Comparison of topical hemostatic effects between oxidized regenerated cellulose and gelatin-thrombin-based hemostatic matrix in total knee arthroplasty

Effective hemostatic management during total knee arthroplasty (TKA) is essential not only for maintaining an adequate intraoperative visual field but also for minimizing postoperative complications such as anemia and swelling, which can adversely affect recovery and rehabilitation. Oxidized regenerated cellulose (ORC) and gelatin–thrombin hemostatic matrix (GTHM) are topical hemostatic agents commonly used in various surgical procedures. However, comparative data regarding their perioperative hemostatic effects in primary TKA remain limited. This study aimed to evaluate the effectiveness of ORC and GTHM in reducing perioperative blood loss and postoperative anemia after primary TKA. We hypothesized that intraoperative application of ORC and GTHM would decrease postoperative blood loss and anemia compared with no hemostatic intervention, and that their hemostatic effects would be comparable to each other. This prospective case-control study included 30 primary TKA cases assigned to three groups: ORC, GTHM, and control. ORC (3 g) and GTHM (5 mL) were applied sequentially at three intraoperative sites: the anteromedial tibia and infrapatellar fat pad region, suprapatellar pouch, and posterior joint capsule after bone cuts. No suction drain was used, and intra-articular tranexamic acid was administered postoperatively. Laboratory assessments, including red blood cell count, and hemoglobin, hematocrit, and D-dimer levels, were performed preoperatively and on postoperative days 1, 7, and 14. Estimated blood loss (EBL) was calculated using Gross’s formula, and the maximum decrease in hemoglobin levels was determined within 2 weeks after surgery. Group comparisons were performed using a t-test, with statistical significance defined as p < 0.05. No significant differences were observed among the groups with respect to demographics, surgical duration, intraoperative blood loss, or perioperative laboratory values. At 1 week postoperatively, EBL was significantly lower in both the ORC group (403 ± 192 mL) and the GTHM group (448 ± 171 mL) compared with the control group (770 ± 232 mL; p < 0.01). Similarly, the maximum hemoglobin decrease within 2 weeks was significantly smaller in the ORC (1.6 ± 0.6 g/dL) and GTHM (2.0 ± 0.6 g/dL) groups than in the control group (2.8 ± 0.7 g/dL; p < 0.01). No significant differences were detected between ORC and GTHM for any hemostatic outcome. Although intraoperative blood loss was not significantly influenced by the use of ORC or GTHM, both agents demonstrated comparable and clinically meaningful reductions in postoperative anemia and perioperative blood loss in primary TKA. These findings suggest that topical hemostatic agents may contribute to improved postoperative recovery, and further optimization of application methods or dosing may enhance hemostatic effectiveness while minimizing potential complications. Level III: Case-control study