This is the editor's interpretation of a paper published in the orthopaedic literature in 2007 - our attempt to make relevant medical articles accessible to lay readers. If you want to read the original it is easy to ask your librarian to obtain a reprint for you from any medical library.

Reference:

Everts PAM, Devilee RJJ, Oosterbos CJM, Mahoney CB, Schattenkerk ME, Knape JTA and van Zundert A. Autologous platelet gel and fibrin sealant enhance the efficacy of total knee arthroplasty: improved range of motion, decreased length of stay and a reduced incidence of arthrofibrosis. Knee Surg Sports Traumatol Arthrosc. 2007, 15(7):888-94.


This study concerns itself with the problem of bleeding into the joint and wound after total knee replacement, which may ultimately be the stimulus for arthrofibrosis. The objective of the study was to determine if using a natural sealant derived from the patient's own blood could reduce bleeding, improve the range of motion and decrease the complication of arthrofibrosis.

 

Procedure

Two similar groups of patients (165 in all) were selected prior to the knee replacement. Blood was taken from the each patient in the operating theatre and the blood was prepared into a platelet gel (PG), containing high numbers of platelets (which are important for blood clotting) and leukocytes (white blood cells) in a plasma base that has been activated with thrombin (a clotting factor) to form a viscous gel cloth. When placed in the wound, this gel will deliver concentrated platelets as well as PGF (platelet-derived growth factor) and TGF-B (transforming growth factor), both of which should improve wound healing.

Fibrin sealant was also prepared from platelet-poor plasma.

All patients had the same surgical procedure for the same indication (osteoarthritis), although the design of the prosthesis might vary. They all had spinal anaesthesia. A tourniquet was used in all patients to stop blood flow to the limb during surgery. After the surgery, the tourniquet was deflated, bleeding vessels were cauterised and the joint was rinsed clean with saline.

PG and fibrin sealant was applied to the wound edges in both groups. In the study group, 10 mls of PG was squirted into the back of the joint space, the posterior recesses and gutters (the cheek-like spaces at the back and sides of the joint) and the exposed bits of tibia and femur bone. The tissues were dried and then 10 mls of fibrin sealant was sprayed to the dried tissues, and then the joint capsule was closed with stitches and a final 10 mls of PG was injected around the stitches and around the patellar structures. Then the outer tissue layers were dried and sprayed with fibrin sealant and then the wound was closed with skin staples. 

The postoperative regime was then the same for both groups, and patients were seen and compared for 5 months.

Outcome

The results showed -

  • the haemoglobin levels remained significantly better in the study group
  • range of motion was significantly better in the study group
  • the incidence of arthrofibrosis requiring manipulation was significantly less in the study group

 

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