Bone Wax Is Effective in Reducing Blood Loss after Total Knee Arthroplasty

• Published in: The Journal of arthroplasty Vol. 32; no. 5; pp. 1483 - 1487
• Main Authors: Moo, Ing How, MBBS, MRCS (Ireland), Chen, Jerry Yong Qiang, MBBS, MMed (Ortho Surg), MRCS, Pagkaliwaga, Eric Hernandez, MD, Tan, See Wei, MBBS, Poon, Kein Boon, MD, MSc Orth (London), FAMS (Ortho)
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017
• Subjects: Aged; Aged, 80 and over; Anticoagulants - therapeutic use; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; bleeding; blood loss; Blood Loss, Surgical - prevention & control; Blood Transfusion; Body Mass Index; Bone Cements; bone wax; Electrocoagulation; Female; Hemoglobins - analysis; Hemostasis; Humans; knee arthroplasty; Male; Middle Aged; Orthopedics; Palmitates - therapeutic use; Postoperative Hemorrhage - etiology; Prospective Studies; Tourniquets; Treatment Outcome; Waxes - therapeutic use; knee arthroplasty; blood loss; bone wax; bleeding
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.12.028

Background 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. Methods 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 grams 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. Results There were no demographic differences between the two groups. The preoperative serum hemoglobin levels were comparable between the two groups. The drop in serum hemoglobin levels at 24 hours post-TKA were 1.6 ± 0.9 and 2.1 ± 1.1 g/dl in the bone wax and control groups, respectively (p=0.021), while the drop in serum hemoglobin levels at 72 hours post-TKA were 2.7 ± 1.1 and 3.6 ± 1.2 g/dl, respectively (p=0.013). Total blood loss at 72 hours post-TKA was 987.9 ml and 1183.5 ml for the bone wax and control groups, respectively (p=0.017). There was no adverse event associated with the use of bone wax at the 3-month follow-up. Conclusions The application of bone wax in TKA was safe and effective for reducing total blood loss and maintaining higher hemoglobin levels.