Oxidized regenerated cellulose powder reduces perioperative bleeding and thigh swelling in total hip arthroplasty: a prospective interventional study.

Abstract

Total hip arthroplasty (THA) is an effective treatment for hip osteoarthritis; however, perioperative blood loss and postoperative thigh swelling are significant challenges that can delay recovery and increase patient discomfort. Minimally invasive THA and pharmacological interventions, such as tranexamic acid, have mitigated some complications; however, achieving localized hemostasis, particularly in cancellous bones, remains problematic. We aimed to evaluate the efficacy of oxidized regenerated cellulose (ORC) powder in reducing perioperative blood loss and postoperative thigh swelling following THA. This prospective interventional study included 152 patients who underwent primary unilateral THA via the direct anterior approach. The patients were divided into ORC (n = 74) and non-ORC (n = 78) groups. ORC powder was applied to three critical surgical sites: the acetabulum, femoral medullary canal, and the surrounding soft tissue. The estimated total blood loss (eTBL), postoperative blood loss (ePBL), thigh swelling, and hematologic parameters (hemoglobin, hematocrit, D-dimer, creatine kinase, and C-reactive protein) were assessed. Clinical outcomes were evaluated using the modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and University of California, Los Angeles (UCLA) activity score at 3 months postoperatively. The ORC group exhibited significantly lower eTBL and ePBL, smaller reductions in hemoglobin levels, and higher hematocrit levels up to postoperative day 7. Postoperative thigh swelling was significantly reduced in the ORC group, particularly on day 1, with a trend toward reduced swelling at all time points. However, there were no significant differences in the clinical scores between the groups at 3 months postoperatively. The ORC powder application during THA effectively reduced perioperative blood loss and postoperative thigh swelling. Powdered ORC has the potential to maximize efficacy in THA because of its ability to be applied to hemispherical acetabular surfaces and deep femoral medullary canals, effectively addressing bleeding from both soft tissue and cancellous bone. This prospective interventional study was reviewed and approved by the Ethics Committee of Shizuoka Red Cross Hospital (Approval No: 2023-36) and was designed and conducted according to the rules of the Declaration of Helsinki. Written informed consent was obtained from patients or their families.