Revolutionizing Total Knee Arthroplasty: The Role of ORC in Bleeding Control

 Effective bleeding control remains a formidable challenge in modern surgery, particularly in orthopedic procedures where managing bleeding from the exposed or cut surface of cancellous bone is a critical concern. Total knee arthroplasty (TKA), a prevalent surgery for severe knee arthritis within orthopedics, is notably associated with significant blood loss due to extensive bone cutting and exposure of a large surface area of cancellous bone [1].

Challenges in TKA:

Patients undergoing primary TKA are particularly susceptible to significant intraoperative and postoperative blood loss, leading to potential complications such as pain, decreased range of motion, and delayed recovery. With an aging population and increased life expectancy, the annual incidence of TKA procedures is expected to rise, reaching an estimated 3 million in the United States by 2030 [2].

Role of Absorbable Haemostatic Agents:

To address bleeding challenges in orthopedic surgeries, particularly in TKA, absorbable haemostatic agents like oxidized regenerated cellulose (ORC) play a pivotal role. ORC, such as Surgicel Fibrillar™, assists in controlling capillary, venous, and small arterial haemorrhage when conventional methods like ligation or electrocoagulation are impractical or ineffective.

Understanding Oxidised regenerated cellulose (ORC)

Oxidized cellulose (OC) was initially employed as a haemostatic agent in 1942, and by 1960, oxidized regenerated cellulose (ORC) was developed[3]. Derived from plant-based cellulose, ORC undergoes oxidation and regeneration, resulting in a biocompatible and bioabsorbable material widely used in medical applications, with haemostasis being a primary focus. ORC facilitates haemostasis likely through the activation of the intrinsic coagulation pathway and also creating a gel-like layer (matrix) that holds clot in place and triggers vasoconstriction by the low pH of the ORC.

Commercially Available ORC Products:

Several commercially available hemostatic materials based on oxidized cellulose are currently in the market including Surgicel, Oxycel, Pahacel, CuraCel, Surgi-ORC® (Aegis Lifesciences Pvt. Ltd.) [3].

Different variants of Surgi-ORC® from Aegis Lifesciences:

Surgi-ORC® Original, Surgi-ORC® Knit, Surgi-ORC® Fibril and Surgi-ORC® Non-woven haemostats are white or pale yellow in color and can be cut into desired sizes for different surgeries.Surgi-ORC® Absorbable haemostats are fully absorbed with minimum tissue reaction.

Clinical study on ORC in total knee arthroplasty (TKA):

A recent clinical study conducted by Li et al. in 2023 investigated the local treatment of 70 TKA patients with oxidized regenerated cellulose (ORC), specifically SurgicelFibrillar™(2.5 * 5.1 cm; Ethicon Inc., San Lorenzo, Puerto Rico, USA). The study demonstrated a significant decrease in overall blood loss among TKA patients treated with regenerated oxidized cellulose (ORC) compared to those in the suture-based group. This underscores the safe and effective application of ORC in reducing postoperative blood loss in Total Knee Arthroplasty.

Conclusion:

As advancements in haemostatic agents continue to reshape the landscape of orthopedic surgeries, ORC emerges as a promising solution in TKA, offering surgeons an effective tool to address bleeding challenges and improve patient outcomes. The future of orthopedic surgery, particularly in TKA, holds exciting possibilities with the continued exploration and utilization of innovative haemostatic technologies. 

References:

  1. Kim JK, Ro DH, Han SM, Lee MC, Han HS. Efficacy and Safety of Bioabsorbable Bone Hemostatic Agent in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. Clinical and Applied Thrombosis/Hemostasis. 2021; 27:1-6.
  2. Helito CP, Bonadio MB, Sobrado MF, Giglio PN, Pécora JR, Camanho GL, Demange MK. Comparison of floseal® and tranexamic acid for bleeding control after total knee arthroplasty: a prospective randomized study. Clinics. 2019; 74:
  3. Rodić-Grabovac B, Sailović P, Lipić N. Medical and pharmaceutical application of oxidized cellulose. Journal of Chemists, Technologists and Environmentalists. 2020;1(1):1-11.
  4. Li B, Pan W, Sun X, Qin K, Bai G, Bao H, Huang Y, Ma J. Hemostatic effect and safety evaluation of oxidized regenerated cellulose in total knee arthroplasty-a randomized controlled trial. BMC Musculoskeletal Disorders. 2023;24(1):797

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