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Leibold CS, Hecker A, Schmaranzer F, Siebenrock KA. Bone wax can lead to foreign body reaction and local osteolysis after open femoroacetabular impingement (FAI) surgery. Arch Orthop Trauma Surg 2025; 145:224. [PMID: 40186677 PMCID: PMC11972202 DOI: 10.1007/s00402-025-05821-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/07/2025] [Indexed: 04/07/2025]
Abstract
INTRODUCTION Bone wax is a haemostatic agent, widely used to prevent bleeding from bone surfaces. Despite its effectiveness in haemostatic control, it can lead to foreign body granuloma and osteolysis. Therefore, the aim of this study was to assess the rate and progress of osteolysis after surgical bone wax application. METHODS We included 425 patients between 01/2002 and 12/2006 that underwent offset correction for cam type femoroacetabular impingement with application of bone wax for homogeneous statistical cohort formation. Comparison was made to a similar cohort group undergoing offset correction without application of bone wax, including 479 patients between 01/2008 and 12/2012. Out of the study group, six hips in five patients presented with persisting pain and growing osteolysis on the X-rays in the area of the offset correction, and two underwent subsequent revision surgery. None of the patients in the cohort group presented with osteolysis. In both groups, patients who presented with persisting pain without radiological osteolysis had other determinable causes as labral tears, progressing osteoarthritis, trochanteric bursitis, and adhesions as suggested source of the pain. We measured the relative area of the osteolysis where present (area of osteolysis/area of femoral head in %) on lateral radiographs on the first postoperative X-rays and latest follow-up X-rays, with a mean follow-up time of 8.6 ± 2.5 years (range, 5-13 years). Histologic samples were taken at revision surgery. RESULTS The relative area of osteolysis increased in all hips from a directly postoperative median of 5.5% ± 2.7% (2.3-10.7%) to 11.2% ± 3.9% (7.1-17.3%) at last follow-up. In patients undergoing revision surgery for osteolysis, remaining wax as a foreign material with attached multinucleated giant cells and abundant mononuclear cells was detected histologically. CONCLUSION The intra-articular use of bone wax should be approached with caution and with awareness of the possible complications. TRIAL REGISTRATION NUMBER KEK 2018-00078, registered April 2018. LEVEL OF EVIDENCE level IV, retrospective case series.
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Affiliation(s)
- Christiane Sylvia Leibold
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University hospital, University of Bern, Freiburgstrasse, Bern, 3010, Switzerland.
| | - Andreas Hecker
- ArthroClinic Bern, Lindenhofspital, Bremgartenstrasse 117, 3012, Bern, Switzerland.
| | - Florian Schmaranzer
- Department of Diagnostic-, Interventional-, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, 3010, Switzerland
- Faculty of Medicine, Department of Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Klaus Arno Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University hospital, University of Bern, Freiburgstrasse, Bern, 3010, Switzerland.
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Wang R, Jin Z, Gao J, Ma Y, Han Q. Effectiveness and Biocompatibility Evaluation of a Novel Absorbable Bone Wax Used in Bone Tissue. Tissue Eng Part C Methods 2024; 30:353-363. [PMID: 39113538 DOI: 10.1089/ten.tec.2024.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2024] Open
Abstract
This study aims to determine the hemostatic effectivity and biocompatibility of a novel absorbable bone wax in comparison with a commercially available product. Eighteen small fat-tail sheep were used to simulate clinical surface bleeding of sternal injury. Hemostasis effectiveness, the degree of bone healing, micro-computed tomography, and histopathology were evaluated over a period after the application of the material to the surgically created wound. The absorbable bone wax used in the study stopped bleeding immediately and did not affect bone healing. The histopathological results also showed that there were no complications associated with the new material. The results showed that the new absorbable bone wax used in this study was effective and biocompatible.
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Affiliation(s)
- Rui Wang
- Division of Biomaterials, National Institutes for Food and Drug Control, Beijing, China
| | - Zejian Jin
- Cardiothoracic Surgery Center, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Jianfeng Gao
- Beijing Ehanri Medical Technology Co. Ltd., Beijing, China
| | - Yan Ma
- Cardiothoracic Surgery Center, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Qianqian Han
- Division of Biomaterials, National Institutes for Food and Drug Control, Beijing, China
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Liu X, Zhang F, Qiu Y, Yin Y, Lv X, Gao M, Shen H, Liu L. Reconstruction of the Large Frontal Sinus Defect With the Small Supporting Bone Pieces in Neurosurgical Anterior Skull Base Surgery. World Neurosurg 2024; 186:e125-e133. [PMID: 38521218 DOI: 10.1016/j.wneu.2024.03.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Large defects of frontal sinus (FS) might be difficult to manage effectively. Mismanagement of the large defects could lead to serious postoperative complications in anterior skull base surgery. This study introduces a simple and reliable method applying small supporting bone pieces to cover or insert into large FS defects, then the large defect of FS was transformed into the small defects which was sealed by bone wax successfully. METHODS Eleven patients underwent anterior skull base surgery for lesions or aneurysms, with the reconstruction of large FS defects by small supporting bone pieces. During craniotomy, mild violations of the FS mucosa were spared and sterilized, while severe violations required mucosal removal. Small supporting bone pieces were obtained from the inner plate of the bone flap and carefully covered or inserted into the large defects. The large defects were transformed into some small ones, which could be sealed effectively by bone wax. Demographic, intraoperative, and postoperative complication data were collected. RESULTS Four patients had severe mucosal violations requiring removal, while 7 had mild violations sparing the mucosa. All underwent effective reconstruction with small supporting bone pieces. Median follow-up was 6 months. All cases showed effective FS morphology reconstruction, with no FS-related complications. CONCLUSIONS Applying the small supporting bone pieces for large FS defect reconstruction can restore the FS morphology, preserve physiological function, and avoid postoperative complications.
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Affiliation(s)
- Xi Liu
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yankai Qiu
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yibo Yin
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xing Lv
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mengyu Gao
- Department of Cardiology, Fourth Hospital of Harbin, Harbin, China
| | - Hong Shen
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Liu
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Lee SS. Post-laparotomy heterotopic ossification of the xiphoid process: A case report. World J Clin Cases 2023; 11:8568-8573. [PMID: 38188202 PMCID: PMC10768515 DOI: 10.12998/wjcc.v11.i36.8568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Heterotopic ossification (HO) represents all types of extraskeletal ossification in the body. It occurs in various areas, including the skin, subcutaneous tissue, muscle, and joints. Surgical excision is recommended for symptomatic HO. Postoperative radiotherapy, oral nonsteroidal anti-inflammatory drugs, and topical sealants, such as bone wax, have been recommended as preventive measures. As HO is rare in occurrence, these recommendations are based on personal experiences, and there is a lack of information on individualized treatments depending on its location. CASE SUMMARY A 62-year-old male was admitted for symptomatic HO along a laparotomy scar. Surgical excision was performed for an 11 cm-sized ossification originating from the xiphoid process, and bone wax was applied to the excisional margin. However, the surgical wound failed to heal. After several weeks of saline-soaked gauze dressing, delayed wound closure was performed. The patient was finally discharged eight weeks after the excision. Because HO can occur in various areas of the body, a treatment strategy that may be effective for some may not be for others. Bone wax has been used as a topical sealant over excisional margins in the shoulder, elbow, and temporomandibular joints. However, in our case, its application on an abdominal surgical wound delayed its primary healing intention. The valuable lesson was that, when choosing a treatment method for HO based on available research data, its location must be considered. CONCLUSION Complete excision should be the priority treatment option for symptomatic HO along the laparotomy scar. Bone wax application is not recommended.
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Affiliation(s)
- Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital, Daegu 41944, South Korea
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
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Li H, Huang C, Ding ZC, Liu ZH, Zhao EZ, Zhou ZK. Bone wax reduces blood loss after total hip arthroplasty: a prospective, randomized controlled study. Front Med (Lausanne) 2023; 10:1246733. [PMID: 37731717 PMCID: PMC10507698 DOI: 10.3389/fmed.2023.1246733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Background Previous studies have demonstrated the efficacy of bone wax in reducing blood loss in various orthopedic surgeries. However, the effect of bone wax on total hip arthroplasty (THA) remains unclear. The objective of this study was to assess the efficacy of bone wax in THA. Methods We enrolled 104 patients in this randomized controlled trial. These patients were randomized (1:1) to either the bone wax or control group. The primary outcome was total blood loss after THA. The secondary outcomes included serum hemoglobin (Hb) level, change in Hb level, lower limb diameters on the first and third postoperative day (POD), range of motion at discharge, length of postoperative hospital stay, and adverse events. Results Patients in the bone wax group had significantly lower total blood loss on PODs 1 and 3 (p < 0.05). Moreover, patients in the bone wax group performed better in terms of postoperative serum Hb level, change in Hb level on PODs 1 and 3, and length of postoperative hospital stay (all p < 0.05). Patients in the bone wax group did not experience any bone wax-related adverse events. Conclusion Bone wax administration in THA significantly reduced perioperative blood loss. Therefore, bone wax is promising for optimizing blood-conserving management protocols in THA. Clinical trial registration [https://clinicaltrials.gov/], identifier [ChiCTR2100043868].
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Affiliation(s)
- Hao Li
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chao Huang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Zi-Chuan Ding
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Zun-Han Liu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
- Department of Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - En-Ze Zhao
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Zong-Ke Zhou
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
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Guo Y, Fu X, Yin W, Jiang Z, Kuang Y, Wu Z, Cao Y, Tan J, Jiang XJ. A practical and economical method for frontal sinus reconstruction after frontal craniotomy: A single-center experience with 140 patients. Front Surg 2022; 9:919276. [PMID: 35937594 PMCID: PMC9346075 DOI: 10.3389/fsurg.2022.919276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background Frontal sinus exposure is a common consequence of frontal craniotomy. Cerebrospinal fluid leakage and infection are the major postoperative complications that may occur as a result of the open frontal sinus. The successful filling of the open frontal sinus provides an approach to prevent significant complications caused by frontal sinus exposure. Objective This article describes a new technique to reconstruct the exposed frontal sinus cavity with the combined application of gelatin sponge and a vascularized pericranial flap. Methods A total of 140 patients underwent frontal sinus reconstruction using gelfoam and vascularized pericranial flaps from 2016 to 2021. Gelatin sponge was used to fill the frontal sinus, and a vascularized pericranial flap was used to cover the frontal sinus when the bone flap was retracted. Results Postoperative cerebrospinal fluid leakage and infection did not occur in any patient. Conclusion Our results validated the effectiveness of our technique in the prevention of exposed frontal sinus-related postoperative complications.
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Affiliation(s)
- Youwei Guo
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xianyong Fu
- Department of Neurosurgery, Hospital of the Chinese People’s Liberation Army, Third Military Medical University, Chongqing, China
| | - Wen Yin
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhipeng Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yirui Kuang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhaoping Wu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yudong Cao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jun Tan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Jun Tan Xing-jun Jiang
| | - Xing-jun Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Jun Tan Xing-jun Jiang
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Choi SY, Rhim J, Heo SA, Han WJ, Kim MH, Ha CW. Efficacy and safety of a novel hemostatic material, BoneStat, compared with Ostene and Bone Wax in a rat calvarial defect model. Int J Artif Organs 2021; 44:734-747. [PMID: 34387533 DOI: 10.1177/03913988211021428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemostasis has critical significance during surgical procedures. Bone Wax has traditionally been commonly used for bone hemostasis despite well-documented undesirable side effects: hindering osteogenesis and induction of inflammatory reactions with consequent increase in infection rates. A later developed formulation, Ostene, offers an alternative to Bone Wax with lesser undesired effects. In this study, BoneStat, a newly developed bone hemostatic formulation comprising water-soluble alkylene oxide co-polymers, was evaluated for water solubility, hemostatic efficacy, ease of handling, bone healing efficacy, and inflammatory reactions compared with Bone Wax and Ostene in a rat calvarial defect model. More than 95% of BoneStat was dissolved in water within 48 h, as was Ostene, but not Bone Wax. The time to hemostasis using BoneStat was significantly faster than with Ostene or Bone Wax. BoneStat also improved ease of handling compared to Ostene or BoneWax. BoneStat- and Ostene-treated groups constantly showed better bone healing than with Bone Wax. The BoneStat and Ostene groups presented no evidence of chronic inflammation reaction contrary to Bone Wax. These results suggest improved hemostasis, ease of handling, non-hindering bone healing, and unnoticeable chronic inflammatory reactions with BoneStat. Thus, Bonestat is a useful and reliable formulation for mechanical hemostasis.
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Affiliation(s)
- Seon Young Choi
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06355, Korea.,Stem Cell & Regenerative Medicine Research Institute, Samsung Medical Center, Gangnam-Gu, Seoul, South Korea
| | - Jiheon Rhim
- Stem Cell & Regenerative Medicine Research Institute, Samsung Medical Center, Gangnam-Gu, Seoul, South Korea
| | - Seon A Heo
- Stem Cell & Regenerative Medicine Research Institute, Samsung Medical Center, Gangnam-Gu, Seoul, South Korea
| | - Woo-Jung Han
- Stem Cell & Regenerative Medicine Research Institute, Samsung Medical Center, Gangnam-Gu, Seoul, South Korea
| | - Myung Hee Kim
- Stem Cell & Regenerative Medicine Research Institute, Samsung Medical Center, Gangnam-Gu, Seoul, South Korea
| | - Chul-Won Ha
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06355, Korea.,Stem Cell & Regenerative Medicine Research Institute, Samsung Medical Center, Gangnam-Gu, Seoul, South Korea.,Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Kim JK, Ro DH, Han SM, Lee MC, Han HS. Efficacy and Safety of Bioabsorbable Bone Hemostatic Agent in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. Clin Appl Thromb Hemost 2021; 27:10760296211023589. [PMID: 34114501 PMCID: PMC8202333 DOI: 10.1177/10760296211023589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Although a bioabsorbable bone hemostatic agent (BBHA) was developed approximately 20 years ago to overcome the shortcomings of conventional bone wax, its bleeding control capacity has not yet been studied. This study was aimed at investigating the efficacy and safety of BBHA in total knee arthroplasty (TKA). Sixty-two patients who underwent unilateral primary TKA for knee osteoarthritis were included and randomized to the control or BBHA group. Before releasing the tourniquet, BBHA was applied on the bone-cut surface that was not covered by implants. The primary variable was the drainage volume during the postoperative period. The secondary outcomes were total estimated blood loss (EBL), hemoglobin level, hematocrit level, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, range of motion (ROM), pain visual analog scale (VAS) score, and rate of complications. There were no significant differences in drainage volume or EBL between the 2 groups. Hemoglobin and hematocrit levels were higher in the BBHA group during the 4-week postoperative period; however, the intergroup differences were not significant. The ESR, CRP, ROM, and pain VAS scores in the BBHA group were not significantly different from the corresponding values in the control group. No specific complications were observed. Although BBHA was found to be safe without complications, it did not decrease bleeding after TKA in general cases. Further studies are necessary to evaluate the efficacy of BBHA in patients with coagulation problems.
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Affiliation(s)
- Jong-Keun Kim
- Department of Orthopedic Surgery, 371135Hanil General Hospital, Dobong-gu, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopedic Surgery, 37990Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
| | - Sang-Min Han
- Department of Orthopedic Surgery, 371135Hanil General Hospital, Dobong-gu, Seoul, South Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, 37990Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, 37990Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
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Hecker A, Di Maro A, Liechti EF, Klenke FM. Avoiding unconscious injection of vial-derived rubber particles during intra-articular drug administration. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100164. [DOI: 10.1016/j.ocarto.2021.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022] Open
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Shin KH, Choe JH, Jang KM, Han SB. Use of bone wax reduces blood loss and transfusion rates after total knee arthroplasty. Knee 2020; 27:1411-1417. [PMID: 33010755 DOI: 10.1016/j.knee.2020.07.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/18/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unnecessary costs and complications can be reduced by minimizing blood loss and allogeneic blood transfusion in cases of total knee arthroplasty (TKA). This study evaluated the effectiveness of bone wax in reducing blood loss and transfusion rates after TKA. METHODS A total of 674 consecutive TKAs performed for degenerative osteoarthritis were retrospectively reviewed. Propensity score-matching and inverse probability of treatment weighting analyses were performed for demographics, comorbidities, use of medications, preoperative laboratory findings and radiologic prosthetic coverage of osteotomy surface. In the bone wax group, bone wax (2.5 g) was applied to the uncovered bone section around the prostheses along with the topical administration of tranexamic acid, whereas hemostasis was achieved in the control group with the topical administration of tranexamic acid. Intergroup comparisons of estimated blood loss, decreases in hemoglobin (Hb) levels, and transfusion rates were performed. RESULTS The mean estimated blood loss and volume of postoperative drainage were reduced in the bone wax group. The maximum decreases in Hb levels on postoperative days 1, 3, 5, and 7 were 1.8 ± 0.7 ml, 2.5 ± 0.8 ml, 2.7 ± 0.8 ml, and 2.8 ± 0.8 ml in the bone wax group and 2.1 ± 1.0 ml, 3.0 ± 1.2 ml, 3.1 ± 1.1 ml, and 3.2 ± 1.1 ml in the control group, respectively. The postoperative transfusion rates decreased markedly from 8.8% to 2.0% when bone wax was used. CONCLUSIONS The use of bone wax significantly reduced blood loss, decreased Hb levels, and the risk of transfusion. LEVEL OF EVIDENCE Level III, Therapeutic studies.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jeong-Hun Choe
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
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Pennestrì F, Maffulli N, Sirtori P, Perazzo P, Negrini F, Banfi G, Peretti GM. Blood management in fast-track orthopedic surgery: an evidence-based narrative review. J Orthop Surg Res 2019; 14:263. [PMID: 31429775 PMCID: PMC6701001 DOI: 10.1186/s13018-019-1296-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 07/25/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Innovations able to maintain patient safety while reducing the amount of transfusion add value to orthopedic procedures. Opportunities for improvement arise especially in elective procedures, as long as room for planning is available. Although many strategies have been proposed, there is no consensus about the most successful combination. The purpose of this investigation is to identify information to support blood management strategies in fast-track total joint arthroplasty (TJA) pathway, to (i) support clinical decision making according to current evidence and best practices, and (ii) identify critical issues which need further research. METHODS AND MATERIALS We identified conventional blood management strategies in elective orthopedic procedures. We performed an electronic search about blood management strategies in fast-track TJA. We designed tables to match every step of the former with the latter. We submitted the findings to clinicians who operate using fast-track surgery protocols in TJA at our research hospital. RESULTS Preoperative anemia detection and treatment, blood anticoagulants/aggregants consumption, transfusion trigger, anesthetic technique, local infiltration analgesia, drainage clamping and removals, and postoperative multimodal thromboprophylaxis are the factors which can add best value to a fast-track pathway, since they provide significant room for planning and prediction. CONCLUSION The difference between conventional and fast-track pathways does not lie in the contents of blood management, which are related to surgeons/surgeries, materials used and patients, but in the way these contents are integrated into each other, since elective orthopedic procedures offer significant room for planning. Further studies are needed to identify optimal regimens.
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Affiliation(s)
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Fisciano, Italy. .,San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Orthopedica" Department, Hospital of Salerno, Salerno, Italy. .,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, London, England.
| | - Paolo Sirtori
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
| | - Paolo Perazzo
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
| | - Francesco Negrini
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy.,Vita-Salute San Raffaele University, Scientific Direction, Milan, Italy
| | - Giuseppe M Peretti
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy.,University of Milan, Department of Biomedical Sciences for Health, Milan, Italy
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12
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Different Materials for Plugging a Dehiscent Superior Semicircular Canal: A Comparative Histologic Study Using a Gerbil Model. Otol Neurotol 2019; 40:e532-e541. [DOI: 10.1097/mao.0000000000002205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Zhou H, Ge J, Bai Y, Liang C, Yang L. Translation of bone wax and its substitutes: History, clinical status and future directions. J Orthop Translat 2019; 17:64-72. [PMID: 31194062 PMCID: PMC6551357 DOI: 10.1016/j.jot.2019.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/25/2022] Open
Abstract
Bone wax, primarily composed of beeswax and softening agent, is a century-old material used to control bleeding of disrupted bone surfaces by acting as a mechanical barrier to seal the wound. The current bone wax products are commonly packed in easy-to-open foil in the form of sterile sticks or plates, with excellent malleability and smooth consistency, enabling cost-effective and easy handling approach for bleeding control. It has also been reported that the inert nature of bone wax causes complications including foreign body reaction, infection promotion and bone healing inhibition. With the advances in biomaterials and the market boost of bone haemostatic materials, the arena of bone wax substitute research has expanded to a wide spectrum of material formulations and forms. However, the development of substitutes of bone wax for translation is a pivotal yet challenging topic because currently a potential candidate is recommended to be just as simple to use, effective and inexpensive to produce as traditional bone wax but also be absorbable and osteogenic. This review provides an overview of bone wax including its history, clinical applications and associated complication. In addition, emerging substitutes of bone wax and outlooks of future directions including the standardised evaluation methods are also discussed as an effort to catalyse the innovation and translation of bone haemostatic agents in the near future. The translational potential of this article: Occurrence of osseous haemorrhage is common in surgically incised or traumatically fractured bone. It is essential to stop bone bleeding to avoid further pathologic consequences such as tissue necrosis and eventually mortalities due to blood loss. Medical sterile bone wax is a classical material for haemostasis of bone during orthopaedic surgeries, thoracic surgeries, neurological surgeries and so on. Along with its widespread use, complications such as foreign body reaction, bone healing inhibition and infection promotion associated with bone wax are observed. With the growing knowledge in biomaterials and the boost of market of bone haemostatic materials, bone wax substitute research is thriving. An overview of bone and its substitutes together with evolution of their design criteria is carried out in this work, providing information for the innovation and translation of bone haemostatic agents in the near future.
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Affiliation(s)
- Huan Zhou
- Center for Health Science and Engineering, Tianjin Key Laboratory of Materials Laminating Fabrication and Interface Control Technology, School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, China
- School of Mechanical Engineering, Jiangsu University of Technology, Jiangsu 213001, China
- International Research Center for Translational Orthopaedics (IRCTO), Jiangsu 215006, China
| | - Jun Ge
- Orthopedic Institute, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu 215006, China
| | - Yanjie Bai
- Key Laboratory of Hebei Province for Molecular Biophysics, Institute of Biophysics, School of Sciences, Hebei University of Technology, Tianjin 300401, China
| | - Chunyong Liang
- Center for Health Science and Engineering, Tianjin Key Laboratory of Materials Laminating Fabrication and Interface Control Technology, School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, China
| | - Lei Yang
- Center for Health Science and Engineering, Tianjin Key Laboratory of Materials Laminating Fabrication and Interface Control Technology, School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, China
- Orthopedic Institute, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu 215006, China
- International Research Center for Translational Orthopaedics (IRCTO), Jiangsu 215006, China
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Intracranial foreign material granulomas after cranial surgery. Acta Neurochir (Wien) 2018; 160:2069-2075. [PMID: 30187219 DOI: 10.1007/s00701-018-3663-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Various synthetic materials are used in neurosurgery and left in place intentionally during surgery for several purposes such as hemostasis, dural closure, or cranioplasty. Although leaving such substances in surgical sites is considered safe, in general, foreign body granuloma may occur months or years after intracranial surgery. Thus, far relatively little is known about treatment and outcome of such lesions. METHODS A systematic review of 3466 histopathological examinations after cranial surgeries achieved over a 13-year period was performed. After excluding patients with Teflon granulomas or infection, a total of 12 patients with foreign body granulomas induced by synthetic material used in a prior surgery were identified. Patient records, imaging studies, and histopathological data were analyzed. Furthermore, postoperative outcome was assessed. RESULTS Mean age at the second surgery was 51 years (range, 11-68 years). The median time between the primary and the secondary surgery was 13 months (range, 1-545 months). Eight patients (75%) presented with signs and symptoms related to the foreign body granulomas. Total resection of the foreign body granulomas was performed in all patients. The granulomas were induced by oxidized cellulose polymer (n = 6), suture material (n = 3), Gelfoam (n = 1), methylmethacrylate (n = 1), and bone wax (n = 1). The mean postoperative follow-up time was 54 months (range 1-137 months). There was symptomatic improvement in all instances. Imaging studies did not demonstrate any recurrence. CONCLUSION Despite its rarity, foreign body granuloma should be taken into consideration in the differential diagnosis of intracranial mass lesions especially in cases of suspected tumor recurrence after prior surgery. The pathogenesis of foreign body granuloma still needs further clarification. Our study demonstrates that they have good prognosis after surgical removal.
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Themistoklis T, Theodosia V, Konstantinos K, Georgios DI. Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now? World J Orthop 2017; 8:441-454. [PMID: 28660135 PMCID: PMC5478486 DOI: 10.5312/wjo.v8.i6.441] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
Total knee replacement (TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions (ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.
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Moo IH, Chen JYQ, Pagkaliwaga EH, Tan SW, Poon KB. Bone Wax Is Effective in Reducing Blood Loss After Total Knee Arthroplasty. J Arthroplasty 2017; 32:1483-1487. [PMID: 28089184 DOI: 10.1016/j.arth.2016.12.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/11/2016] [Accepted: 12/15/2016] [Indexed: 02/01/2023] Open
Abstract
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 g 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 2 groups. The preoperative serum hemoglobin levels were comparable between the 2 groups. The drop in serum hemoglobin levels at 24 h post-TKA was 1.6 ± 0.9 and 2.1 ± 1.1 g/dL in the bone wax and control groups respectively (P = .021), while the drop in serum hemoglobin levels at 72 h post-TKA was 2.7 ± 1.1 and 3.6 ± 1.2 g/dL respectively (P = .013). Total blood loss at 72 h post-TKA was 987.9 and 1183.5 mL for the bone wax and control groups respectively (P = .017). There was no adverse event associated with the use of bone wax at the 3-month follow-up. CONCLUSION The application of bone wax in TKA was safe and effective for reducing total blood loss and maintaining higher hemoglobin levels.
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Affiliation(s)
- Ing H Moo
- Department of Orthopaedics Surgery, Changi General Hospital, Singapore
| | - Jerry Y Q Chen
- Department of Orthopaedics Surgery, Changi General Hospital, Singapore
| | | | - See W Tan
- Department of Orthopaedics Surgery, Changi General Hospital, Singapore
| | - Kein B Poon
- Department of Orthopaedics Surgery, Changi General Hospital, Singapore
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Özer A, Köstü B. Use of Gelatin Sponge Affects Postoperative Morbidity In Cesarean Section Patients. Med Sci Monit 2017; 23:1141-1145. [PMID: 28258978 PMCID: PMC5347987 DOI: 10.12659/msm.899860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background This study aimed to determine the effects of use of a local hemostatic gelatin sponge (GS) on postoperative morbidity in patients undergoing cesarean section (CS). Material/Methods The records of 318 patients who underwent CS surgery were retrospectively evaluated. Group 1 consisted of 59 patients with gelatin sponge (GS) applied, and Group 2 consisted of 259 patients with no GS applied. The groups were compared for time to the first flatus, nausea and vomiting, requirement for anti-emetic drugs, development of postoperative ileus, and the length of hospitalization. Results The patients in Group 1 and Group 2 were statistically similar in mean age, gravida, parity, and body mass index (BMI) (p=0.352, p=0.275, p=0.458, and p=0.814, respectively). No significant difference was determined in the number of patients with nausea, vomiting, anti-emetic drug use, febrile morbidity, and postoperative ileus (p=0.063, p=0.436, p=328, p=0.632, and p=0.179, respectively). Time to the first flatus and length of hospitalization were significantly longer in Group 2 (p<0.001 and p<0.001, respectively). Conclusions Delay in recovery of bowel motility may be due to the local hypersensitivity reaction caused by GS and/or dislocation of this local hemostat. Women who receive gelatin sponge treatment during CS should be monitored closely for the recovery of postoperative intestinal motility.
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Affiliation(s)
- Alev Özer
- Department of Obstetrics and Gynecology, Kahramanmaraş Sütçü İmam University Hospital, Kahramanmaraş, Turkey
| | - Bülent Köstü
- Department of Obstetrics and Gynecology, Kahramanmaraş Sütçü İmam University Hospital, Kahramanmaraş, Turkey
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Sadoni H, Arti H. Unusual Foreign Bone Fragment in Femoral Open Fracture. Trauma Mon 2016; 21:e22957. [PMID: 27218050 PMCID: PMC4869435 DOI: 10.5812/traumamon.22957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 04/24/2015] [Accepted: 06/28/2015] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Femoral shaft fracture is one of the typical bone fractures due to high energy trauma and may occur as an open fracture. Some foreign materials may enter the fracture site such as sand, cloth particles and so on. CASE PRESENTATION A 28-year-old motorcycle riding military member and his collaborator were received in the hospital because of multiple traumas due to a fall in a hollow during a surveillance mission. His collaborator died because of head trauma and multiple severe open fractures. When fixing the patients femoral fracture, a large femoral butterfly fragment was removed from the patient's thigh as a foreign segment. The patient's femur was fixed with a plate and screws. No femoral defect was detected during surgery or post-operative X-rays and CT scan. The removed segment was not a part of the patient's femur. CONCLUSIONS Surgical and post-surgical findings showed that this segment was not related to the patient's femur. The foreign segment may have belonged to the other victim of this trauma.
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Affiliation(s)
- Hanon Sadoni
- Department of Orthopedic Surgery, Ahvaz Jundishapur University of Medical Sciences (AJUMS), Ahvaz, IR Iran
- Corresponding author: Hanon Sadoni, Department of Orthopedic Surgery, Ahvaz Jundishapur University of Medical Sciences (AJUMS), Ahvaz, IR Iran. Tel: +98-9122131206; +98-6133335935, E-mail:
| | - Hamidreza Arti
- Department of Orthopedic Surgery, Ahvaz Jundishapur University of Medical Sciences (AJUMS), Ahvaz, IR Iran
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