USE OF QUIXIL (THROMBIN FIBRO-SEALANT) IN REDUCING BLOOD LOSS IN REVISION THR

Abstract

We undertook a retrospective audit to assess the effectiveness of use of Quixil in reducing the amount of blood transfusion requirements following revision THR. As Quixil was used from mid 2007 for revision THRs, we looked at blood transfusion requirements for 1 year before introduction of Quixil and compared it with requirements after introduction of Quixil for a similar period.

Method and Materials: 44 patients underwent revision THR by the senior author during the period from June 2007 – June 2008 (Quixil group) while 45 patients did not have Quixil during revision THR for the period May 2006 – May 2007 (Non-quixil group). In the quixil group, M: F = 18:26 and average age 75.3 (range: 63 – 88 yrs). In the non-quixil group, M: F = 17:28 and average age 71.3 (range: 47 – 85 yrs). The duration of surgery was similar in both groups. Blood loss during the operation was evaluated by measuring the volume in the suction apparatus and by estimating the amount of lost blood in the swabs at the end of the operation. Drains were not used in these procedures. All blood transfusions were recorded.

Results: The average blood loss was 1010 mls (range: 300 – 2200 mls) in the quixil group vs. 1021 mls (range: 500 – 2000 mls) in the non-quixil group. The use of cell saver and intra-operative blood transfusion were similar in both groups. The mean pre-op Hb in quixil vs. non-quixil group was 13.0 g/dl (range: 9.7– 16.2) vs. 12.4 g/dl (range: 8.8 – 16.2). The mean post-op Hb in quixil group vs. non-quixil group was 10.2 g/dl (range: 6.4 – 13.2) vs. 9.1 g/dl (range: 5.3 – 12.9)(a difference of 1.1 g/dl). There was a difference in the blood transfused post-operatively between the two groups – 21 vs. 29 patients. Total units of blood transfused in quixil vs. non-quixil group were 60 vs. 86 (a difference of 26 units stastically significant) and total units of intra-op blood transfused in quixil vs. non-quixil group were 16 vs. 23 (a difference of 7 units).

Limitations of the study: Retrospective study, Small numbers of patients

Conclusion: The use of fibrin tissue adhesive in revision total hip arthroplasty seems to be an effective and safe means with which to reduce blood loss and blood-transfusion requirements as well as prevent in the postoperative decrease in the level of hemoglobin.