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2020 Abstracts 04-01-20 Pk MID-AMERICA ORTHOPAEDIC ASSOCIATION 38th Annual Meeting April 22-26, 2020 Hyatt Regency Coconut Point Resort Bonita Springs, FL Meeting canceled due to COVID-19 Podium and Poster Abstracts NOTE: Disclosure information is listed at the end of this document. *Denotes presenter MAOA FIRST PLENARY SESSION April 23, 2020 Differentiating Conversion Total Knee Arthroplasty from Primary Total Knee Arthroplasty Abstract ID: Paper 001 Nicholas B. Frisch, M.D., M.B.A. / Rochester, MI *Timothy C. Keating, M.D. / Chicago, IL Tyler E. Calkins, M.D. / Memphis, TN Chris Culvern, M.S. / Chicago, IL Craig J. Della Valle, M.D. / Chicago, IL INTRODUCTION: With the continued push toward increased efficiency and improved clinical outcome pathways, there is a growing need to differentiate routine primary total knee arthroplasty (TKA) from more complex primary TKA procedures. Patients with a previous fracture or corrective osteotomy about the knee often require complex primary, or “conversion,” total knee arthroplasty due to retained hardware, scarred tissue, malalignment, bone loss, and other patient factors. The objective of this study is to compare short-term outcomes and resource utilization of primary and conversion TKA, and to differentiate what previous surgeries or injuries are likely to require conversion TKA. METHODS: Retrospective chart review of 1319 primary TKA performed by a single surgeon at a single institution between 2011 and 2017 identified 130 patients with a history of previous knee surgery to form a ‘conversion’ cohort. One-to-one nearest-neighbor matching was used to identify 130 patients of similar age, ASA BMI, and sex without a history of previous knee surgery for a ‘primary’ cohort. Patient demographics, hospital stay, operative resource utilization, and outcomes for each group were compared. Patients in the conversion group were further stratified into those who had a previous fracture about the knee, osteotomy, ligament repair, open arthrotomy, or extensor mechanism realignment or repair. RESULTS: The conversion group as a whole had longer operative times (96.1 vs. 90.8 minutes, p = 0.022) and revision component utilization (15.4% vs. 3.1%, p = 0.003) compared to the primary cohort. Comparing patients with prior fracture and osteotomy to the remaining patients in the conversion group who had previous soft-tissue procedures showed a larger difference in operative time (107.1 minutes vs. 91.3 minutes, p < 0.001), higher 90-day readmission rate (21.1% vs. 4.4%, p = 0.006) and utilized more revision components (36.8% vs. 6.6%, p < 0.001). CONCLUSION: Compared to routine primary TKA, conversion TKA requires increased resource utilization, specifically operative time and revision components. Conversion patients with prior fracture or osteotomy about the knee showed significantly longer operative times, revision component utilization and higher readmission rates compared to patients with previous soft tissue procedures. Policymakers should consider these variables, as they did in conversion THA, to consider adding an additional code to account for the increased complexity and resource utilization of select patients undergoing TKA. Intravenous and Oral Tranexamic Acid are Equivalent at Reducing Blood Loss in Thoracolumbar Spinal Fusion: A Prospective Randomized Trial Phase 3 Abstract ID: Paper 002 *Charles C. Yu, M.D. / Detroit, MI Omar M. Kadri, M.D. / Detroit, MI Allen A. Kadado, M.D. / Detroit, MI Mohsin S. Fidai, M.D. / Detroit, MI Justin Jabara, M.D. / Detroit, MI Jacob A. Pawloski, M.D. / Detroit, MI Morenikeji A. Buraimoh, M.D. / Baltimore, MD Stephen Bartol, M.D. / Detroit, MI Gregory P. Graziano, M.D. / Detroit, MI INTRODUCTION: The use of antifibrinolytic agents such as tranexamic acid (TXA) to decrease operative blood loss and allogenic blood transfusions is well documented in the literature. While evidence supports the use of intravenous (IV) and topical formulations of TXA in spine surgery, the use of oral (PO) TXA has not been studied. The objective of the study is to compare perioperative blood loss in patients undergoing elective posterior thoracolumbar fusion who were treated with IV versus PO TXA. METHODS: A prospective randomized trial of patients enrolled at a university affiliated tertiary medical center between February 2017 and October 2018. 171 patients undergoing thoracolumbar fusion were randomized to receive 1.95g of PO TXA 2 hours preoperatively or 2g IV TXA (1g before incision and 1g before wound closure) intraoperatively. The sample was further stratified into 3 categories based on number of levels fused (1-2 level fusions, 3-5, and >5). The primary outcome was the reduction of hemoglobin. Secondary outcomes included calculated blood loss, drain output, postoperative transfusion, complications, and length of hospital stay. Equivalence analysis was performed with a two one-sided test (TOST). A P-value of <0.05 suggested equivalence between treatments. RESULTS: 91 patients received IV TXA and 80 patients received PO TXA. Patient demographic factors were similar between groups except for age, weight, and BMI. The mean reduction of hemoglobin was similar between IV and PO groups (3.48 g/dL vs. 3.19 g/dL, respectively; P = 0.004, equivalence). Similarly, the calculated blood loss was equivalent (1274 mL vs. 1206 mL, respectively; P = 0.001, equivalence). 21 patients (23%) in IV TXA group received a transfusion compared with 10 patients in PO TXA group (13%) (P = 0.07). 2 patients (2% and 3% in IV and PO, respectively) in each group experienced a DVT/PE (P = 0.90). This is the last phase of an ongoing trial, so we predict that we will achieve over 300 patients by the MAOA meeting time. DISCUSSION AND CONCLUSION: Patients treated with IV and PO TXA experienced the same perioperative blood loss after spinal fusions. Given its lower cost, PO TXA represents an excellent alternative to IV TXA in patients undergoing elective posterior thoracolumbar fusion and may improve healthcare cost-efficiency in the studied population. The Diabetic Pilon Fracture: Are They As Bad As We Think? Abstract ID: Paper 003 *Lasun O. Oladeji, M.D., M.S. / Columbia, MO Brooks Platt / Indianapolis, IN Brett D. Crist, M.D., F.A.C.S. / Columbia, MO INTRODUCTION: Pilon fracture open reduction and internal fixation (ORIF) is associated with a relatively high risk of complications. Diabetes is a known risk factor for complications associated with any type of surgery. However, to date, little has been published on the outcomes for operative management of pilon fractures in diabetic patients. We sought to specifically identify how diabetes impacts the risk of complications (deep surgical site infection, nonunion, amputation, and arthrodesis) following pilon fracture ORIF. METHODS: A retrospective review was performed to identify patients who presented for ORIF of a tibial pilon fracture (AO/OTA 43). Patient demographics, medical comorbidities, AO/OTA fracture type, and surgical outcomes were reviewed. Patients were stratified into cohorts based on the presence or absence of diabetes at the time of surgery. The complications of interest that proved significant during univariate analyses were then entered into a multivariable logistic regression model using stepwise method to identify the independent predictors for diabetes. RESULTS: A total of 279 pilon fractures (276 patients) were included in this study. There were 43 fractures (15.4%) in patients with diabetes mellitus; 17 (39.5%) occurred in insulin-dependent diabetics. Patients with diabetes were significantly more likely to have a higher BMI (34.81 vs. 29.57, p=0.002) and be older (55.30 ± 16.3 years vs. 41.70 ± 14.05, p<0.001) at the time of injury. Patients without diabetes were more likely to sustain an AO/OTA 43-C3 fracture (36.0% vs. 11.6%, p=0.001). Univariate logistic regression demonstrated that overall, patients with diabetes were 3.64 times more likely to experience a complication following surgery (95% CI= 1.854-7.159; <0.001). Diabetics were 5.5 times more likely to require an arthrodesis (95% CI=1.894-16.214; p=0.001) and 2.7 times more likely to develop a deep infection (95% CI=1.261-5.630; p=0.008). Following multivariable logistic regression analysis, diabetes remained an independent risk factor for both arthrodesis (OR=4.30, CI=1.350-13.566, p=0.013) and deep infection (OR= 2.31, CI 1.061-5.006, p=0.035). CONCLUSION: Diabetic patients have a significantly higher risk of complications following pilon fracture ORIF. Diabetics in this study were 3.64 times more likely to experience any complication, despite having less complex fractures. Given the increased rate of complications in diabetic patients, it is essential that diabetic patients understand their risk of complication and receive closer perioperative diabetic evaluation and management including screening for peripheral neuropathy and peripheral vascular disease, a hemoglobin A1C, and strict glycemic control. Primary Reverse Shoulder Arthroplasty with Glenoid and Humeral Lateralization Does Not Result in Increased Blood Metal Ion Levels Regardless of Glenosphere Size: A Randomized Controlled Trial Abstract ID: Paper 004 *Ayoosh Pareek, M.D. Ngoc Tram V. Nguyen, B.A. Mark E. Morrey, M.D. Joaquin Sanchez-Sotelo, M.D., Ph.D. Rochester, MN INTRODUCTION: Metal ions have been identified as a source for adverse tissue reactions and implant failure in hip arthroplasty. Most reverse shoulder arthroplasty designs incorporate one or more trunnions. However, changes in blood metal ions levels have not been investigated to date in reverse shoulder arthroplasty (RTSA), and they may change depending on design features and sphere size. The purpose of this study was to (1) determine in vivo levels of cobalt, chromium, and nickel in a randomized controlled trial of patients undergoing reverse total shoulder arthroplasty (RTSA) with one of four glenosphere sizes, and (2) to identify possible factors affecting metal ion levels. METHODS: Between 2016 and 2018, 67 RTSA were performed for cuff tear arthropathy, massive irreparable cuff tear, or osteoarthritis as part of a prospective randomized controlled trial.
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