A new method of hemostasis for cementless total knee arthroplasty.

Heavy bleeding often occurs following cementless total knee arthroplasty (TKA) and it is difficult to control. We devised a new method of hemostasis after cementless TKA. In brief, the implant was inserted after coating the exposed surface of the cancellous bone with fibrin glue. Before removal of the tourniquet after completion of the operation a cocktail of hemostatic agents (containing 25 mg of carbazochrome sodium sulfonate and 250 mg of tranexamic acid) in 50 ml of physiological saline was injected into the joint cavity via the drain tube and the drain was clamped for about 30 min after removal of the tourniquet. After removal of the clamp, standard negative pressure suction was performed. This method was used on 84 knees in 42 patients who underwent simultaneous bilateral cementless TKA and 64 knees in 64 patients who underwent unilateral TKA. The mean total amount of blood loss during and after the operation was 235 +/- 178 ml in the unilateral TKA patients and 402 +/- 208 ml in the bilateral TKA patients. No patient required blood transfusions postoperatively. This method was effective for achieving hemostasis after cementless TKA.