Abstract
Educational Objectives
As a result of reading this article, physicians should be able to:
| 1. | Discuss the available blood-saving strategies for patients treated with total joint arthroplasty (TJA). | ||||
| 2. | State the potential strengths and limitations of using monopolar and bipolar sealer in TJA. | ||||
| 3. | Describe the available evidence regarding monopolar and bipolar sealer use in TJA. | ||||
| 4. | Describe the best situation for use of a bipolar sealer in TJA. | ||||
The goal of the clinical use of a bipolar blood-sealing system is to reduce perioperative blood loss in total joint arthroplasty (TJA). This study was performed to determine whether a bipolar sealer is safe and effective in TJA and whether there are any advantages over monopolar sealers. The authors searched electronic databases and reference lists of relevant articles; retrieved all published randomized, controlled trials concerning the subject; and then performed a meta-analysis. Nine clinical trials involving 871 patients were included. The results of the meta-analysis indicate that using a bipolar sealer in TJA could reduce total measured blood loss, intraoperative blood loss, and operative time, which was especially observed in revision TJA for infection and primary total knee arthroplasty without tourniquet use. However, there was no significant difference between the 2 groups in terms of calculated blood loss, hemoglobin decrease, transfusion requirements, length of stay, and complications. The results of the comparison between bipolar and monopolar sealers used in TJA indicate that the routine use of a bipolar sealer for TJA may be of limited benefit except in revision TJA and primary total knee arthroplasty without tourniquet use. In the future, more high-quality randomized, controlled trials are needed to provide robust evidence and confirm the best option. [Orthopedics. 2015; 38(12):757–763.]
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