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Fibrinogen-based sealants have been used to improve hemostasis after total hip replacement (THR) with conflicting results. We therefore conducted a double-blind randomized controlled trial to determine whether the commercially available fibrin sealant Quixil is effective in reducing the volume of red blood cell transfusions, postoperative blood loss and postoperative hemoglobin drop. Patients with coxarthrosis scheduled for primary cementless THR, were enrolled in a single hospital setting and randomized to either a fibrin sealant group (n=35) or a negative control group (n=35). The surgeon was blind to group allocation until the moment of fibrin application, while the cardiologist determining the need for transfusions remained blind throughout the intervention. In the fibrin sealant group, less blood was lost in the first 48 hours (median, 125 vs200 ml), fewer patients required allogeneic blood transfusion (1 vs6 in the control group), and fewer total units of allogeneic blood were transfused (2 vs12). These differences, however, were not significant partly due to confounding from the use of autologous transfusion of predeposited blood (according to a more liberal regime) and intraoperative autologous blood reinfusion in some patients of both groups. Excluding these last individuals from analysis, no remaining patient of the fibrin sealant group had an allogeneic blood transfusion that, instead, was carried out on 5 patients (23.8%) of the control group (p=0.048). Overall postoperative hemoglobin drop from baseline was significantly less in the fibrin-treated group on day 7 (mean, 3.5 vs4.5 g/dl; p=0.02). No adverse events were associated with fibrin treatment. These results strengthen the evidence in support of the safety and efficacy of the use of fibrin sealant in improving hemostasis after THR. Clinical trial registration: EudraCT 2008-002024-28.

Total hip arthroplasty (THA) in congenital high grade hip dislocation often represents a problematic issue. Reviewing their selected cases and literature data, authors focus on some key points for this demanding surgery. Most important steps are acetabular positioning and surgical approach (exposure and release).We used two different cups, the Zweymuller and the Wagner cup, with good primary stability. A Conus stem (Wagner) or an Alloclassic stem (in less displastic femoral shape) were used.We always performed this surgery as a one step procedure.In the same cases a shortening femoral osteotomy was performed to allow refractory reduction.Possible complications are discussed.