Bipolar vs. monopolar sealer in decreasing blood loss and transfusion rate in patients undergoing two-stage exchange in infected total knee arthroplasty: propensity score-matched study.

Abstract

Background: Two-stage revision in infected total knee arthroplasty increases the risk of blood loss and the need for transfusion. The present study aimed to test the hemostatic efficacy of a bipolar sealer to reduce blood loss and transfusion requirements after the first stage in patients affected by peri-prosthetic knee infections.

Methods: Twenty-four patients undergoing 2-stage arthroplasty for infected TKA using a bipolar sealer (Haemodiss, Kylix, Naples, IT) were compared with 24 patients of a historical control group in which conventional electrocautery was used. Transfusion data, clinical information, and operative data were evaluated. The primary outcome measure was estimated blood loss at the time of the lowest hemoglobin level (nadir). The secondary outcome measures were the transfusion requirement and the number of units transfused.

Results: The total blood loss was significantly lower in the prospective bipolar sealer group than the control group (1.19 (IQR 1.03-1.93) vs. 1.75 (IQR 1.13-2.07) L; p = 0.022). The transfusion rate was 8% in the bipolar sealer group, whereas 33% in the control group (p = 0.036). Furthermore, the mean number of blood units transfused was higher in the control group (0.4 ± 0.7 vs. 0.08 ± 0.3; p < 0.01). The Baseline Hematocrit and Operative time were directly associated with blood loss, whereas the bipolar use represented inverse predictor using multiple linear regression analysis.

Conclusion: After the first stage of a two-stage exchange for periprosthetic knee infection, several factors influence postoperative blood loss, including preoperative HCT level and operative time. The bipolar sealer effectively supports hemostasis, thus reducing blood loss and the need for transfusions.