Topical oxidized regenerated cellulose for perioperative blood management in total hip and knee arthroplasty: a systematic review and meta-analysis.

BACKGROUND

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are established procedures for end-stage joint disease, but perioperative blood loss remains a practical concern. Oxidized regenerated cellulose (ORC) has been used as a local hemostatic material during arthroplasty; however, its comparative value in contemporary blood-management protocols remains uncertain.

METHODS

PubMed, Embase, the Cochrane Library, and Scopus were searched from inception to March 2026. Randomized controlled trials and comparative observational studies were eligible if they evaluated ORC in THA or TKA and reported blood-loss-related or complication-related outcomes. Continuous outcomes were pooled as mean differences (MDs), and dichotomous outcomes as risk ratios (RRs), with 95% confidence intervals (CIs). Random-effects models were used.

RESULTS

Eleven studies were included. Compared with no ORC or standard care, ORC was associated with lower total perioperative blood loss (MD = -124.77 mL, 95% CI -181.71 to -67.83; P < 0.0001), postoperative or hidden blood loss (MD = -136.54 mL, 95% CI -214.97 to -58.10; P = 0.0006), and hemoglobin drop/loss (MD = -0.57 g/dL, 95% CI -0.81 to -0.34; P < 0.00001). No significant differences were found for intraoperative blood loss, transfusion rate, thrombotic events, or overall complications. Compared with active topical comparators, ORC showed no clear advantage. Evidence for ORC plus TXA vs. TXA alone was based on a single study and should be interpreted as exploratory. These effects mainly represent surrogate outcomes rather than definitive patient-important benefits.

CONCLUSIONS

ORC may modestly reduce blood-loss-related surrogate outcomes when compared with no ORC or standard care. Current evidence does not show clear superiority over active topical comparators or establish definite incremental benefit in TXA-based protocols. Because overall certainty remains limited, routine ORC use in unselected arthroplasty patients is not supported; future trials should focus on patient-important outcomes.

REGISTRATION: PROSPERO registration number: CRD420261384870.