The Ambiguous Role of Hemostatic Matrix in Total Knee Arthroplasty: A Randomized Controlled Trial

Vol 31 | Issue 1 | Jan – Jun 2018 | page: 15-18 | Appu Benny Thomas, Jacob Varghese, Gnanavel, J C Vinay, Biju Pankappilly.

Authors: Appu Benny Thomas [1], Jacob Varghese [1], Gnanavel [1], J C Vinay [1], Biju Pankappilly [1]

[1] Department of Orthopedics, VPS Lakeshore Hospital and Research Center, Kochi, Kerala, India.

Address of Correspondence
Dr. Appu Benny Thomas
Department of Orthopedics,
VPS Lakeshore Hospital and Research Center, Kochi, Kerala, India


Background: Blood loss which is one of the major complications following major surgeries and leads to significant morbidity and substantially increases the need for blood transfusions. Use of hemostatic agent’s intraoperatively is one of the widely used techniques to reduce blood loss. The use of hemostatic agents to reduce blood loss has been widely studied with mixed results. The aim of this study was to evaluate whether the use of Floseal®, a hemostatic most commonly used in our hospital as an adjuvant to conventional hemostasis reduces blood loss and reduces the requirement of transfusions postoperatively in patients undergoing total knee arthroplasty (TKA).
Materials and Methods: This study was a prospective randomized controlled trial conducted on 67 female patients operated between January 2012 and January 2013 with the primary endpoint being blood loss as estimated by a decrease in hemoglobin (Hb) on days 0, 1, and 4 postoperatively. The number of transfusions required postoperatively was also assessed. The patients were divided into two groups: Group A and Group B. Group A consisted of 35 patients in whom the hemostatic was not used. Group B consisted of 32 patients in whom 5ml of hemostatic matrix Floseal®. All the statistical analyses were performed using GraphPad Prism 7.0. Results: Sixty-seven patients participated in the study, and the data of all the patients were analyzed. The demographic data and the mean percentage decrease of Hb from pre-operative values were analyzed which did not show any statistical difference. The odds ratio and relative risk were less than one and were not statistically significant.
Conclusion: The use of a hemostatic agent does not necessarily decrease the need for blood transfusions postoperatively, and the role of hemostatic agents in TKA for reducing blood loss remains uncertain.
Keywords: Blood transfusion, Hemostatic Matrix, Total Knee Arthroplasty.


1. Sundaram CP, Keenan AC. Evolution of hemostatic agents in surgical practice. Indian J Urol 2010;26:374-8.

2. Kim HJ, Fraser MR, Kahn B, Lyman S, Figgie MP. The efficacy of a thrombin-based hemostatic agent in unilateral total knee arthroplasty: A randomized controlled trial. J Bone Joint Surg Am 2012;94:1160-5.

3. Wang C, Han Z, Zhang T, Ma JX, Jiang X, Wang Y, et al. The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: A meta-analysis. J Orthop Surg Res 2014;9:90.

4. Widman J, Isacson J Surgical hemostasis after tourniquet release does not reduce blood loss in knee replacement. A prospective randomized study of 81 patients. Acta Orthop Scand 1999;70:268-70.

5. Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY. Tourniquet use in total knee arthroplasty: A meta-analysis. Knee Surg Sports Traumatol Arthrosc 2011;19:1121-30.

6. Jones HW, Savage L, White C, Goddard R, Lumley H, Kashif F, et al. Postoperative autologous blood salvage drains – Are they useful in primary uncemented hip and knee arthroplasty? A prospective study of 186 cases. Acta Orthop Belg 2004;70:466-73.

7. Iwai T, Tsuji S, Tomita T, Sugamoto K, Hideki Y, Hamada M. Repeat-dose intravenous tranexamic acid further decreases blood loss in total knee arthroplasty. Int Orthop 2013;37:441-5.

8. Sepah YJ, Umer M, Ahmad T, Nasim F, Chaudhry MU, Umar M. Use of tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement. J Orthop Surg Res 2011;6:22.

9. Carlin G, Karlström G, Modig J, Saldeen T. Effect of dextran on fibrinolysis inhibition activity in the blood after major surgery. Acta Anaesthesiol Scand 1980;24:375-8.

10. Choi YJ, Hwang JK, Ahn HS, Bae EJ, Kim CH, Kim E. The effect of aprotinin for reducing blood loss and amount of transfusion in total knee arthroplasty. J Korean Knee Soc 2005;17:241-5.

11. Camarasa MA, Olle G, Serra-Prat M, Martín A, Sanchez M, Ricos P, et al. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: A randomized clinical trial. Br J Anaesth 2006;96:576-82.

12. Gazzeri R, Galarza M, Alfier A. Safety biocompatibility of gelatin hemostatic matrix (Floseal and Surgiflo) in neurosurgical procedures. Surg Technol Int 2012;22:49-54.

13. Harris JA, Uppal S, Kamdar N, Swenson CW, Campbell D, Morgan DM. A retrospective cohort study of hemostatic agent use during hysterectomy and risk of post-operative complications. Int J Gynaecol Obstet 2017;136:232-7.

14. Di Francesco A, Flamini S, Fiori F, Mastri F. Safety biocompatibility of gelatin hemostatic matrix (Floseal and Surgiflo) in neurosurgical procedures. Indian J Orthop 2013;47:474-81.

15. Bloomfield MR, Klika AK, Molloy RM, Froimson MI, Krebs VE, Barsoum WK. Prospective randomized evaluation of a collagen/thrombin and autologous platelet hemostatic agent during total knee arthroplasty. J Arthroplasty 2012;27:695702.

How to Cite this Article: Thomas A B, Varghese J, Gnanavel, Vinay J C, Pankappilly B. The Ambiguous Role of Hemostatic Matrix in Total Knee Arthroplasty: A Randomized Controlled Trial. Kerala Journal of Orthopaedics Jan- Jun 2018;31(1):12-15 .


(Abstract)      (Full Text HTML)   (Download PDF)