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MID-AMERICA ORTHOPAEDIC ASSOCIATION 34th Annual Meeting April 13-17, 2016 Hyatt Regency Coconut Point Resort Bonita Springs, FL Podium and Poster Abstracts NOTE: Disclosure information is listed at the end of this document. *Denotes presenter MAOA FIRST PLENARY SESSION April 14, 2016 Liposomal Bupivacaine vs. Femoral Nerve Block in Managing Pain After Anterior Cruciate Ligament Reconstruction Abstract ID: Paper 001 ____________________________________________________________________________ Kelechi R. Okoroha, M.D. Robert A. Keller, M.D. Edward Jung, M.D. Nima Mehran, M.D., M.S. *Eric T. Owashi, M.D. Vasilios Moutzouros, M.D. Detroit, MI INTRODUCTION: Adequate postoperative pain management following arthroscopic anterior cruciate ligament (ACL) reconstruction is essential to hasten rehabilitation and improve patient satisfaction. Currently, the gold standard for pain management after knee surgery is femoral nerve block (FNB); however, recent trials have demonstrated reasonable postoperative pain control with locally infiltrated Liposomal Bupivacaine. No clinical studies have examined the effectiveness of Liposomal Bupivacaine at pain control following ACL reconstructions. The aim of this study was to compare the effectiveness of Liposomal Bupivacaine to FNB in controlling post-ACL reconstruction pain. METHODS: This study was a prospective, randomized clinical trial. One hundred patients surgically treated for primary ACL tears were consented for participation. Patients were randomized to receive either intraoperative local infiltration of Liposomal Bupivacaine (20 cc Bupivacaine/10 cc saline) using a standardized injection protocol or preoperative FNB. Following surgery, patient’s pain and opioid consumption was recorded using a Visual Analog Scale (VAS) and IV morphine equivalents for four days. The primary outcome of interest was postoperative pain levels. Secondary outcomes assessed include opioid consumption, hours slept, and patient satisfaction with pain management. RESULTS: A total of 100 patients were evaluated; 50 were given a preoperative FNB and 50 were treated with local Liposomal Bupivacaine infiltration. Outcomes showed no significant difference between average pain levels in the two groups on postoperative day (POD) 0; mean 5.6 vs. 5.6 (p=0.99), POD 1; mean 4.9 vs. 5.2 (p= 0.65), and POD 2; mean 3.9 vs. 4.2 (p=0.67). No differences were found in average IV morphine equivalents used between the two groups on POD 0, 1, and 2 (p= 0.12, 0.48, 0.74). Patients receiving Liposomal Bupivacaine reported a statistically significant greater number of hours slept on POD 0, 1, and 3 (P= 0.031, 0.007, 0.041). There was also a non-significant perception of greater satisfaction with pain management in the Liposomal Bupivacaine group on POD 0,1 and 2 (67% vs. 57%, 80% vs. 56%, 94% vs. 65%). CONCLUSION: No significant difference was seen when comparing Liposomal Bupivacaine to FNB for control of post-ACL reconstruction pain. Additionally, there was no significant difference in opioid consumption postoperatively. However, patients in the Liposomal Bupivacaine group reported a greater number of hours slept and a non-significant increase in satisfaction with their pain management. These results suggest that Liposomal Bupivacaine is at least as effective as FNB in ACL reconstruction patients and can be used as a primary method to manage pain control post-ACL reconstruction. Administration of Oral Antibiotics Following Two-Stage Exchange for Periprosthetic Joint Infection Reduces Subsequent Failure: A Multi-Center, Randomized Controlled Trial Abstract ID: Paper 002 ____________________________________________________________________________ Jonathan M. Frank, M.D. / Chicago, IL Erdan Kayupov, M.S. / Chicago, IL Gregory K. Deirmengian, M.D. / Philadelphia, PA Matthew S. Austin, M.D. / Philadelphia, PA Scott M. Sporer, M.D. / Winfield, IL Curtis W. Hartman, M.D. / Omaha, NE Kevin L. Garvin, M.D. / Omaha, NE Erik Hansen, M.D. / San Francisco, CA Javad Parvizi, M.D. / Philadelphia, PA James J. Purtill, M.D. / Philadelphia, PA *Craig J. Della Valle, M.D. / Chicago, IL INTRODUCTION: A substantial number of patients develop recurrent periprosthetic joint infection (PJI) following two-stage exchange arthroplasty. The purpose of this multicenter randomized controlled trial was to determine if three months of oral antibiotics would decrease the risk of failure following a two-stage exchange. METHODS: We invited all members of the Knee Society to participate in the trial. Following Institutional Review Board approval, seven centers enrolled patients who were randomized to receive three months of oral antibiotics or no further antibiotic treatment after operative cultures following the second stage reimplantation were negative. Oral antibiotic therapy was tailored to the original infecting organism(s) in consultation with an Infectious Disease specialist. A priori power analysis determined that 77 patients per group would be required to demonstrate a reduction in infection recurrence from 16% to 4% (β=0.80 and α=0.05). A log rank survival curve was used to analyze the primary outcome of reinfection. RESULTS: 53 patients were randomized to the antibiotic group and 41 in the control group; 14 were excluded for protocol deviations (most commonly discontinuation of antibiotics prior to 90 days) leaving 40 patients in each group with a mean follow-up of 16.3 months in the antibiotic and 11.4 months in the control group. PJI followed a TKA in 41 patients and a THA in 39. Mean age, BMI, sex distribution, and Charlson index were similar amongst the groups suggesting appropriate randomization. There have been two failures in the antibiotic group compared to eight amongst controls (5% vs. 20%; p=0.0232 using log rank survival curve analysis). Seven of the 8 failures in the control group were with new organisms and both failures in the antibiotic group were with the same organism. CONCLUSIONS: This multicenter randomized trial suggests that at short-term follow-up, the addition of three months of oral antibiotics significantly improved infection-free survival. Improvement of Pedicle Screw Placement With First-Time Use of Patient Specific Drill Guides by Novice Surgeon Abstract ID: Paper 003 ____________________________________________________________________________ *Kyle Walker, M.D. Michael Silverstein, M.D. David Gurd, M.D. Cleveland, OH INTRODUCTION: Accurate placement of pedicle screws is a key component spine surgery, but allows small margin of error. Misplacement can result in paralysis or a major bleed. Current methods require the surgeon to place the screw blindly and/or at with the aid of expensive equipment that typically exposes the patient to radiation. Some studies have been performed to validate the use of 3D-printed, patient-specific instrumentation (PSI), but none to date have compared their efficacy over freehand (FH) placement. Also, no studies have measured PSI effectiveness when used by a novice surgeon. METHODS: A CT scan of a cadaveric spine was obtained and 3D reconstructed. Trajectories for screw placement were planned for T1-L5 vertebral levels. A PSI was created in CAD software around said trajectories. One pedicle was randomized to the PSI group at each vertebra with the opposite pedicle serving as the control for the FH group. A junior orthopedic resident using a PSI, 3 mm drill, and standard instrumentation placed all 17 PSI grouped pedicles. A scan was performed and the screws were removed. Three days later the surgeon returned to the spine and repeated the steps using only FH instrumentation. All placements were timed. No fluoroscopy or adjustments from initial placement were allowed in either grouping. Postoperative reconstruction of each scan was analyzed by a staff surgeon for perforation, adequacy of placement, and likelihood of unfavorable outcome. The PSI grouping was also analyzed for deviation from plan. RESULTS: There were three perforations in the PSI group as opposed to eight in the FH grouping (p-value 0.1411). Only one of the PSI screws was designated as needing to be adjusted compared to six of the FH screws (p-value=0.0854). Five of the FH screws were deemed to likely or definitely result in paralysis vs. zero in the PSI grouping (p-value 0.0445). The surgeon had a mean PSI placement time 47.9 second faster than the FH placement time (145.2±74.4 vs. 193.1±43.0 seconds; p-value 0.0319). The PSI trajectories were accurate within 3 mm and within 9.5° from the planned trajectories (p-value 0.0213; p-value 0.0287). CONCUSIONS: Our study was limited by a small sample size and by lack of control of screw placement after pilot hole creation. Regardless, the PSI seems to offer a relatively cheap, user friendly, and sufficiently accurate solution to pedicle screw placement in even a novice surgeon. MAOA BREAKOUT SESSION #1 HAND/ELBOW April 14, 2016 Metacarpophalangeal Arthroplasty for Osteoarthritis: An Implant Comparison Analysis Abstract ID: Paper 005 ____________________________________________________________________________ Eric R. Wagner, M.D. *John T. Weston, M.D. Robert E. Van Demark, III, M.D. Steven L. Moran, M.D. Marco Rizzo, M.D. Rochester, MN PURPOSE: The objective of this study was to assess the results MCP arthroplasty in patients with OA, comparing the functional and radiographic outcomes of 3 different types of implants. METHODS: We performed an analysis of 60 MCP arthroplasties in 59 patients for osteoarthritis at our institution from 1998 to 2012. The mean age at surgery was 62 years, BMI 30,
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