Selective Serotonin Reuptake Inhibitors Are Associated with Increased Bleeding Related Complications Following Primary Total Hip and Total Knee Arthroplasty

Introduction: Approximately 10-22% of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are diagnosed with depression. Pre-operative depression is associated with poorer patient reported outcomes, costs and increased complications. Selective serotonin-reuptake inhibitors (SSRIs) are first-line treatment for depression due to their efficacy and low side effect profile. There are conflicting studies regarding SSRI-related bleeding complications. This study compares the rate of bleeding-related complications in THA and TKA patients taking SSRI’s to a control group of non-SSRI users. Methods: A retrospective single institution study of 16,407 primary THA and TKA’s from 2008 to 2018 was performed. Patients with THA for fracture, conversion arthroplasty with existing hardware, revision TJA, and uni-compartmental knee arthroplasty. Patients taking SSRIs (2,588) were compared to non-SSRI users (13,819). Patient demographics were reviewed and matched at a 3:1 ratio. Multivariate logistic regression analysis was performed and adjusted to control for potential confounders. Results: Patients on SSRI had a significant increase in transfusion, post-operative anemia, irrigation and debridement (I&D) and superficial infection. There was a trend towards increased hematoma and revision. There was a significantly higher rate of pulmonary embolism for SSRI users compared to non-SSRI. Rates of 1-year PJI, hematoma removal or calculated blood loss did not differ. Discussion: The rate of bleeding related complications is significantly greater in SSRI users undergoing TKA and THA. Poorer outcomes in depression may be due to the intrinsic nature of the disease; however, increased pain due to swelling and wound complications may be due to increased rates of bleeding in SSRI users

Low Dose Aspirin: An Effective Chemoprophylaxis for Preventing Venous Thromboembolic Events

The available guidelines, endorsed by Surgical Care Improvement Project (SCIP), have advocated that aspirin (ASA) is a safe and eff­ective strategy for venous thromboembolic events (VTE) prophylaxis following total joint arthroplasty (TJA). The optimal dose of aspirin for this purpose is not known. The first guidelines for prevention of VTE that were issued by the American Academy of Orthopedic Surgeons recommended 325 mg Bis in die (twice a day) (bid) for this purpose with the recommendation having a 1C grade (little evidence to support the recommendation). It is known that platelet aggregation inhibition occurs at lower doses. Traditionally, ASA 81mg has been used as a cardioprotective medication. Additionally, all available randomized studies, including the sentinel study on Pulmonary Embolism Prevention (PEP) trial1-4 have used lower doses of ASA. It was our hypothesis that lower dose aspirin is likely to be as eff­ective as higher dose aspirin while reducing the gastrointestinal side e­ffects associated with the higher dose aspirin

The Patellar Tendon Can Cause External Tibial Component Malrotation in Lateral Unicondylar Knee Arthroplasty

Introduction: The optimal rotational axis of the tibial component in lateral unicompartmental knee arthroplasty (UKA) should be aligned parallel to the lateral tibial spine. However, the relatively lateral positions of the tibial tubercle and patellar tendon make the sagittal tibial cut in lateral UKA difficult and commonly predisposes to inadvertent external rotation of the tibial component. The purpose of this study was to quantify the potential rotational impact that occurs when aligning the anterior edge of the sagittal tibial cut with the lateral edge of the patellar tendon in lateral UKA

Rotational Alignment in Medial Unicompartmental Knee Arthroplasty: Comparison of Anatomic Landmarks

Introduction: The landmarks used for tibial component rotation in total knee arthroplasty (TKA) and medial unicompartmental knee arthroplasty (UKA) may differ, utilizing the medial edge of the tibial tubercle and the medial edge of the tibial spine, respectively. However, some surgeons reference from the medial edge of the tibial tubercle in UKA. Use of the tibial tubercle to determine orientation of the sagittal cut in medial UKA can result in external rotation of the tibial component, leading to rotational mismatch between the femoral and tibial components, potential disruption of the ACL and tibial component undersizing. The purpose of this study was to define the angular differences that would result when using the tibial spine versus the medial edge of the tibial tubercle for determining tibial component rotation in medial UKA

Routine Patellar Resurfacing During Total Knee Arthroplasty is not Cost-Effective in Patients without Patellar Arthritis

During total knee arthroplasty (TKA), whether or not one should routinely resurface the patella is controversial. Leaving an unresurfaced patella following index TKA may lead to anterior knee pain (AKP), patellofemoral crepitus, and future secondary resurfacing operations. However, routinely resurfacing the patella (PR) may lead to patellar fracture, aseptic loosening, patellar instability, avascular necrosis, and patellar clunk. The purpose of the present study is to utilize the existing level one evidence to assess the cost-utility of routine patella resurfacing during primary TKA. Hypothesis: Selective resurfacing of the patella is more cost effective than routine patellar resurfacing during primary TKA.https://jdc.jefferson.edu/orthoposters/1000/thumbnail.jp

Synovial fluid biomarkers for periprosthetic infection. Clin Orthop Relat Res.

Abstract Background We have previously described a unique gene expression signature exhibited by synovial fluid leukocytes in response to bacterial infection, identifying a number of potential biomarkers for infection. However, the diagnostic performance of these potential biomarkers in an immunoassay format is unknown. Questions/purposes We therefore evaluated the sensitivity, specificity, and accuracy of several potential synovial fluid biomarkers for infection, and compared them to current standards of testing for periprosthetic infection. Methods We prospectively collected synovial fluid from 14 patients classified as having a periprosthetic infection and 37 patients classified as having an aseptic failure. The synovial fluid samples were tested for 23 potential biomarkers for periprosthetic infection. We then determined differences in biomarker levels between infected and aseptic groups, then computed the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for select biomarkers, and finally compared those to current standard tests for infection. Results Twelve synovial fluid biomarkers had substantially higher average levels in the synovial fluid of infected versus aseptic patients. Synovial fluid levels of IL-1 were a mean of 258 times higher in patients with a periprosthetic infection compared to patients having revision for aseptic diagnoses. Synovial fluid IL-1 and IL-6 levels correctly classified all patients in this study with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy equal to 1. Several markers tested in this study outperformed the ESR and CRP tests. Conclusions Patients with a periprosthetic infection have elevated levels of numerous synovial fluid biomarkers, when compared to patients with aseptic diagnoses. Several of these biomarkers exhibited nearly ideal sensitivity, specificity, and accuracy in this study, suggesting that synovial fluid biomarkers could be a valuable tool for diagnosing periprosthetic infection