OBJECTIVES: This retrospective matched cohort study evaluated clinical and cost outcomes among patients undergoing primary total hip arthroplasty (THA) with vs. without use of a saline-coupled bipolar sealer (SCBS).   METHODS: Using the MedAssets Research Services™ database, two cohorts were identified: THA with SCBS (Cases), THA without SCBS (Controls). Patients were >18 years old, undergoing primary THA, without fracture of the lower limb, and with continuous health plan enrollment over the study period. Each Case patient was matched to three Controls using an exact propensity score matching algorithm. Covariates included: age group, gender, coexisting clinical characteristics (i.e. Charlson score and obesity); hospital size, hospital teaching status, and geographic region.   RESULTS: Post-match, there were 1,967 Cases and 5,901 Controls for analysis. Patients were predominantly female, with mean age of 64 years. Incidence of transfusion was significantly lower in the Case cohort (3.0% vs. 4.5%, P=0.005); use of tranexamic acid (TXA) was also greater in the Case cohort (24.3% vs. 17.7%, P<0.001). Transfusions were significantly lower among patients without TXA use in the Case cohort vs. Controls (3.1% vs. 5.2%, P=0.001). Mean length of stay was significantly shorter in in the Case cohort (3.8 vs. 4.1 days, P<0.001), and Cases were 17.3% more likely to be discharged home with no home health services versus Controls (35.3% vs. 18.0%, P<.001). Mean total index hospitalization costs (SD) for the Case and Control cohorts were $18,319 ($8,456) and $17,033 ($7,971), P = .004, respectively. CONCLUSIONS: Use of SBCS was associated with a significant reduction in transfusion and increased proportion of patients discharged home. While hospitalization cost was significantly higher in the Case cohort, total episode cost is mitigated by the greater proportion of patients discharged home.  In the current era of Medicare bundled payments future research on post-discharge costs of care is warranted.