The Efficacy of Bone Wax in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

Objectives: This meta-analysis was conducted to study the hemostatic efficacy of bone wax in total joint arthroplasty (TJA) defined in this manuscript as total knee arthroplasty and total hip arthroplasty. Methods: PubMed, Embase, Google Scholar (page ۱-۲۰), and Scopus were searched updated to November ۲۰۲۳. Only comparative studies were included. The clinical outcomes evaluated were the transfusion rate, total blood loss, and the loss of hemoglobin on day ۱, ۳, and ۵ post-operatively. Results: Only ۳ studies met the inclusion criteria and were included in this meta-analysis. Bone wax was associated with a reduced transfusion rate (p=۰.۰۱), reduced total blood loss (p=۰.۰۰۱), and a decrease in hemoglobin loss on day ۱ (p<۰.۰۰۰۰۱), day ۳ (p<۰.۰۰۰۱), and day ۵ (p<۰.۰۰۰۰۱) after the surgery. Conclusion: Bone wax reduced the rate of transfusion, total blood loss, and hemoglobin loss after the surgery. This may induce a reduction the cost of correcting post-operative anemia as well as decrease hospital stay and improving functional outcomes in patients undergoing TJA. Better-conducted randomized controlled studies and cost-effectivity studies could strengthen these findings. Level of evidence: III

Keywords:

Bone wax , hemostasis , Post-operative anemia , Total hip arthroplasty , Total knee arthroplasty