Procedure-specific outcomes of bipolar versus monopolar electrocautery in primary hip and knee arthroplasty: A systematic review and meta-analysis.

BACKGROUND

Bipolar (BP) electrocautery has been introduced as an alternative to monopolar (MP) electrocautery in arthroplasty, with proposed advantages including reduced blood loss and improved haemostasis. This study aimed to compare peri-operative blood loss and haemoglobin levels associated with bipolar versus monopolar electrocautery in PrimaryTHA and TKA.

METHODS

A systematic review and meta-analysis of randomised controlled trials (RCTs) was performed in accordance with PRISMA guidelines. MEDLINE, EMBASE, and Cochrane databases were searched by two independent reviewers. Studies comparing BP and MP electrocautery in primary THA or TKA were included. Meta-analysis was performed using fixed-effect models.

RESULTS

Eight RCTs comprising 971 patients (476 bipolar, 495 monopolar) were included; six were suitable for meta-analysis. Pooled THA and TKA analyses showed no significant differences in haemoglobin drop (MD 0.21 g/dL; p = 0.07), total blood loss (MD 5.06 mL; p = 0.57), or length of stay (MD 0.12 days; p = 0.26). Subgroup analysis in TKA showed reduced haemoglobin drop (MD 0.32 g/dL; p = 0.002) and blood loss (MD 89.67 mL; p = 0.03) with BP electrocautery; this was not observed in THA.

CONCLUSION

This meta-analysis found no clinically meaningful advantage of BP over MP electrocautery in primary THA and TKA. Reductions in blood loss and haemoglobin drop in TKA are likely multi-factorial and not clearly attributable to electrocautery type. Routine use of BP electrocautery in primary arthroplasty is not supported.