Effects of intraoperative use of the topical hemostatic matrix agent, Floseal, in primary unilateral total knee arthroplasty

Background: Total knee arthroplasty can result in blood loss severe enough to require postoperative blood transfusions. Minimizing blood loss perioperatively is therefore essential to minimize morbidity in patients undergoing total knee arthroplasty. Floseal (Baxter International, Inc., Deerfield, IL) is a topical hemostatic matrix agent used for hemostasis during surgical operations. Methods: Patients undergoing routine total knee arthroplasty were randomized into two groups. One group received intraoperative standard hemostatic therapy and another group received intraoperative standard hemostatic therapy as well as Floseal. The groups were compared based on 24-hour postoperative drain output, 3-day postoperative drop in hematocrit and hemoglobin levels, and the incidence of postoperative transfusions. Results: One hundred and forty patients with primary unilateral total knee arthroplasties were recruited and 70 were randomized to the control group and 70 to the Floseal group. The mean 24- hour postoperative drain output for patients in the control group was 457.1 (-28.60) mL compared with 405.0 (-22.93) mL in the Floseal group. This difference was not significant (P=0.1651). Comparison of 3-day postoperative drops in hemoglobin and hematocrit values between the control and experimental groups also demonstrated no statistical significance (P=0.5422 and P=0.6524, respectively). The incidences of postoperative blood transfusions based on intraoperative use of Floseal were not significantly different (P=0.4389). Perioperative complications and their rates were not found to be changed with the intraoperative use of Floseal. Conclusions: Our data suggest that there is no benefit from the regular use of Floseal in routine total knee arthroplasty. Intraoperative use of Floseal in total knee arthroplasty did not increase complications and can likely be used safely.