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Is bipolar sealer superior than standard electrocautery for blood loss control after primary total knee arthroplasty: A meta-analysis.

ABSTRACT: BACKGROUND:Whether bipolar sealer (BS) is superior to standard electrocautery in patients with primary total knee arthroplasty (TKA) remains controversial. Thus, we conducted this meta-analysis involving comparative studies (S) to evaluate whether administration with BS (I) was associated with less blood loss (O) than standard electrocautery (C) after primary TKA (P). METHODS:PubMed (1950-January 2017), EMBASE (1974-January 2017), the Cochrane Library (January 2017 Issue 3), and the Google database (1950-January 2017) were systematically searched. Studies were included in accordance with Population, Intervention, Comparison, Outcomes, and Setting including criteria. Only the patients prepared for primary TKA and administrated with BS as the intervention group and standard electrocautery as control group were included in this meta-analysis. Outcomes include need for transfusion, total blood loss, blood loss in drainage, hemoglobin at discharge, hemoglobin drop, and length of hospital stay. Continuous outcomes and discontinuous outcomes were expressed as weighted mean difference (WMD) and risk ratio (RR) with corresponding confidence intervals (CIs), respectively. Stata 13.0 software was used for relevant data calculation. RESULTS:A total of 7 clinical trials with 718 patients (398 patients in BS group and 320 in standard electrocautery group) were finally included in this meta-analysis. The pooled results indicated that administration with BS was associated with little reduction of total blood loss (WMD?=?-123.80, 95%CI -236.56 to -11.04, P?=?.031). There was no significant difference between the need for transfusion, blood loss in drainage, hemoglobin at discharge, hemoglobin drop, and length of hospital stay (P?>?.05). CONCLUSION:Based on the current meta-analysis, we found no evidence to support the routine use of bipolar sealer in the management of blood loss in primary TKA. Since the poor quality of the included studies, more randomized controlled trials are still needed to further identify the efficacy of BS after primary TKA.

SUBMITTER: Chen X

PROVIDER: S-EPMC6867738 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Is bipolar sealer superior than standard electrocautery for blood loss control after primary total knee arthroplasty: A meta-analysis.

Chen Xinxin X Yang Wenhui W Wang Xiao X

Medicine 20191101 46

<h4>Background</h4>Whether bipolar sealer (BS) is superior to standard electrocautery in patients with primary total knee arthroplasty (TKA) remains controversial. Thus, we conducted this meta-analysis involving comparative studies (S) to evaluate whether administration with BS (I) was associated with less blood loss (O) than standard electrocautery (C) after primary TKA (P).<h4>Methods</h4>PubMed (1950-January 2017), EMBASE (1974-January 2017), the Cochrane Library (January 2017 Issue 3), and t ...[more]

PMID: 31725616

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Project description:Arthrofibrosis is characterized by excessive extracellular matrix (ECM) deposition that results in restricted joint motion after total knee arthroplasty (TKA). Current surgical and pharmacologic treatment options are limited. Therefore, an in vitro model for joint myofibroblastogenesis is valuable to investigate the arthrofibrotic process and identify diagnostic biomarkers and treatment options. In this study, we obtained intraoperative posterior capsule (PC), quadriceps tendon (QT), and suprapatellar pouch (SP) tissue from knees of four patients undergoing primary TKA for osteoarthritis and characterized primary outgrowth cells from these tissues in the absence and presence of transforming growth factor beta 1 (TGFβ1), a pro-myofibroblastic cytokine. Light microscopy of knee outgrowth cells revealed spindle-shaped cells while immunofluorescence (IF) established staining for the fibroblast-specific antigen TE-7 and Vimentin, which are characteristics of fibroblasts. These fibroblasts differentiate readily into myofibroblasts as highlighted by enhanced alpha smooth muscle actin (ACTA2) mRNA and protein expression and increased collagen mRNA (i.e., collagen type 1 (COL1A1) and collagen type 3 (COL3A1)) expression and collagenous matrix deposition in the presence of TGFβ1. Of note, these studies also revealed that knee-derived fibroblasts are more sensitive to TGFβ1-mediated myofibroblastogenesis than adipose-derived mesenchymal stem cells. Importantly, while outgrowth fibroblasts isolated from four patients and three anatomical regions exhibit similar gene expression profiles, these knee fibroblasts form a unique gene expression cluster within the fibroblast niche as revealed by RNA-sequencing analysis. In conclusion, our study provides a fibroblast/myofibroblast model of outgrowth knee cells derived from patients undergoing primary TKA that can be employed to assess myofibroblast-related processes and test novel pharmacological strategies in vitro for arthrofibrosis.

Dataset Information

Is bipolar sealer superior than standard electrocautery for blood loss control after primary total knee arthroplasty: A meta-analysis.

Publications

Is bipolar sealer superior than standard electrocautery for blood loss control after primary total knee arthroplasty: A meta-analysis.

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