Efficacy and Outcomes of Oxidized Regenerated Cellulose (ORC) in Total Joint Arthroplasty (TJA): A Systematic Review and Meta-Analysis.

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Background: Novel hemostatic agents, such as oxidized regenerated cellulose (ORC) have grown in popularity. The aim of this systematic review and meta-analysis is to evaluate the efficacy of ORC for intraoperative and postoperative blood loss in total joint arthroplasty (TJA). Methods: A search was conducted across seven databases. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and included if they met eligibility criteria. Demographics and results of the studies were extracted. Meta-analysis was conducted to evaluate outcomes. Results: Eleven studies met inclusion criteria. One case report study did report a hypersensitivity reaction, however, the remaining studies showed no additional complications from the use of ORC. Five studies reported equivalent rates of blood transfusion, with one study finding that ORC led to lower rates of blood transfusions. Nine studies were included for meta-analysis. Total blood loss (Cohen's d: -0.42, CI: -0.66-0.19, p<0.001) and intraoperative blood loss (Cohen's d: -0.33, CI: -0.51-0.14, p<0.001) were significantly lower in the ORC cohort compared to using no ORC. The ORC cohort also had significantly lower hemoglobin drop on postoperative day 1, however, publication bias was present in association with this finding. There was no significant difference between the ORC cohort and the no ORC cohort for postoperative day 7 hemoglobin (Cohen's d: 1.13, CI: -0.15- 2.42, p=0.08), postoperative day 1 C-Reactive Protein (CRP) (Cohen's d: 0.09, CI: -0.10- 0.29, p=0.36), and postoperative day 7 CRP (Cohen's d: 0.04, CI: -0.50- 0.58, p=0.88).. Conclusion: ORC may help to reduce total blood loss and intraoperative blood loss in TJA, however, it does not appear to have sustained effects over the following week, nor does it appear to lower transfusion rates with the current available evidence. ORC has been shown to be safe, with CRP levels remaining constant postoperatively, and only one case report showing a self-limited hypersensitivity reaction (local rash). ORC may be a useful adjunct to help reduce blood loss for TJA, however, it is not currently clear if its usage leads to significant improvements in clinical outcomes. Level of Evidence: IV.

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