Efficacy of intraoperative periarticular Ranawat solution in reducing hidden blood loss and transfusion requirements in hip fracture hemiarthroplasty: a randomized controlled trial

Aims: This randomized controlled trial evaluated the efficacy of intraoperative periarticular Ranawat solution injection in reducing total and hidden blood loss (HBL), as well as allogeneic blood transfusion (ABT) rates, in elderly patients undergoing bipolar hemiarthroplasty for intra-articular hip fractures. Methods: In this single-center trial (NCT06701695), 84 patients (aged 65-95) undergoing bipolar hemiarthroplasty between May 2020 and February 2022 were randomized to receive either the Ranawat solution injection or no injection. Primary outcomes were total blood loss (TBL), HBL, and ABT rate. Secondary outcomes included intraoperative blood loss (IBL), postoperative drainage volume, and hospital stay duration. Results: The injection group included 41 patients (14 males, 34.1%; mean age 82.6±6.96 years), whereas the control group comprised 43 patients (18 males, 41.8%; mean age 81.5±8.47 years).The injection group showed significantly lower HBL (327.4±148.8 mL vs. 442.2±168.9 mL, p=0.013) and TBL (1100.2±423.4 mL vs. 1330.3±434.2 mL, p=0.049) compared to controls. ABT was required in 34.1% of the injection group versus 58.1% in controls (p=0.043). Ranawat solution reduced HBL by 26% and TBL by 17.2%. No significant differences were found in IBL or drainage volume, and no injection-related adverse effects were observed. Conclusions: Intraoperative periarticular Ranawat solution injection effectively reduces perioperative blood loss and transfusion requirements in elderly patients undergoing hemiarthroplasty for hip fractures, supporting its use to enhance outcomes and safety in this population.