Hemostatic Adjuncts in Orthopedic Surgery: Innovations in Technique, Technology, and Biosurgical Applications

Abstract

Significant blood loss is an obstacle frequently encountered in orthopedic surgery in both elective and trauma settings. Notwithstanding the nature of orthopedic surgery creates a unique environment, where hemostasis may be difficult to achieve. In total hip and knee arthroplasty, freshly cut bone edges bleed persistently and often do not respond to typical hemostatic methods utilized in soft tissues. Spine surgery requires strict adherence to hemostatic principles as uncontrolled bleeding can result in compression of neural elements. Blood loss in orthopedic trauma presents a highly variable environment where methods of hemostasis must match the severity of the injury. Lastly, orthopedic tumor procedures often require bloodless fields in order to limit the risk of hemostatic spread. The following chapter takes a subspecialized approach to blood loss management in orthopedic surgery, including perioperative management of anticoagulant medications, protocols for utilization of pharmacologic agents, and techniques for the application of topical hemostatic compounds.