
ORC Powder: A Breakthrough in Hemostasis for Total Knee Arthroplasty Procedures

Total Knee Arthroplasty (TKA) is an effective solution for advanced knee osteoarthritis, providing pain relief and improved mobility. However, significant perioperative blood loss remains a major challenge, potentially delaying recovery and increasing complications [1]. Oxidized Regenerated Cellulose (ORC) powder is an advanced, absorbable hemostatic agent that effectively controls bleeding, addressing this critical concern during TKA procedures. This blog delves into the challenges posed by blood loss in TKA, the limitations of traditional hemostatic materials, and the transformative role of modern agents like ORC powder, providing a comprehensive understanding of how they contribute to better surgical outcomes.
Challenges in TKA Surgeries
TKA procedures typically involve extensive exposure of cancellous bone and soft tissues, with the use of tourniquets contributing to both intraoperative and hidden blood loss. This blood loss can lead to postoperative anaemia, prolong hospital stays, and increase the risk of complications, such as infections and delayed wound healing [2]. These challenges highlight the critical need for efficient blood management solutions to optimize patient outcomes.
Limitations of Traditional Hemostatic Materials
Traditional hemostatic materials—such as foam, fabric, and gel—have been used for years to control bleeding. However, these materials often fall short in anatomically complex regions like the joint capsule, where their conformability is limited and their action slower. Additionally, their application can be cumbersome, especially when addressing bleeding in irregular or hard-to-reach anatomical areas [3].
Traditional solutions have limitations in addressing these challenges, which brings us to the transformative role of ORC powder.
Why ORC Powder Excels
ORC powder such as Surgi-ORC® powder derived from oxidized regenerated cellulose, is specifically designed to address the challenges associated with controlling oozing blood over broad, irregular surfaces like the joint capsule. The powder’s granular structure adheres precisely to complex anatomical regions, offering superior performance compared to traditional hemostatic agents like foam and fabric [4].
Upon application, ORC powder comes into contact with blood, it forms a brownish or black gelatinous mass. This mass acts as a physical matrix to which platelets can adhere. As platelet aggregation occurs and a platelet-fibrin plug forms, the swelling material generates pressure on the surrounding tissue, contributing to haemostasis. In addition, the ORC maintains a low pH environment that supports vasoconstriction, effectively reducing blood flow at the site of application [5, 6].
Fig. 1: Surgi-ORC® powder with bellow bottle
Clinical Evidence of ORC Powder in TKA
A retrospective study conducted at Peking University Third Hospital evaluated the efficacy of ORC powder in TKA surgeries. The study involved 85 patients, demonstrated the following key outcomes for those treated with ORC powder [7]:
- Reduced Blood Loss: Patients treated with ORC powder experienced a reduction in perioperative blood loss by an average of 154 mL compared to the control group (without ORC powder).
- Improved Recovery Metrics: Postoperative hemoglobin (Hb) and hematocrit (HCT) levels remained consistently higher in ORC powder group, aiding in faster recovery.
- Proven Surgical Safety: The use of ORC powder did not increase surgical time or complication rates, ensuring its safety profile.
Fig. 2: The application of ORC powder: (a) posterior joint capsule (b) medial gap (c) lateral gap (d) suprapatellar pouch (e) infrapatellar fat pad (f) the joint capsule after washing away the residual powder [7]
Key Benefits of ORC Powder
- Enhanced Conformability: The granular structure of ORC powder ensures superior adhesion to irregular surfaces, making it more effective than fabric or foam-based agents.
- Effective Hemostasis: The rapid formation of a clot helps significantly reduces perioperative bleeding.
- Biocompatibility and Absorbability: Fully absorbable, ORC powder minimizes the risk of residue-related complications.
- Ease of Application: The granular form of ORC powder is prefilled in a bellow bottle, allowing for easy dispensing directly onto the target bleeding site, ensuring precise coverage even in complex anatomical areas.
Conclusion
ORC powder represents a significant advancement in surgical hemostasis, providing a dual-action mechanism that not only reduces blood loss but also enhances recovery in Total Knee Arthroplasty. As the demand for TKA procedures increases, incorporating innovative solutions like ORC powder can improve patient outcomes, reduce complications, and set new standards in orthopedic surgery. Its ability to effectively control bleeding, while maintaining ease of application and biocompatibility, makes ORC powder a game-changer in modern TKA practices.
References
- Abdel MP, Oussedik S, Parratte S, Lustig S, Haddad FS. Coronal alignment in total knee replacement: Historical review, contemporary analysis, and future direction. Bone Joint J. 2014;96-b(7):857-862.
- Helito CP, Bonadio MB, Sobrado MF, Giglio PN, Pécora JR, Camanho GL, Demange MK. Comparison of floseal® and tranexamic acid for bleeding control after total knee arthroplasty: a prospective randomized study. Clinics. 2019; 74:
- Dong R, Zhang H, Guo B. Emerging hemostatic materials for non-compressible hemorrhage control. Natl Sci Rev. 2022;9(11): nwac162.
- Keshavarzi S, MacDougall M, Lulic D, Kasasbeh A, Levy M. Clinical experience with the surgicel family of absorbable hemostats (oxidized regenerated cellulose) in neurosurgical applications: A review. Wounds. 2013;25(6):160-167.
- Li B, Pan W, Sun X, et al. Hemostatic effect and safety evaluation of oxidized regenerated cellulose in total knee arthroplasty- a randomized controlledtrial. BMC MusculoskeletDisord. 2023;24(1):797.
- Wagenhäuser MU, Mulorz J, Ibing W, et al. Oxidized (non)- regenerated cellulose affects fundamental cellular processes of wound healing. Sci Rep. 2016;6:32238.
- Wang X, Han Z, Zhang G, Zhang S, Li Z, Tian H. Safety and Efficacy of a Novel Hemostatic Powder in Total Knee Arthroplasty. Clinical and Applied Thrombosis/Hemostasis. 2024 Dec;30:10760296241306749.