enhances surgical hemostasis by sealing vessels at the surgical site through radiofrequency ablation.
  • The use of TXA, with and without the concomitant use of a bipolar sealer, decreases intraoperative blood loss and postoperative transfusion requirements.
  • The addition of a bipolar sealer did not offer an advantage to transfusion requirements in anterior THA.
  • TXA should be used routinely in THA.

Similarly, the bipolar sealer has been shown to decrease transfusion rates and stabilize perioperative hemoglobin levels.25-27 In this recent prospective clinical trial evaluating the use of a bipolar sealer during DA THA, we observed decreased intraoperative blood loss and transfusion requirements in patients managed with a bipolar sealer.28 However, in a study conducted by Barsoum and colleagues37 evaluating the use of a bipolar sealer in THA with a posterior approach, there were no significant postoperative benefits in terms of blood loss, transfusion requirements, clinical evaluations, functionality, or health-related quality of life in patients managed with a bipolar sealer.

Although the results of our research are in line with those of previous publications, it is important to address 3 limitations within this study. First, only the control group in this study was enrolled prospectively; the remaining groups were reviewed retrospectively. Second, our adoption of TXA was recent; therefore, a confounding factor is that our surgeons had more experience in the anterior approach when using TXA. Third, the established transfusion threshold of <8 g/dl for this study led to more liberal use of transfusions. Since the conclusion of this study, we have adopted stricter transfusion criteria (hemoglobin <7.0 g/dL with clinical symptoms) which has led to even lower transfusion requirements.

CONCLUSION

In the reviewed patient population, TXA decreased blood loss and transfusion requirements following DA THA. However, the addition of a bipolar sealer did not provide an advantage. The results of this study do not support the routine use of a bipolar sealer in DA THA.

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