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A Randomized, Prospective Evaluation on the Effectiveness of Tranexamic Acid in Reducing Blood Loss after Total Shoulder Arthroplasty
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ASES Abstracts
J Shoulder Elbow Surg August 2015
of pins based on automated software calculations. This method may ultimately provide a cost effective solution enabling surgeons to obtain desired orientation of the glenoid. Reference 1. Hendel MD, Bryan JA, Rodriguez EJ, Brems JJ, Evans PJ, Iannotti JP. J Bone Joint Surg Am 2012;94:21-67-75
8 A RANDOMIZED, PROSPECTIVE EVALUATION ON THE EFFECTIVENESS OF TRANEXAMIC ACID IN REDUCING BLOOD LOSS AFTER TOTAL SHOULDER ARTHROPLASTY
Figure 2 Points on the drill were 3D digitized and transferred to corresponding glenoid 3D image. to align the central hole as desired by the surgeon. For this study we tested a configuration which has the screws placed at the four glenoid poles and two central points of the glenoid face. A surgical simulator (Fig. 1) was used for testing that mounted 3D printed arthritic scapulae and allowed for variability in scapula positioning (hidden from the surgeon). Physical models of glenoids were created from de-identified CT scans from nine arthritic patients. Three drill alignment methods were tested: using only the finger guided technique along anterior glenoid vault, with the aid of 3D reconstructed images, and using the novel drill guide. The alignment of the drill relative to the glenoid face was collected using a 3D coordinate digitizer arm and transferred to a digital model to determine orientation of the drill relative to standard anatomical planes (Fig. 2). Error in version and inclination were compared among alignment methods using a linear mixed effects model with repeated measures. Results: Errors in version and inclination of the glenoid, using the three different drill alignment methods, are shown in Fig. 3. Errors in drill line orientation using no assistance avg 9.1 6 6.7 in version and 8.7 65.9 inclination, errors using preop 3D imaging avg 7.8 66.1 version and 6.6 64.5 inclination, whereas errors using the Pin Guide avg 2.6 61.7 version and 2.9 6 2.4 inclination. Version errors using the pin guide were significantly lower than version errors associated with the other 2 methods. Conclusions: The new pin guide method reduced errors in orientation of the central drill line. The guide method is patient specific, but does not require rapid prototyping and instead uses adjustments to an array
Robert J. Gillespie, MD, Yousef Shishani, MD, Shane Hanzlik, MD, Jonathan J. Streit, MD, Reuben Gobezie, MD, Case Western Reserve University, Department of Orthopaedic Surgery, Cleveland Shoulder Institute, University Hospitals of Cleveland, Cleveland, OH, USA Introduction: Tranexamic Acid(TA) is an antifibrinolytic agent that significantly reduces blood loss and transfusion requirements after total knee and hip arthroplasty. The use of TA in shoulder arthroplasty has been limited to date. Aim: To evaluate the ability of TA to reduce postoperative blood loss after shoulder arthroplasty. Methods: We performed a blinded, prospective randomized study of 88 patients(mean age 67 years, 58% female) in which patients received either 100mL normal saline or 100mL normal saline with 2g TA by topical wound application at the completion of primary total (37 patients) or reverse (51 patients) shoulder arthroplasty. Blood loss during surgery (EBL), day-one drain output after surgery (DO), and change in hemoglobin were recorded for all patients. Results: Overall DO was 46mL635mL for TA and 55mL640mL for placebo (p¼0.29), mean change in hemoglobin was 2.161.0 for TA and 2.760.8 for placebo (p¼0.007), and mean EBL during surgery was not different (p¼0.20) between the TA and placebo groups. For TSA, mean DO was 42mL637 mL for TA and 57mL632mL for placebo (p¼0.22), mean change in hemoglobin was 2.361.3 for TA and 2.760.5 for placebo (p¼0.23), and mean EBL was similar between groups (p¼0.76). For RTSA, mean DO was 50mL634mL for TA and 54mL644mL for placebo (p¼0.73), mean change in hemoglobin was 1.960.8 for TA and 2.660.9 for placebo (p¼0.004), although the placebo group experienced greater surgical EBL (137mL694mL vs 91mL645mL, p¼0.03). There were no transfusions or complications recorded. All clinical parameters improved (p¼0.05 or better) for the group overall. Conclusion: Tranexamic acid appears to decrease blood loss following shoulder arthoplasty, however further study utilizing more patients is warranted.
9 ANALYSIS OF CYTOKINE PROFILES IN THE DIAGNOSIS OF PERIPROSTHETIC JOINT INFECTIONS OF THE SHOULDER
Figure 3 Mean version and inclination errors for the three drill alignment methods *indicates sign decrease using Pin Guide compared to No assistance, # indicates sign decrease using Pin Guide compared to Preop Image (p<0.05). Error bars indicate standard error of mean.
Salvatore J. Frangiamore, MD, MS, Anas Saleh, MD, Matthew J. Grosso, MD, Mario Farias-Kovac, MD, Xiaochun S. Zhang, MD, PhD, Thomas M. Daly, MD, Thomas W. Bauer, MD, PhD, Joseph P. Iannotti, MD, PhD, Eric T. Ricchetti, MD, Orthopaedic & Rheumatologic Institute, Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA Introduction: Periprosthetic joint infection (PJI) following shoulder arthroplasty can present both a diagnostic and therapeutic challenge due to the indolent nature of the most common offending organisms. Newer markers of infection have shown potential for increased sensitivity in diagnosis of PJI of the shoulder, in particular, synovial levels of pro-inflammatory cytokines such as interleukin-6 (IL-6). The purpose of this study was to evaluate the efficacy of broader synovial fluid cytokine analysis in the diagnosis of PJI of the shoulder. Methods: Thirty-seven consecutive patients that underwent revision surgery (n¼40 cases) for a painful shoulder arthroplasty were prospectively
ASES Abstracts
J Shoulder Elbow Surg August 2015
of pins based on automated software calculations. This method may ultimately provide a cost effective solution enabling surgeons to obtain desired orientation of the glenoid. Reference 1. Hendel MD, Bryan JA, Rodriguez EJ, Brems JJ, Evans PJ, Iannotti JP. J Bone Joint Surg Am 2012;94:21-67-75
8 A RANDOMIZED, PROSPECTIVE EVALUATION ON THE EFFECTIVENESS OF TRANEXAMIC ACID IN REDUCING BLOOD LOSS AFTER TOTAL SHOULDER ARTHROPLASTY
Figure 2 Points on the drill were 3D digitized and transferred to corresponding glenoid 3D image. to align the central hole as desired by the surgeon. For this study we tested a configuration which has the screws placed at the four glenoid poles and two central points of the glenoid face. A surgical simulator (Fig. 1) was used for testing that mounted 3D printed arthritic scapulae and allowed for variability in scapula positioning (hidden from the surgeon). Physical models of glenoids were created from de-identified CT scans from nine arthritic patients. Three drill alignment methods were tested: using only the finger guided technique along anterior glenoid vault, with the aid of 3D reconstructed images, and using the novel drill guide. The alignment of the drill relative to the glenoid face was collected using a 3D coordinate digitizer arm and transferred to a digital model to determine orientation of the drill relative to standard anatomical planes (Fig. 2). Error in version and inclination were compared among alignment methods using a linear mixed effects model with repeated measures. Results: Errors in version and inclination of the glenoid, using the three different drill alignment methods, are shown in Fig. 3. Errors in drill line orientation using no assistance avg 9.1 6 6.7 in version and 8.7 65.9 inclination, errors using preop 3D imaging avg 7.8 66.1 version and 6.6 64.5 inclination, whereas errors using the Pin Guide avg 2.6 61.7 version and 2.9 6 2.4 inclination. Version errors using the pin guide were significantly lower than version errors associated with the other 2 methods. Conclusions: The new pin guide method reduced errors in orientation of the central drill line. The guide method is patient specific, but does not require rapid prototyping and instead uses adjustments to an array
Robert J. Gillespie, MD, Yousef Shishani, MD, Shane Hanzlik, MD, Jonathan J. Streit, MD, Reuben Gobezie, MD, Case Western Reserve University, Department of Orthopaedic Surgery, Cleveland Shoulder Institute, University Hospitals of Cleveland, Cleveland, OH, USA Introduction: Tranexamic Acid(TA) is an antifibrinolytic agent that significantly reduces blood loss and transfusion requirements after total knee and hip arthroplasty. The use of TA in shoulder arthroplasty has been limited to date. Aim: To evaluate the ability of TA to reduce postoperative blood loss after shoulder arthroplasty. Methods: We performed a blinded, prospective randomized study of 88 patients(mean age 67 years, 58% female) in which patients received either 100mL normal saline or 100mL normal saline with 2g TA by topical wound application at the completion of primary total (37 patients) or reverse (51 patients) shoulder arthroplasty. Blood loss during surgery (EBL), day-one drain output after surgery (DO), and change in hemoglobin were recorded for all patients. Results: Overall DO was 46mL635mL for TA and 55mL640mL for placebo (p¼0.29), mean change in hemoglobin was 2.161.0 for TA and 2.760.8 for placebo (p¼0.007), and mean EBL during surgery was not different (p¼0.20) between the TA and placebo groups. For TSA, mean DO was 42mL637 mL for TA and 57mL632mL for placebo (p¼0.22), mean change in hemoglobin was 2.361.3 for TA and 2.760.5 for placebo (p¼0.23), and mean EBL was similar between groups (p¼0.76). For RTSA, mean DO was 50mL634mL for TA and 54mL644mL for placebo (p¼0.73), mean change in hemoglobin was 1.960.8 for TA and 2.660.9 for placebo (p¼0.004), although the placebo group experienced greater surgical EBL (137mL694mL vs 91mL645mL, p¼0.03). There were no transfusions or complications recorded. All clinical parameters improved (p¼0.05 or better) for the group overall. Conclusion: Tranexamic acid appears to decrease blood loss following shoulder arthoplasty, however further study utilizing more patients is warranted.
9 ANALYSIS OF CYTOKINE PROFILES IN THE DIAGNOSIS OF PERIPROSTHETIC JOINT INFECTIONS OF THE SHOULDER
Figure 3 Mean version and inclination errors for the three drill alignment methods *indicates sign decrease using Pin Guide compared to No assistance, # indicates sign decrease using Pin Guide compared to Preop Image (p<0.05). Error bars indicate standard error of mean.
Salvatore J. Frangiamore, MD, MS, Anas Saleh, MD, Matthew J. Grosso, MD, Mario Farias-Kovac, MD, Xiaochun S. Zhang, MD, PhD, Thomas M. Daly, MD, Thomas W. Bauer, MD, PhD, Joseph P. Iannotti, MD, PhD, Eric T. Ricchetti, MD, Orthopaedic & Rheumatologic Institute, Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA Introduction: Periprosthetic joint infection (PJI) following shoulder arthroplasty can present both a diagnostic and therapeutic challenge due to the indolent nature of the most common offending organisms. Newer markers of infection have shown potential for increased sensitivity in diagnosis of PJI of the shoulder, in particular, synovial levels of pro-inflammatory cytokines such as interleukin-6 (IL-6). The purpose of this study was to evaluate the efficacy of broader synovial fluid cytokine analysis in the diagnosis of PJI of the shoulder. Methods: Thirty-seven consecutive patients that underwent revision surgery (n¼40 cases) for a painful shoulder arthroplasty were prospectively