Symbol: Effectiveness of fibrin sealants in reducing blood drainage after total knee arthroplasty

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BACKGROUND:There is no systematic evaluation about effectiveness and safety of fibrin sealants in reducing blood drainage after total knee arthroplasty.OBJECTIVE:To systematically evaluate the effectiveness and safety of fibrin sealants in reducing blood drainage after total knee arthroplasty.METHODS:A computer-based search was performed in PubMed database, Cochrane Library, EMBASE database, OVID database, China Journal Full-text database, Chinese Biomedicine database and Chinese Scientific Journals Full-text database for randomized controlled trials from 1975 to October 2012 and manual search was performed in the relevant orthopedic journals. The Chinese key words were “total knee arthroplasty, knee joint replacement, fibrin sealants, tissue glue”. The quality of the extracted data was evaluated by Jadad methodological assessment, and Revman 5.1 software was used for the statistical analysis. The blood drainge, rate of transfusion, the average hospital stay, range of motion of knee joint and the rate of deep vein thrombosis after total knee arthroplasty were observed.RESULTS AND CONCLUSION:A total of 310 cases in five clinical prospective randomized controlled trials were included. Totally 168 patients were enrolled in the fibrin sealants group and 142 in the control group. Meta-analysis results showed that fibrin sealants could reduce the amount of blood drainage significantly in fibrin sealant group [weighted mean difference (MD)=-386.88, 95% confidence interval (CI): -583.66-, -190.10, P < 0.01]; moreover, the rate of transfusion in fibrin sealants group was significantly lower than that in the control group [relative risk (RR)=0.53, 95%CI: 0.42, 0.83, P < 0.01]. Fibrin sealants could reduce the average hospital stay in fibrin sealant group (MD=-3.56, 95%CI: -4.97-2.16, P < 0.01), meanwhile, it could improve the range of motion of knee joint in fibrin sealant group (MD=16.48, 95%CI: 5.94-27.02, P < 0.01). There was no significant difference of deep vein thrombosis between two groups (RR=1.18, 95%CI: 0.18-7.84, P=0.86). The results indicated that fibrin sealants could significantly reduce the blood drainage and rate of transfusion after total knee arthroplasty and had a good hemostatic effect, but there was still no evidence that the fibrin sealants could increase the incidence of deep vein thrombosis.

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