Bone Wax in Total Hip Arthroplasty

Bone wax used on the cut surface of the femoral neck during total hip arthroplasty (THA) using the direct anterior method can greatly minimize perioperative blood loss (PBL), says an article published in The Journal of Bone & Joint Surgery.

A major area of research now is perioperative blood management in total hip arthroplasty. Numerous strategies have been put forth to lessen perioperative blood loss since postoperative anemia is associated with morbidity, a slower rate of recovery, and a longer stay in the hospital. This investigation was carried out by Seyed Mohammad Javad Mortazavi and colleagues to determine the effectiveness of applying bone wax to the distal cut surface of the femoral neck in minimizing PBL during THA via the direct anterior method.

In a clinical experiment with randomization, 152 patients had THA using the direct anterior approach with or without bone wax (control) (n = 75). Three blinds were used in the investigation. On postoperative days (PODs) 3 and 5, apparent PBL (blood in sponges and suction canister) and total PBL were the main results (as calculated with the Good and Nadler methods). The incidental results were transfusion and complications.

Key Findings

• Age, body mass index, sex, preoperative hematologic/coagulation profile, American Society of Anesthesiologists score, etiology, preoperative hematologic/coagulation profile, anesthetic, intraoperative mean arterial pressure, or operation time did not significantly differ between the two groups.
• The wax group had considerably reduced apparent PBL, total PBL on POD3, total PBL on POD5, and total PBL, in milliliters, on POD5 with median values of 200 vs 370, 505.2 compared 747, and 536.7 versus 767.8 in the wax and control groups, respectively (p 0.001).
• There were no discernible variations in the transfusion and complication rates.

In conclusion, bone wax is readily available, affordable, and may be regarded as a standard component of the surgical method used in THA via the direct anterior route. There is no effect of this intervention on transfusion or complication rates.

Reference

Mortazavi, S. M. J., Razzaghof, M., Ghadimi, E., Seyedtabaei, S. M. M., Vahedian Ardakani, M., & Moharrami, A. (2022). The Efficacy of Bone Wax in Reduction of Perioperative Blood Loss in Total Hip Arthroplasty via Direct Anterior Approach. In Journal of Bone and Joint Surgery (Vol. 104, Issue 20, pp. 1805–1813). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.2106/jbjs.22.00376