Clinical Outcomes for Orthopaedic Surgery

Marulanda et al. demonstrated a statistically significant difference in intra- (p = 0.002) and post-operative (p = 0.001) blood loss using the Aquamantys System. They also demonstrated a reduction in both allogeneic and autologous transfusion rates from 28% to 23% and 24% to 12% respectively. Transfusions overall were significantly reduced from 53% to 20% (p = 0.005).

This paper emphasizes the need for a multi-disciplinary team of physicians with a focus on a rational use of allogeneic blood. Intra-operative methods employing an RF tissue-sealing effect are indicated for minimizing blood loss and have shown promise in all areas of joint reconstruction.

This study reviewing infected hip revision procedures demonstrated significantly lower total blood loss (998 mL vs. 1330 mL; p = 0.038), change in hemoglobin (2.32 units vs. 3.99 units; p = 0.013) and OR time (134 min vs. 157.5 min; p = 0.039) in the bipolar sealer group with a cost-neutral to cost savings of $1300 based on OR space allocation.

This study demonstrated that when a bipolar sealer is used as part of a comprehensive blood management program, the following benefits may be observed: 1) may be more effective for preventing blood transfusion than a cell saver; and 2) may contribute to minimizing cost and complications associated with intra-operative blood loss and transfusions.

Morris MJ, Berend K, Lombardi AV. Haemostasis in anterior supine intermuscular total hip arthroplasty: pilot study comparing standard electrocautery and a bipolar sealer. Surgical Technology International 2010; 20:352-6.

Ulrich S, Kyle B, Johnson AJ et al. Strategies to reduce blood loss in lower extremity total joint arthroplasty. Surgical Technology International XX 2010; 341-347.

Menendez M, Ishihara A, Weisbrode S et al. Radiofrequency energy on cortical bone and soft tissue: a pilot study. Clinical Orthopaedics and Related Research 2010, 468(4): 1157-64.

Rosenberg AG. Reducing blood loss in total joint surgery with a saline-coupled bipolar sealing technology.J Arthroplasty 2007; 22(4 Suppl 1), 82-85.

Paliotta V, Martelli G, Tucciarone Ne et al. The use of a bipolar sealer for hemostasis in major orthopaedic surgery. Total hip and knee arthroplasty and spinal surgery. Journal of Orthopaedics and Traumatology 2007; Volume 8, Supplement 1.

Bertone A, Lipson D, Kamei J et al. Effective bone hemostasis and healing using radiofrequency and conductive fluid. Clinical Orthopaedics and Related Research 2006; 446:278-85.

Geier KA. The bipolar sealing device: reducing blood loss in orthopaedic surgery. Orthopaedic Nurse 2005; 34(3):224-226.

Podium Presentations

Krebs V. Do second generation coagulation devices decrease blood loss?

• Harvard Hip Course 2010; Cambridge, MA

Mannion S. Case controlled study in the use of Aquamantys field diathermy compared with conventional diathermy in total joint arthroplasty.

• Northwest Orthopaedic Association 2009; Manchester, UK

Marulanda G, Johnson D, Letson GD. Impact of a bipolar sealer device in orthopaedic oncology.

• International Society of Limb Salvage/Musculoskeletal Tumor Society 2009; Boston, MA
• Society of Surgical Oncology 2009; Phoenix, AZ

Marulanda G, Born T, Henderson E et al. A novel technique of large musculoskeletal sarcoma resection with the use of a bipolar sealer device

• International Society of Limb Salvage/Musculoskeletal Tumor Society 2009; Boston, MA
• Society of Surgical Oncology 2009; Phoenix, AZ
• Connective Tissue Oncology Society 2008; London, UK

Arndt S, Patney M. Efficacy of a bipolar sealer in reducing post-operative transfusion rates in total joint arthroplasty.

• Eastern Orthopaedic Association 2009; Paradise Island, Bahamas

Adeoye S, Butenas T, Keggi K et al. Minimally invasive partial denervation and anterior release of the hip joint capsule: a surgical technique to relieve pain and improve hip function.

• Eastern Orthopaedic Assoiciation 2009; Paradise Island, Bahamas

Webb L, Gross TP. The value of a comprehensive perioperative blood management program.

• American Academy of Nurse Practitioners 2009; Nashville, TN

Siegel H, Sparks DR, Cassillas Jr., M et al. The use of bipolar hemosealing technology in orthopaedic oncology: safety and clinical impact. Orthopedics 2008; 31:10.

• American Association of Orthopedic Surgeons 2005; Washington, DC

Marulanda G. Soft tissue sarcoma resection with the use of a cutting stapler and a bipolar sealer device.

• Connective Tissue Oncology Society 2008; London, UK

Astore F. Incidence of transfusion in THA with use of a new bipolar coagulator.

• Società Italiana di Ortopedia e Traumatologia 2007; Bologna.

Barresim C, Falez F. Advantages in the use of a new method of electrocoagulation in orthopaedic surgery.

• Società Italiana di Ortopedia e Traumatologia 2007; Bologna

Astore F, Scardino M, Dagnino A et al. Are there new solutions for blood saving in hip surgery?

• European Federation of National Associations of Orthopaedics and Traumatology 2007; Florence, Italy

Rosneck J., Klicka A., Barsoum W. The Effectiveness of TissueLink’s hemosealing technology during THA.

• European Federation of National Associations of Orthopaedics and Traumatology 2007; Florence, Italy

This multi-center prospective randomized trial demonstrated that the amount of blood loss and decrease in post-operative hemoglobin were significantly lower in the bipolar sealer group (p = 0.0073 and p = 0.0417 respectively).

Marulanda et al. in a 50 patient study demonstrated a significant reduction in post-operative and total blood loss in the bipolar sealer group (p = 0.05 and p = 0.02, respectively), as well as an absence of tissue charring and smoke production.

This prospective, controlled, randomized study demonstrated a mean decline in post-operative hemoglobin that was significantly lower for the bipolar sealer group than control (p = 0.01).

This study demonstrated a 64% reduction in transfusions in the bipolar sealer group. Patients in this group had a significantly lower mean decline in post-operative hemoglobin compared to the control group (3.3 ± 1.1 g/dL vs. 3.9 ± 1.2 g/dL; p = 0.0085).

This study of sample size 3,172 in the bipolar sealer group and 667 in the electrocautery group demonstrated several benefits in the bipolar sealer group, including significantly lower knee drainage output (807 mL vs. 1290 mL; p<0.0001), a statistically higher hematocrit at discharge (31.5 vs. 30.2; p<0.0001), and a reduction in transfusions from 10% to 3%.

Rosenberg AG. Reducing blood loss in total joint surgery with a saline-coupled bipolar sealing technology. J Arthroplasty 2007; 22(4 Suppl 1), 82-85.

Trousdale RT, McGrory BJ, Berry DJ et al. Patients’ concerns prior to undergoing total hip and total knee arthroplasty. Mayo Clinic Proceedings 1999; 74:978-982.

Abdel-Salam A, Eyres K. Effects of tourniquet during total knee arthroplasty. Journal of Bone and Joint Surgery - British Volume 1995; Vol 77-B, Issue 2, 250-253.

Barwell J, Anderson G, Hassan A et al. The effects of early tourniquet release during total knee arthroplasty. Journal of Bone and Joint Surgery - British Volume 1997; 79:265-268.

Vandenbussche E, Duranthon L, Couturier M et al. The effect of tourniquet use in total knee arthroplasty. International Orthopedics 2002; 26(5):306-309.

Worland RL, Arredondo J, Angles F et al. Thigh pain following tourniquet application in simultaneous bilateral total knee replacement arthroplasty. Journal of Arthroplasty 1997; 12(8)848-852.

Ulrich S, Kyle B, Johnson AJ et al. Strategies to reduce blood loss in lower extremity total joint arthroplasty. Surgical Technology International 2010; 20:341-7.

Menendez M, Ishihara A, Weisbrode S et al. Radiofrequency energy on cortical bone and soft tissue: a pilot study. Clinical Orthopaedics and Related Research 2010, 468(4):1157-64.

Bertone A, Lipson D, Kamei J et al. Effective bone hemostasis and healing using radiofrequency and conductive fluid. Clinical Orthopaedics and Related Research 2006; 446:278-85.

Geier KA. The bipolar sealing device: reducing blood loss in orthopaedic surgery. Orthopaedic Nurse 2005; 34(3):224-226.

Pfeiffer MA, Brautigam H, Draws D et al. A new bipolar blood sealing system embedded in perioperative strategies vs. a conventional regimen for total knee arthroplasty: results of a matched-pair study. German Medical Sciences 2005; 3:Doc10.

Marulanda G, Ragland P, Seyler T et al. Reductions in blood loss with use of a bipolar sealer for haemostasis in primary total knee arthroplasty. Surgical Technology International XIV 2005; 12:281-6.

Laskin RS. Minimizing blood loss after total knee replacement. Orthopedics 2004; 27(9):981-2.

Podium Presentations

Mannion S. Case controlled study in the use of Aquamantys field diathermy compared with conventional diathermy in total joint arthroplasty.

• Northwest Orthopaedic Association 2009; Manchester, UK

Marulanda G, Johnson D, Letson GD. Impact of a bipolar sealer device in orthopaedic oncology.

• International Society of Limb Salvage/Musculoskeletal Tumor Society 2009; Boston, MA
• Society of Surgical Oncology 2009; Phoenix, AZ

Marulanda G, Born T, Henderson E et al. A novel technique of large musculoskeletal sarcoma resection with the use of a bipolar sealer device.

• International Society of Limb Salvage/Musculoskeletal Tumor Society 2009; Boston, MA
• Society of Surgical Oncology 2009; Phoenix, AZ
• Connective Tissue Oncology Society 2008; London, UK

Arndt S, Patney M. Efficacy of a bipolar sealer in reducing post-operative transfusion rates in total joint arthroplasty.

• Eastern Orthopaedic Assoiciation 2009; Paradise Island, Bahamas

Webb L, Gross TP. The value of a comprehensive perioperative blood management program.

• American Academy of Nurse Practitioners 2009; Nashville, TN.

Siegel H, Sparks DR, Cassillas Jr., M et al. The use of bipolar hemosealing technology in orthopaedic oncology: safety and clinical impact. Orthopedics 2008; 31:10.

• American Association of Orthopedic Surgeons 2005; Washington, D.C.

Marulanda G. Soft tissue sarcoma resection with the use of a cutting stapler and a bipolar sealer device.

• Connective Tissue Oncology Society 2008; London, UK

Isabell G, Weeden S. Haemostatic efficacy of a bipolar sealing device in minimally invasive total knee arthroplasty.

• European Federation of National Associations of Orthopaedics and Traumatology 2007; Florence, Italy
• Southern Orthopaedic Society Meeting 2007; British Columbia
• Texas Orthopeadic Association 2006; Houston, TX

Astore F. Irrigated coagulation in knee prosthesis surgery.

• Società Italiana di Ortopedia e Traumatologia 2007; Bologna

Barresim C, Falez F. Advantages in the use of a new method of electrocoagulation in orthopaedic surgery.

• Società Italiana di Ortopedia e Traumatologia 2007; Bologna

Krebs V, Marulanda G et al. Haemostasis using a bipolar sealer in primary unilateral total knee arthoplasty.

• American Association of Orthopedic Surgeons 2007; San Diego, CA