Use of Bone Wax to Reduce Blood Loss in THA with Direct Anterior Approach

A number of measures have been suggested for reducing perioperative blood loss (PBL) in total hip arthroplasty (THA). A new randomized clinical trial in JBJS assesses the efficacy of bone wax application in reducing PBL in total hip arthroplasty performed via the direct anterior approach.  

The Efficacy of Bone Wax in Reduction of Perioperative Blood Loss in Total Hip Arthroplasty via Direct Anterior Approach. A Prospective Randomized Clinical Trial 

Study Highlights 

• This triple-blinded, Level-I study by Mortazavi et al. was performed at the Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.  
• Included were 152 patients who underwent THA via the direct anterior approach. In 75 patients, bone wax was applied on the surface of the distal part of the femoral neck following osteotomy, and in 77 patients (control group), no bone wax was used. 
• The mean age of the patients was 47.7 years; 50.7% of the patients were female, and 49.3% of the patients were male. Demographics and baseline hematologic variables did not differ between the groups. 
• The primary outcomes were apparent PBL (blood in sponges and the suction canister) and total PBL on postoperative days 3 and 5. Secondary outcomes were transfusion and complications.  

Findings 

The authors found that apparent PBL, total PBL on postoperative day 3, and total PBL on postoperative day 5 were significantly lower in the group treated with bone wax. The corresponding median values (in millimeters) were as follows: 200 (IQR, 115 to 310) vs. 370 (IQR, 195 to 513.7); 505.2 (IQR, 409.2 to 637.6) vs. 747 (IQR, 494.6 to 955.4); and 536.7 (IQR, 430.9 to 689.3) vs. 767.8 (IQR, 537.8 to 1,021.9) in the wax and control groups, respectively (p < 0.001 for all). 

The authors found no significant difference between the 2 groups in the rates of transfusion and complications.  

They note that their described technique is not intended for surgeons who broach the femur first. They conclude that “bone wax on the distal cut surface of the femoral neck during THA through the direct anterior approach can significantly reduce PBL. It is practical, readily available, and inexpensive and could be considered as a routine part of the surgical technique in THA through the direct anterior approach.” 

Access the full JBJS report: The Efficacy of Bone Wax in Reduction of Perioperative Blood Loss in Total Hip Arthroplasty via Direct Anterior Approach. A Prospective Randomized Clinical Trial