This is a well written paper on the potential benefits of saline-coupled bipolar sealing (SCBS) in reducing blood loss in surgery for revision of infected total knee arthroplasty. In a retrospective manner, the authors, by using two groups of 36 patients each (one control and one experimental), show that by applying the SCBS method they achieve a significant reduction in intraoperative blood loss, an improvement in Hb status, as well as a significant financial benefit. Surprisingly, the above do not result in an equivalent reduction in blood transfusions, reduction that represents a major issue when using methods aimed at reducing intraoperative blood loss. The groups are not perfectly mached, as there is a significant age difference between them, as well as consumption of anticoagulants.

The paper presents evidence in favor of SCBS to reduce blood loss during surgery for revision of infected total knee arthroplasty. However, as also mentioned by the authors, further prospective multicenter randomized studies are required to verify the benefit of the method in this group of patients.

– Constatine Vagianos