The role of a saline coupled bipolar sealant to reduce blood loss in anterior total hip arthroplasty

The aim of this study is to compare the clinical and economic benefits of using a bipolar sealant (Aquamantys System; Medtronic Advanced Energy) during DAA-THA (Direct Anterior Approach-Total Hip Arthroplasty) with a matched cohort that used Ligasure Bipolar Diathermy, Unipolar Electrocautery, Fibrin Spray (EVICEL) and Absorbable haemostat (SURGICEL FIBRILLAR). We hypothesized that the use of a bipolar sealer would decrease operative blood loss in patients undergoing DAA-THA . The study is a single center, retrospective comparative study with all participants recruited from an orthopaedic private practice. Demographic variables including age, gender, height and weight, body mass index (BMI), indication for surgery, surgical side, and American Society of Anesthesiologists (ASA) classification were captured. All patients undergoing unilateral DAA-THA between January 2020 - December 2021 were considered for inclusion. Patient grouping was determined by the bipolar sealant (Group 1), with a historical group of patients undergoing the same surgery by the same surgeon, forming the comparative group that used other forms of hemostatic sealants (Group 2). The primary outcome measure was blood loss. The secondary outcomes measured included transfusion requirements, the change in hemoglobin, length of hospital stay, and duration of surgery. The difference in blood loss was not found to be statistically significant between the two groups (p=0.26), however the mean blood loss in the bipolar sealant group was 601 cc vs the monopolar group with a loss of 725 cc and a change in Hb war 15.09 the bipolar group vs a change of 20.48 in the monopolar group. There was no statistically significant difference between the two groups with two patients in both the control and treatment group requiring transfusion. The study group had a lower length of hospital stay and duration of surgery, which were statistically significant p=0.01and p=0.02 respectively. The reduction in surgical duration and length of hospital stay in DAA THA patients following the use of a bipolar sealer is indicative that it has provided a cost-effective solution as a blood management tool.