The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Matthew J Smith - One of the best experts on this subject based on the ideXlab platform.
-
safety and efficacy of hyperosmolar irrigation solution in Shoulder Arthroscopy
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Nicholas M Capito, James L Cook, Bernardo Yahuaca, Marie D Capito, Seth L Sherman, Matthew J SmithAbstract:Background A hyperosmolar irrigation solution has been reported to be safe and have potential benefits for use during Shoulder Arthroscopy in an animal model study. In this study, the clinical effects of a hyperosmolar solution were compared with a standard isotonic solution when used for Shoulder Arthroscopy. Methods A prospective, double-blind, randomized controlled trial was performed to compare isotonic (273 mOsm/L) and hyperosmolar (593 mOsm/L) irrigation solutions used for arthroscopic rotator cuff repair. Primary outcomes focused on the amount of periarticular fluid retention based on net weight gain, change in Shoulder girth, and pain. All patients were tracked through standard postsurgical follow-up to ensure no additional complications arose. Patients were contacted at 1 year to assess American Shoulder and Elbow Surgeon score, visual analog scale pain score, and the Single Assessment Numeric Evaluation Shoulder scores Results Fifty patients (n = 25/group) were enrolled and completed the study. No statistically significant differences were noted between cohorts in demographics or surgical variables. The hyperosmolar group experienced significantly less mean weight gain (1.6 ± 0.82 kg vs. 2.25 ± 0.77 kg; P = .005), significantly less change in Shoulder girth ( P P = .036). At 1 year postoperatively, the differences between groups for American Shoulder and Elbow Surgeons, visual analog scale pain, and Single Assessment Numeric Evaluation were not significant ( P > .2). Conclusion A hyperosmolar irrigation solution provides a safe and effective way to decrease periarticular fluid retention associated with arthroscopic rotator cuff surgery without any adverse long-term effects. Use of a hyperosmolar irrigation solution for Shoulder Arthroscopy has potential clinical benefits to surgeons and patients.
-
safety and efficacy of hyperosmolar irrigation solution in Shoulder Arthroscopy
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Nicholas M Capito, James L Cook, Bernardo Yahuaca, Marie D Capito, Seth L Sherman, Matthew J SmithAbstract:Background A hyperosmolar irrigation solution has been reported to be safe and have potential benefits for use during Shoulder Arthroscopy in an animal model study. In this study, the clinical effects of a hyperosmolar solution were compared with a standard isotonic solution when used for Shoulder Arthroscopy. Methods A prospective, double-blind, randomized controlled trial was performed to compare isotonic (273 mOsm/L) and hyperosmolar (593 mOsm/L) irrigation solutions used for arthroscopic rotator cuff repair. Primary outcomes focused on the amount of periarticular fluid retention based on net weight gain, change in Shoulder girth, and pain. All patients were tracked through standard postsurgical follow-up to ensure no additional complications arose. Patients were contacted at 1 year to assess American Shoulder and Elbow Surgeon score, visual analog scale pain score, and the Single Assessment Numeric Evaluation Shoulder scores Results Fifty patients (n = 25/group) were enrolled and completed the study. No statistically significant differences were noted between cohorts in demographics or surgical variables. The hyperosmolar group experienced significantly less mean weight gain (1.6 ± 0.82 kg vs. 2.25 ± 0.77 kg; P = .005), significantly less change in Shoulder girth (P .2). Conclusion A hyperosmolar irrigation solution provides a safe and effective way to decrease periarticular fluid retention associated with arthroscopic rotator cuff surgery without any adverse long-term effects. Use of a hyperosmolar irrigation solution for Shoulder Arthroscopy has potential clinical benefits to surgeons and patients.
-
hyperosmolar irrigation compared with a standard solution in a canine Shoulder Arthroscopy model
Journal of Shoulder and Elbow Surgery, 2015Co-Authors: Nicholas M Capito, Matthew J Smith, Aaron M Stoker, Nikki Werner, James L CookAbstract:Background A hyperosmolar irrigation solution may decrease fluid extravasation during arthroscopic procedures. Demonstrating the safety of a hyperosmolar irrigation solution with respect to chondrocyte viability and cartilage water content was deemed necessary before designing a clinical efficacy study. Methods We designed a translational animal model study in which hyperosmolar Arthroscopy irrigation fluid (1.8%, 600 mOsm/L) was compared with normal saline (0.9%, 300 mOsm/L). Purpose-bred research dogs (n = 5) underwent bilateral Shoulder Arthroscopy. Irrigation fluid was delivered to each Shoulder joint (n = 10) at 40 mm Hg for 120 minutes using standard ingress and egress portals. The percentage change in Shoulder girth was documented at the completion of 120 minutes. Articular cartilage sections from the glenoid and humeral head were harvested from both Shoulders. Chondrocyte viability and tissue water content were evaluated. Differences between groups and compared with time 0 controls were determined, with significance set at P Results The mean percentage change in Shoulder girth was higher in the isotonic control group (13.3%) than in the hyperosmolar group (10.4%). Chondrocyte viability and tissue water content for glenoid and humeral head cartilage were well maintained in both treatment groups, and differences were not statistically significant. Conclusions The data from this study suggest that doubling the osmolarity of the standard irrigation solution used for Arthroscopy was not associated with any detrimental effects on chondrocyte viability or tissue water content after 2 hours of arthroscopic irrigation. On the basis of potential benefits in conjunction with the safety demonstrated in these data, clinical evaluation of a hyperosmolar solution for irrigation during Shoulder Arthroscopy appears warranted.
Nicholas M Capito - One of the best experts on this subject based on the ideXlab platform.
-
safety and efficacy of hyperosmolar irrigation solution in Shoulder Arthroscopy
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Nicholas M Capito, James L Cook, Bernardo Yahuaca, Marie D Capito, Seth L Sherman, Matthew J SmithAbstract:Background A hyperosmolar irrigation solution has been reported to be safe and have potential benefits for use during Shoulder Arthroscopy in an animal model study. In this study, the clinical effects of a hyperosmolar solution were compared with a standard isotonic solution when used for Shoulder Arthroscopy. Methods A prospective, double-blind, randomized controlled trial was performed to compare isotonic (273 mOsm/L) and hyperosmolar (593 mOsm/L) irrigation solutions used for arthroscopic rotator cuff repair. Primary outcomes focused on the amount of periarticular fluid retention based on net weight gain, change in Shoulder girth, and pain. All patients were tracked through standard postsurgical follow-up to ensure no additional complications arose. Patients were contacted at 1 year to assess American Shoulder and Elbow Surgeon score, visual analog scale pain score, and the Single Assessment Numeric Evaluation Shoulder scores Results Fifty patients (n = 25/group) were enrolled and completed the study. No statistically significant differences were noted between cohorts in demographics or surgical variables. The hyperosmolar group experienced significantly less mean weight gain (1.6 ± 0.82 kg vs. 2.25 ± 0.77 kg; P = .005), significantly less change in Shoulder girth ( P P = .036). At 1 year postoperatively, the differences between groups for American Shoulder and Elbow Surgeons, visual analog scale pain, and Single Assessment Numeric Evaluation were not significant ( P > .2). Conclusion A hyperosmolar irrigation solution provides a safe and effective way to decrease periarticular fluid retention associated with arthroscopic rotator cuff surgery without any adverse long-term effects. Use of a hyperosmolar irrigation solution for Shoulder Arthroscopy has potential clinical benefits to surgeons and patients.
-
safety and efficacy of hyperosmolar irrigation solution in Shoulder Arthroscopy
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Nicholas M Capito, James L Cook, Bernardo Yahuaca, Marie D Capito, Seth L Sherman, Matthew J SmithAbstract:Background A hyperosmolar irrigation solution has been reported to be safe and have potential benefits for use during Shoulder Arthroscopy in an animal model study. In this study, the clinical effects of a hyperosmolar solution were compared with a standard isotonic solution when used for Shoulder Arthroscopy. Methods A prospective, double-blind, randomized controlled trial was performed to compare isotonic (273 mOsm/L) and hyperosmolar (593 mOsm/L) irrigation solutions used for arthroscopic rotator cuff repair. Primary outcomes focused on the amount of periarticular fluid retention based on net weight gain, change in Shoulder girth, and pain. All patients were tracked through standard postsurgical follow-up to ensure no additional complications arose. Patients were contacted at 1 year to assess American Shoulder and Elbow Surgeon score, visual analog scale pain score, and the Single Assessment Numeric Evaluation Shoulder scores Results Fifty patients (n = 25/group) were enrolled and completed the study. No statistically significant differences were noted between cohorts in demographics or surgical variables. The hyperosmolar group experienced significantly less mean weight gain (1.6 ± 0.82 kg vs. 2.25 ± 0.77 kg; P = .005), significantly less change in Shoulder girth (P .2). Conclusion A hyperosmolar irrigation solution provides a safe and effective way to decrease periarticular fluid retention associated with arthroscopic rotator cuff surgery without any adverse long-term effects. Use of a hyperosmolar irrigation solution for Shoulder Arthroscopy has potential clinical benefits to surgeons and patients.
-
hyperosmolar irrigation compared with a standard solution in a canine Shoulder Arthroscopy model
Journal of Shoulder and Elbow Surgery, 2015Co-Authors: Nicholas M Capito, Matthew J Smith, Aaron M Stoker, Nikki Werner, James L CookAbstract:Background A hyperosmolar irrigation solution may decrease fluid extravasation during arthroscopic procedures. Demonstrating the safety of a hyperosmolar irrigation solution with respect to chondrocyte viability and cartilage water content was deemed necessary before designing a clinical efficacy study. Methods We designed a translational animal model study in which hyperosmolar Arthroscopy irrigation fluid (1.8%, 600 mOsm/L) was compared with normal saline (0.9%, 300 mOsm/L). Purpose-bred research dogs (n = 5) underwent bilateral Shoulder Arthroscopy. Irrigation fluid was delivered to each Shoulder joint (n = 10) at 40 mm Hg for 120 minutes using standard ingress and egress portals. The percentage change in Shoulder girth was documented at the completion of 120 minutes. Articular cartilage sections from the glenoid and humeral head were harvested from both Shoulders. Chondrocyte viability and tissue water content were evaluated. Differences between groups and compared with time 0 controls were determined, with significance set at P Results The mean percentage change in Shoulder girth was higher in the isotonic control group (13.3%) than in the hyperosmolar group (10.4%). Chondrocyte viability and tissue water content for glenoid and humeral head cartilage were well maintained in both treatment groups, and differences were not statistically significant. Conclusions The data from this study suggest that doubling the osmolarity of the standard irrigation solution used for Arthroscopy was not associated with any detrimental effects on chondrocyte viability or tissue water content after 2 hours of arthroscopic irrigation. On the basis of potential benefits in conjunction with the safety demonstrated in these data, clinical evaluation of a hyperosmolar solution for irrigation during Shoulder Arthroscopy appears warranted.
Nikhil N Verma - One of the best experts on this subject based on the ideXlab platform.
-
perioperative opioid use predicts postoperative opioid use and inferior outcomes after Shoulder Arthroscopy
Arthroscopy, 2020Co-Authors: Alexander Beletsky, Nikhil N Verma, Jourdan M Cancienne, Brian J Cole, Matthew R Cohn, Bhavik H Patel, Michael Nemsick, William Skallerud, Adam B Yanke, Brian ForsytheAbstract:Purpose The purpose of this study is to define the impact of preoperative opioid use on postoperative opioid use, patient-reported outcomes, and revision rates in a cohort of patients receiving arthroscopic Shoulder surgery. Methods Patients who underwent Shoulder Arthroscopy were identified from an institutional database. Inclusion criteria were completion of preoperative and postoperative patient-reported outcome measures (PROMs) at 1-year follow-up and completion of a questionnaire on use of opioids and number of pills per day. Outcomes assessed included postoperative PROM scores, postoperative opioid use, persistent pain, and achievement of the patient acceptable symptomatic state. A matched cohort analysis was performed to evaluate the impact of opioid use on achievement of postoperative outcomes, whereas a multivariate regression was performed to determine additional risk factors. Receiver operating characteristic curves were used to establish threshold values in oral morphine equivalents (OMEs) that predicted each outcome. Results A total of 184 (16.3%) patients were included in the opioid use (OU) group and 1,058 in the no opioid use (NOU) group. The OU and NOU groups showed statistically significant differences in both preoperative and postoperative scores across all PROMs (P 1430 mg/d in the perioperative period (area under the curve, 0.76) and perioperative daily OME >32.5 predicted postoperative opioid consumption (area under the curve, 0.79). Conclusions Patients with a history of preoperative opioid use can achieve significant improvements in patient-reported outcomes after arthroscopic Shoulder surgery. However, preoperative opioid use negatively impacts patients’ level of satisfaction and is a significant predictor of pain and continued opioid usage. Level of evidence Level III, retrospective cohort study
-
resident involvement in Shoulder Arthroscopy is not associated with short term risk to patients
Orthopaedic Journal of Sports Medicine, 2018Co-Authors: Bryce A Basques, Nikhil N Verma, Anthony A. Romeo, Bryan M Saltzman, Erik N Mayer, Bernard R Bach, Brian J Cole, Alexander E WeberAbstract:Background Shoulder Arthroscopy is a commonly performed, critical component of orthopaedic residency training. However, it is unclear whether there are additional risks to patients in cases associated with resident involvement. Purpose To compare Shoulder Arthroscopy cases with and without resident involvement via a large, prospectively maintained national surgical registry to characterize perioperative risks. Study Design Cohort study; Level of evidence, 3. Methods The prospectively maintained American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent 1 of 12 Shoulder Arthroscopy procedures from 2005 through 2012. Multivariate Poisson regression with robust error variance was used to compare the rates of postoperative adverse events and readmission within 30 days between cases with and without resident involvement. Multivariate linear regression was used to compare operative time between cohorts. Results A total of 15,774 patients with Shoulder Arthroscopy were included in the study, and 12.3% of these had a resident involved with the case. The overall rate of adverse events was 1.09%. On multivariate analysis, resident involvement was not associated with increased rates of any aggregate or individual adverse event. There was also no association between resident involvement and risk of readmission within 30 days. Resident involvement was not associated with any difference in operative time (P = .219). Conclusion Resident involvement in Shoulder Arthroscopy was not associated with increased risk of adverse events, increased operative time, or readmission within 30 days. The results of this study suggest that resident involvement in Shoulder Arthroscopy cases is a safe method for trainees to learn these procedures.
-
patient compliance with electronic patient reported outcomes following Shoulder Arthroscopy
Arthroscopy, 2017Co-Authors: Eric C. Makhni, Jason T Hamamoto, John D Higgins, B. Cole, Anthony A. Romeo, Nikhil N VermaAbstract:Purpose To determine the patient compliance in completing electronically administered patient-reported outcome (PRO) scores following Shoulder Arthroscopy, and to determine if dedicated research assistants improve patient compliance. Methods Patients undergoing arthroscopic Shoulder surgery from January 1, 2014, to December 31, 2014, were prospectively enrolled into an electronic data collection system with retrospective review of compliance data. A total of 143 patients were included in this study; 406 patients were excluded (for any or all of the following reasons, such as incomplete follow-up, inaccessibility to the order sets, and inability to complete the order sets). All patients were assigned an order set of PROs through an electronic reporting system, with order sets to be completed prior to surgery, as well as 6 and 12 months postoperatively. Compliance rates of form completion were documented. Patients who underwent arthroscopic anterior and/or posterior stabilization were excluded. Results The average age of the patients was 53.1 years, ranging from 20 to 83. Compliance of form completion was highest preoperatively (76%), and then dropped subsequently at 6 months postoperatively (57%) and 12 months postoperatively (45%). Use of research assistants improved compliance by approximately 20% at each time point. No differences were found according to patient gender and age group. Of those completing forms, a majority completed forms at home or elsewhere prior to returning to the office for the clinic visit. Conclusions Electronic administration of PRO may decrease the amount of time required in the office setting for PRO completion by patients. This may be mutually beneficial to providers and patients. It is unclear if an electronic system improves patient compliance in voluntary completion PRO. Compliance rates at final follow-up remain a concern if data are to be used for establishing quality or outcome metrics. Level of Evidence Level IV, case series.
-
Shoulder Arthroscopy in the beach chair position
Arthroscopy techniques, 2017Co-Authors: John D Higgins, Jason T Hamamoto, Anthony A. Romeo, Rachel M. Frank, Matthew T. Provencher, Nikhil N VermaAbstract:Arthroscopic Shoulder surgery can be performed in both the beach chair and lateral decubitus positions. The beach chair position is a reliable, safe, and effective position to perform nearly all types of Shoulder arthroscopic procedures. The advantages of the beach chair position include the ease of setup, limited brachial plexus stress, increased glenohumeral and subacromial visualization, anesthesia flexibility, and the ability to easily convert to an open procedure. This position is most commonly used for rotator cuff repair, subacromial decompression, and superior labrum anterior-to-posterior repair procedures. To perform Arthroscopy surgery in the beach chair position successfully, meticulous care during patient positioning and setup must be taken. In this Technical Note, we describe the necessary steps to safely and efficiently prepare patients in the beach chair position for arthroscopic Shoulder surgery.
-
Shoulder Arthroscopy in the Lateral Decubitus Position.
Arthroscopy techniques, 2017Co-Authors: Jason T Hamamoto, John D Higgins, Anthony A. Romeo, Rachel M. Frank, Matthew T. Provencher, Nikhil N VermaAbstract:Arthroscopic Shoulder surgery can be performed in both the beach chair and lateral decubitus positions. The lateral decubitus position allows for excellent exposure to all aspects of the glenohumeral joint and is therefore frequently employed in procedures such as stabilization, in which extensive visualization of the inferior and posterior aspects of the joint is required. Improved visualization is imparted due to applied lateral and axial traction on the operative arm, which increases the glenohumeral joint space. To perform Arthroscopy surgery in the lateral decubitus position successfully, meticulous care during patient positioning and setup must be taken. In this Technical Note, we describe the steps required to safely, efficiently, and reproducibly perform arthroscopic Shoulder surgery in the lateral decubitus position.
Jon J.p. Warner - One of the best experts on this subject based on the ideXlab platform.
-
Shoulder Arthroscopy simulator training improves Shoulder Arthroscopy performance in a cadaveric model.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation, 2013Co-Authors: R. Frank Henn, Neel Shah, Jon J.p. Warner, Andreas H. GomollAbstract:Purpose The purpose of this study was to quantify the benefits of Shoulder Arthroscopy simulator training with a cadaveric model of Shoulder Arthroscopy. Methods Seventeen first-year medical students with no prior experience in Shoulder Arthroscopy were enrolled and completed this study. Each subject completed a baseline proctored Arthroscopy on a cadaveric Shoulder, which included controlling the camera and completing a standard series of tasks using the probe. The subjects were randomized, and 9 of the subjects received training on a virtual reality simulator for Shoulder Arthroscopy. All subjects then repeated the same cadaveric Arthroscopy. The arthroscopic videos were analyzed in a blinded fashion for time to task completion and subjective assessment of technical performance. The 2 groups were compared by use of Student t tests, and change over time within groups was analyzed with paired t tests. Results There were no observed differences between the 2 groups on the baseline evaluation. The simulator group improved significantly from baseline with respect to time to completion and subjective performance ( P P P = .98). Conclusions Shoulder Arthroscopy simulator training resulted in significant benefits in clinical Shoulder Arthroscopy time to task completion in this cadaveric model. This study provides important additional evidence of the benefit of simulators in orthopaedic surgical training. Clinical Relevance There may be a role for simulator training in Shoulder Arthroscopy education.
-
ultrasound guided interscalene block anesthesia for Shoulder Arthroscopy a prospective study of 1319 patients
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Anshu Singh, Charles Kelly, Travis Obrien, Jeffrey R Wilson, Jon J.p. WarnerAbstract:Background: Ultrasound guidance improves the localization of anesthetic placement during regional anesthesia, but a decreased rate of adverse events has not been demonstrated in the current literature. In this large prospective study, we evaluated the safety, efficacy, and patient satisfaction associated with ultrasound-guided interscalene block. Methods: A cohort of 1319 patients undergoing arthroscopic Shoulder surgery at an outpatient surgery center was prospectively evaluated. Interscalene blocks were performed by experienced anesthesiologists and trainees with use of ultrasound guidance. Patients were queried by a physician twenty-four hours postoperatively regarding their satisfaction with the interscalene block and were screened for a comprehensive register of minor and major adverse events. Individuals with adverse events were followed until symptoms resolved. Results: Interscalene block was ultimately successful in 99.6% of the cases. A total of thirty-eight adverse events (prevalence, 2.88%) were noted. At the time of the latest follow-up, permanent sequelae were present in three patients (0.23%), all of whom had relevant comorbidities. With regard to patient satisfaction, 99.06% of the respondents were “satisfied” or “very satisfied” with the interscalene block, whereas 0.94% of respondents were unsatisfied. In addition, 97.8% of the patients stated that they would elect to have an interscalene block again in the future. Conclusions: The present study supports the use of ultrasound-guided interscalene block by trained anesthesiologists for well-screened patients undergoing Shoulder Arthroscopy, given the high rate of patient satisfaction and the low rate of adverse events. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
-
surgical experience correlates with performance on a virtual reality simulator for Shoulder Arthroscopy
American Journal of Sports Medicine, 2007Co-Authors: Andreas H. Gomoll, Robert V Otoole, Joseph Czarnecki, Jon J.p. WarnerAbstract:BackgroundThe traditional process of surgical education is being increasingly challenged by economic constraints and concerns about patient safety. Sophisticated computer-based devices have become available to simulate the surgical experience in a protected environment. As with any new educational tool, these devices have generated controversy about the validity of the training experience.HypothesisPerformance on a virtual reality simulator correlates with actual surgical experience.Study DesignControlled laboratory study.MethodsForty-three test subjects of various experience levels in Shoulder Arthroscopy were tested on an Arthroscopy simulator according to a standardized protocol. Subjects were evaluated for time to completion, distance traveled with the tip of the simulated probe compared with a computer-determined optimal distance, average probe velocity, and number of probe collisions with the tissues.ResultsSubjects were grouped according to prior experience with Shoulder Arthroscopy. Comparing the ...
James L Cook - One of the best experts on this subject based on the ideXlab platform.
-
safety and efficacy of hyperosmolar irrigation solution in Shoulder Arthroscopy
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Nicholas M Capito, James L Cook, Bernardo Yahuaca, Marie D Capito, Seth L Sherman, Matthew J SmithAbstract:Background A hyperosmolar irrigation solution has been reported to be safe and have potential benefits for use during Shoulder Arthroscopy in an animal model study. In this study, the clinical effects of a hyperosmolar solution were compared with a standard isotonic solution when used for Shoulder Arthroscopy. Methods A prospective, double-blind, randomized controlled trial was performed to compare isotonic (273 mOsm/L) and hyperosmolar (593 mOsm/L) irrigation solutions used for arthroscopic rotator cuff repair. Primary outcomes focused on the amount of periarticular fluid retention based on net weight gain, change in Shoulder girth, and pain. All patients were tracked through standard postsurgical follow-up to ensure no additional complications arose. Patients were contacted at 1 year to assess American Shoulder and Elbow Surgeon score, visual analog scale pain score, and the Single Assessment Numeric Evaluation Shoulder scores Results Fifty patients (n = 25/group) were enrolled and completed the study. No statistically significant differences were noted between cohorts in demographics or surgical variables. The hyperosmolar group experienced significantly less mean weight gain (1.6 ± 0.82 kg vs. 2.25 ± 0.77 kg; P = .005), significantly less change in Shoulder girth ( P P = .036). At 1 year postoperatively, the differences between groups for American Shoulder and Elbow Surgeons, visual analog scale pain, and Single Assessment Numeric Evaluation were not significant ( P > .2). Conclusion A hyperosmolar irrigation solution provides a safe and effective way to decrease periarticular fluid retention associated with arthroscopic rotator cuff surgery without any adverse long-term effects. Use of a hyperosmolar irrigation solution for Shoulder Arthroscopy has potential clinical benefits to surgeons and patients.
-
safety and efficacy of hyperosmolar irrigation solution in Shoulder Arthroscopy
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Nicholas M Capito, James L Cook, Bernardo Yahuaca, Marie D Capito, Seth L Sherman, Matthew J SmithAbstract:Background A hyperosmolar irrigation solution has been reported to be safe and have potential benefits for use during Shoulder Arthroscopy in an animal model study. In this study, the clinical effects of a hyperosmolar solution were compared with a standard isotonic solution when used for Shoulder Arthroscopy. Methods A prospective, double-blind, randomized controlled trial was performed to compare isotonic (273 mOsm/L) and hyperosmolar (593 mOsm/L) irrigation solutions used for arthroscopic rotator cuff repair. Primary outcomes focused on the amount of periarticular fluid retention based on net weight gain, change in Shoulder girth, and pain. All patients were tracked through standard postsurgical follow-up to ensure no additional complications arose. Patients were contacted at 1 year to assess American Shoulder and Elbow Surgeon score, visual analog scale pain score, and the Single Assessment Numeric Evaluation Shoulder scores Results Fifty patients (n = 25/group) were enrolled and completed the study. No statistically significant differences were noted between cohorts in demographics or surgical variables. The hyperosmolar group experienced significantly less mean weight gain (1.6 ± 0.82 kg vs. 2.25 ± 0.77 kg; P = .005), significantly less change in Shoulder girth (P .2). Conclusion A hyperosmolar irrigation solution provides a safe and effective way to decrease periarticular fluid retention associated with arthroscopic rotator cuff surgery without any adverse long-term effects. Use of a hyperosmolar irrigation solution for Shoulder Arthroscopy has potential clinical benefits to surgeons and patients.
-
hyperosmolar irrigation compared with a standard solution in a canine Shoulder Arthroscopy model
Journal of Shoulder and Elbow Surgery, 2015Co-Authors: Nicholas M Capito, Matthew J Smith, Aaron M Stoker, Nikki Werner, James L CookAbstract:Background A hyperosmolar irrigation solution may decrease fluid extravasation during arthroscopic procedures. Demonstrating the safety of a hyperosmolar irrigation solution with respect to chondrocyte viability and cartilage water content was deemed necessary before designing a clinical efficacy study. Methods We designed a translational animal model study in which hyperosmolar Arthroscopy irrigation fluid (1.8%, 600 mOsm/L) was compared with normal saline (0.9%, 300 mOsm/L). Purpose-bred research dogs (n = 5) underwent bilateral Shoulder Arthroscopy. Irrigation fluid was delivered to each Shoulder joint (n = 10) at 40 mm Hg for 120 minutes using standard ingress and egress portals. The percentage change in Shoulder girth was documented at the completion of 120 minutes. Articular cartilage sections from the glenoid and humeral head were harvested from both Shoulders. Chondrocyte viability and tissue water content were evaluated. Differences between groups and compared with time 0 controls were determined, with significance set at P Results The mean percentage change in Shoulder girth was higher in the isotonic control group (13.3%) than in the hyperosmolar group (10.4%). Chondrocyte viability and tissue water content for glenoid and humeral head cartilage were well maintained in both treatment groups, and differences were not statistically significant. Conclusions The data from this study suggest that doubling the osmolarity of the standard irrigation solution used for Arthroscopy was not associated with any detrimental effects on chondrocyte viability or tissue water content after 2 hours of arthroscopic irrigation. On the basis of potential benefits in conjunction with the safety demonstrated in these data, clinical evaluation of a hyperosmolar solution for irrigation during Shoulder Arthroscopy appears warranted.