18 The primary objective of this work is to assess whether hemostasis with electrocautery compared to Floseal(r) during primary total knee arthroplasty leads to different rates of perioperative bleeding. MATERIALS AND METHODS We conducted a comparative study between two groups: inhibitor Imatinib Mesylate one study group with ten consecutive cases of primary prosthesis using Floseal(r) as hemostatic method, and the control group with 10 consecutive cases of primary prosthesis using electrocautery as hemostatic method. The study included the first 20 patients with primary arthrosis undergoing primary total knee arthroplasty. Patients with bleeding disorders or using medications that affect blood clotting were excluded from the study. Anesthetic care, operative and postoperative periods were equal and standardized for both groups.

Anesthetic care All study patients underwent spinal anesthesia with isobaric marcaine 0.5%. The anesthesia team used for volume replacement lactated ringer saline at doses of 10 to 15 ml per kg body weight per hour, and colloidal solution of 6% hydroxyethyl starch in a maximum dose of 1,500 ml during the first 24 hours. The criteria adopted for blood transfusion by the clinical and anesthetic team were: heart rate higher than 120 associated with mean arterial pressure lower than 80 mm Hg or blood pressure less than 100 mm Hg (systolic) and 60 mmHg (diastolic), pulse oximetry lower than 90% and tachypnea (respiratory rate higher than 20). The presence of any of these signs or the need to use vaso-active drug to maintain blood pressure were considered “trigger condition” for blood transfusion.

Surgical standardization Before beginning the procedure, all patients were evaluated according to the objective criteria of the Knee Society Scoring (KSS). 19 All surgeries were performed with the use of an inflated pneumatic tourniquet after venous emptying by elevation of the member for three minutes, without using elastic bandage for limb exsanguination. The pressure used in pneumatic tourniquet was 300 mmHg. Data were collected on the time of limb ischemia and surgical time, in minutes, of all the patients. The surgical time, defined as the time between the start of the skin incision and the last point of incision in the skin was measured in minutes. The surgical approach used was the medial parapatellar way.

The implants used were primary arthroplasties with replacement of Cilengitide the posterior cruciate ligament fixed with cement. In the control group, after placement of the implants, the surgical route was tamponed with surgical dressings and bandages for five minutes, after deflating the tourniquet. After tamponed, hemostasis was performed with monopolar electrocautery. In the study group, Floseal(r) was applied before release of the tourniquet, the regions of potential bleeding, especially in the superior, medial, and lateral recesses. The surgical approach was then tamponed the same way as in the control group.