Discussion
lower extremity venous thrombosis, bleeding, OA, blood loss, intraoperative blood loss, infections, nerve damage, knee arthroplasty, burns, TKA, tissue damage
CLOT, INFILTRATION, BLEEDING, BLOOD LOSS, INFLAMMATION, ADVERSE EVENTS, INFECTIONS, ADHESION, CAVITY, INTRAOPERATIVE BLOOD LOSS, COMPLICATIONS
In our study, the total blood loss was higher in the control group (1052.25 ± 308.44 mL) than in the ORC group (902.32 ± 307.82 mL), validating the prior result that the use of ORC could decrease blood loss in the field of surgery. This result can be explained by two facts: (i) after encountering blood in the joint cavity, ORC changes to dark brown or black gelatinous substances due to the degradation of red blood cells and subsequent production of acid hematin, which promotes clot formation; (ii) the use of ORC produces the local low-pH environment, promoting vasoconstriction and provides a scaffold for platelet adhesion and aggregation, which reduces blood loss.Perioperative blood loss during TKA consists of two main parts, including intraoperative blood loss (IBL) and hidden blood loss (HBL)our data revealed that the intraoperative blood loss was 102.29 ± 14.47 mL in the control group, whilst intraoperative were 100.71 ± 14.51 mL in the ORC group. Intraoperative blood loss in the two groups was almost insignificant different, which might be due to the fact that the surgery was almost complete when ORC was placed such that ORC had little effect on reducing blood loss throughout the surgery.In general, blood loss measured and recorded after TKA is only intraoperative blood loss and postoperative drainage, which, however, do not consist of the hidden blood loss caused by the combination of blood infiltration into tissues, residual blood in the knee, and damage to red blood cells from high levels of free fatty acids in the blood [The perioperative risks after arthroplasty cannot be ignored, among which lower extremity venous thrombosis is one of the common and high-risk complications [Extensive bone resection and soft tissue damage during TKA can trigger inflammation. In addition to the property of promoting hemostasis, ORC has the function of producing a low-pH environment to exert broad-spectrum antibacterial effects. Furthermore, in vitro experiments have reported that ORC has antibacterial activity against both Gram-positive and Gram-negative strains, including drug-resistant strains, which can diminish the incidence of infections [Despite its good biocompatibility and bioabsorbability, ORC has been occasionally reported to result in some adverse events. For example, ORC implantation in the surgical cavity may change surgical scars after breast-conserving surgery [In addition, the use of ORC can diminish the use of an electrocoagulation knife for hemostasis before suturing and also decrease some side reactions and complications associated with electrocoagulation, such as tissue damage, burns, bleeding, and nerve damage [Regenerated oxidized cellulose, as a degradable hemostatic material derived from plants, can effectively reduce the total blood loss and hidden blood loss of patients after total knee arthroplasty under the premise of ensuring safety, and avoid transfusion due to excessive blood loss. In daily clinical work, it can play a positive role in postoperative rehabilitation and functional exercise of patients. Compared with the more hemostatic drugs currently used clinically, ORC has been proved by research to reduce blood loss without increasing additional risks. Avoid the complications of chemicals such as tranexamic acid.Our study has several limitations. First, the sample size was small, and all patients were from the same study center. Second, the different degrees of osteotomy and soft tissue release during surgery can interfere with the amount of blood loss. The severity of KNEE OA in patients was not graded in this experiment, which might affect the results. Third, postoperative functional factors were not assessed, and the follow-up period was short. Hence, the effect of ORC on the long-term knee function of patients after surgery is unknown. Fourth, This study did not include the widely used tranexamic acid group in current clinical practice. In the future, a further comparison of the clinical efficacy and safety between ORC and tranexamic acid should be conducted, aiming to provide a safer and more effective hemostatic solution for patients with contraindications to tranexamic acid usage.