Bone wax can lead to foreign body reaction and local osteolysis after open femoroacetabular impingement (FAI) surgery.

Christiane Sylvia Leibold, Andreas Hecker, Florian Schmaranzer, Klaus Arno Siebenrock

Abstract read

In one paragraph

Article in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it

0cells of the map it votes in

2citing papers in PubMed, 1 pooled it

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

Effectiveness and Safety of Oxidized Regenerated Cellulose for Hemostasis in Joint Arthroplasty: A Systematic Review and Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
Pooled it
Novel Bioresorbable Bone Wax for Potentiated Hemostasis and Osteogenesis.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Christiane Sylvia LeiboldDepartment of Orthopaedic Surgery and Traumatology, Inselspital, Bern University hospital, University of Bern, Freiburgstrasse, Bern, 3010, Switzerland. christianesylvia.leibold@insel.ch.ORCID http://orcid.org/0000-0003-4442-8562

Andreas HeckerArthroClinic Bern, Lindenhofspital, Bremgartenstrasse 117, 3012, Bern, Switzerland. arthroclinic-bern@hin.ch.

Florian SchmaranzerDepartment of Diagnostic-, Interventional-, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, 3010, Switzerland.

Klaus Arno SiebenrockDepartment of Orthopaedic Surgery and Traumatology, Inselspital, Bern University hospital, University of Bern, Freiburgstrasse, Bern, 3010, Switzerland. klaus.siebenrock@insel.ch.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionBone wax is a haemostatic agent, widely used to prevent bleeding from bone surfaces. Despite its effectiveness in haemostatic control, it can lead to foreign body granuloma and osteolysis. Therefore, the aim of this study was to assess the rate and progress of osteolysis after surgical bone wax application.

methodsWe included 425 patients between 01/2002 and 12/2006 that underwent offset correction for cam type femoroacetabular impingement with application of bone wax for homogeneous statistical cohort formation. Comparison was made to a similar cohort group undergoing offset correction without application of bone wax, including 479 patients between 01/2008 and 12/2012. Out of the study group, six hips in five patients presented with persisting pain and growing osteolysis on the X-rays in the area of the offset correction, and two underwent subsequent revision surgery. None of the patients in the cohort group presented with osteolysis. In both groups, patients who presented with persisting pain without radiological osteolysis had other determinable causes as labral tears, progressing osteoarthritis, trochanteric bursitis, and adhesions as suggested source of the pain. We measured the relative area of the osteolysis where present (area of osteolysis/area of femoral head in %) on lateral radiographs on the first postoperative X-rays and latest follow-up X-rays, with a mean follow-up time of 8.6 ± 2.5 years (range, 5-13 years). Histologic samples were taken at revision surgery.

resultsThe relative area of osteolysis increased in all hips from a directly postoperative median of 5.5% ± 2.7% (2.3-10.7%) to 11.2% ± 3.9% (7.1-17.3%) at last follow-up. In patients undergoing revision surgery for osteolysis, remaining wax as a foreign material with attached multinucleated giant cells and abundant mononuclear cells was detected histologically.

conclusionThe intra-articular use of bone wax should be approached with caution and with awareness of the possible complications. TRIAL REGISTRATION NUMBER: KEK 2018-00078, registered April 2018. LEVEL OF EVIDENCE: level IV, retrospective case series.

Indexed as

Femoracetabular ImpingementForeign-Body ReactionHemostaticsOsteolysisPalmitatesPostoperative ComplicationsWaxesAdolescentAdultFemaleHumansMaleMiddle AgedRetrospective StudiesYoung Adultbone waxHemostaticsPalmitatesWaxesBone waxFemoroacetabular impingementForeign body granulomaOffset correctionOsteolysis

Identifiers

PMID40186677

DOI10.1016/j.jot.2019.03.005

PMCPMC11972202

What OpenQuestion holds

Textmetadata

LicenceCC BY

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.