Sinai Hospital of Baltimore Baltimore

Bethesda, Maryland, United States

Sinai Hospital of Baltimore Baltimore

Bethesda, Maryland, United States
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Jauregui J.J.,Rubin Institute for Advanced Orthopedics | Issa K.,Seton Hall University | Kapadia B.H.,Rubin Institute for Advanced Orthopedics | Banerjee S.,Rubin Institute for Advanced Orthopedics | Mont M.A.,Sinai Hospital of Baltimore Baltimore
Surgical technology international | Year: 2014

Total hip arthroplasty is increasing in incidence due to our aging population. However, this procedure has a high potential for increased blood loss, with allogeneic blood transfusions commonly used. However, due to potential transfusion-related risks such as immunosuppression or infections, attempts have been made to reduce the amount of blood loss and minimize transfusions. Therefore, our aim was to provide a broad overview of the widely used methods for reducing post-operative blood loss after total hip arthroplasty. These include antifibrinolytic agents, autologous blood transfusion drains, avoiding the use of drains, and modifications in drainage techniques. In addition, lowering the transfusion threshold is another method used to decrease the rates of allogeneic blood transfusion. Current evidence suggests that the use of some of these strategies-either alone, or in combination-may reduce the amount of blood loss and the need for allogeneic transfusions. However, further research is needed to create new, more standardized guidelines.


Jauregui J.J.,Rubin Institute for Advanced Orthopedics | Kapadia B.H.,Rubin Institute for Advanced Orthopedics | Banerjee S.,Rubin Institute for Advanced Orthopedics | Issa K.,Seton Hall University | And 2 more authors.
Surgical technology international | Year: 2014

Total hip arthroplasty is associated with extensive blood loss, which is often corrected using allogeneic blood transfusions. However, Jehovah's Witnesses often refuse allogeneic blood transfusions or certain types of autologous blood transfusions due to their religious beliefs. This may represent a tremendous challenge for the orthopaedic surgeon and their team. Performing a total hip arthroplasty on a Jehovah's Witness patient requires a well-trained group of physicians willing to pre-operatively optimize the patient, attempt to minimize the blood loss during the surgery, adequately manage the post-operative period, and be aware of which of the life-saving strategies can be used in these patients during an emergency situation. Ultimately, physicians should be prepared to deal with marked blood loss and respect the patients' wishes, values, and beliefs. This review focuses on studies where primary or revision total hip arthroplasty was performed in Jehovah's Witness patients. Therefore, we will illustrate that with a prepared team and an optimized patient, it is potentially quite safe to perform total hip arthroplasties in Jehovah's Witness patients.


Kapadia B.H.,Sinai Hospital of Baltimore Baltimore
Surgical technology international | Year: 2012

Venous thromboembolic disease remains a serious complication following lower extremity total joint arthroplasty. Postoperative thromboembolic complications, which include symptomatic deep vein thrombosis, bleeding, and pulmonary embolus, are recognized causes of patient morbidity, mortality, increased length of stay, and higher healthcare costs. Various thromboprophylaxis guidelines have been recommended to prevent and thereby reduce the incidence of such events. However, despite various studies exploring prophylaxis measures, the incidence of venous thromboembolic events has remained relatively unchanged over the past 10 years. We therefore aimed to: (1) evaluate the current 2011 American Academy of Orthopaedic Surgeons (AAOS) and the 2012 American College of Chest Physicians (ACCP) recommendations concerning venous thromboembolic disease after lower extremity joint arthroplasty; and (2) report on different modalities of prophylaxis, specifically, pharmacological agents, mechanical compression devices, and inferior vena cava filters. Both AAOS and ACCP guidelines recommend a combined approach with mechanical compression devices and pharmacological prophylaxis. A major difference is that the AAOS work group does not recommend specific pharmacological agents, whereas the ACCP guidelines give specific recommendations. Additionally, routine primary thromboprophylaxis with inferior vena cava filters is only recommended when there are contraindications to anticoagulation therapy.


Mont M.A.,Sinai Hospital of Baltimore Baltimore
Surgical technology international | Year: 2012

Because total knee arthroplasty is one of the most common orthopaedic procedures, it is important that the medical community continually strive for cost reductions. This prospective controlled trial aimed to determine if cost decreases could be achieved in non-navigated and navigated procedures by replacing traditional saws, cutting blocks, and trials with a specialized single-use system. Costs were lowered by an estimated $140.00-220.00 per surgery as a result of fewer instrument trays being reprocessed, and an estimated $75.00-330.00 per instrument case due to a 10-24-minute time savings during tray rewrapping. This study has positive financial implications for patients, hospitals, institutions, and third-party carriers.


PubMed | Sinai Hospital of Baltimore Baltimore, Beth Israel Medical Center Adult Reconstruction and Total Joint Replacement Service, Rubin Institute for Advanced Orthopedics and Seton Hall University
Type: | Journal: Surgical technology international | Year: 2014

The substantial blood loss that can occur during total hip arthroplasty frequently requires allogeneic transfusions. Both allogeneic transfusions and post-operative anemia are causes of increased morbidity, cardiovascular risks, and length of stay. This anemia can also lead to decreased vigor, suboptimal rehabilitation, and lowered quality of life in patients undergoing total hip arthroplasty. The aim of this review was to analyze recent evidence on nonsurgical intra-operative blood management strategies utilized for total hip arthroplasty. Specifically, we evaluated the use of fibrin sealants, desmopressin, acute normovolemic hemodilution, hypotensive anesthesia, blood salvage, and peri-operative normothermia. No single strategy has been shown to provide superior results over another in reducing the need for allogeneic transfusions. However, a combination of the above blood management strategies may further result in reduced blood loss over one strategy. Larger prospective randomized studies comparing the individual strategies, as well as their combination, are needed to develop the best algorithm that can be the most effective and safe for intra-operative blood management in total hip arthroplasty.


PubMed | Sinai Hospital of Baltimore Baltimore, Rubin Institute for Advanced Orthopedics and Seton Hall University
Type: | Journal: Surgical technology international | Year: 2014

Total hip arthroplasty is associated with extensive blood loss, which is often corrected using allogeneic blood transfusions. However, Jehovahs Witnesses often refuse allogeneic blood transfusions or certain types of autologous blood transfusions due to their religious beliefs. This may represent a tremendous challenge for the orthopaedic surgeon and their team. Performing a total hip arthroplasty on a Jehovahs Witness patient requires a well-trained group of physicians willing to pre-operatively optimize the patient, attempt to minimize the blood loss during the surgery, adequately manage the post-operative period, and be aware of which of the life-saving strategies can be used in these patients during an emergency situation. Ultimately, physicians should be prepared to deal with marked blood loss and respect the patients wishes, values, and beliefs. This review focuses on studies where primary or revision total hip arthroplasty was performed in Jehovahs Witness patients. Therefore, we will illustrate that with a prepared team and an optimized patient, it is potentially quite safe to perform total hip arthroplasties in Jehovahs Witness patients.


PubMed | Sinai Hospital of Baltimore Baltimore, Rubin Institute for Advanced Orthopedics and Seton Hall University
Type: | Journal: Surgical technology international | Year: 2013

This section will complement other recent review articles of blood conservation in total hip arthroplasty. The purpose of this review was to provide a broad overview, as well as to evaluate the recent evidence on surgical intra-operative blood management strategies utilized for total hip arthroplasty. In this section, we specifically evaluated the use of bipolar sealants, patient positioning, wound compression, computer-assisted surgery, minimally invasive surgical approach, and cemented versus noncemented prostheses.


PubMed | Sinai Hospital of Baltimore Baltimore, Rubin Institute for Advanced Orthopedics and Seton Hall University
Type: | Journal: Surgical technology international | Year: 2014

Total hip arthroplasty is increasing in incidence due to our aging population. However, this procedure has a high potential for increased blood loss, with allogeneic blood transfusions commonly used. However, due to potential transfusion-related risks such as immunosuppression or infections, attempts have been made to reduce the amount of blood loss and minimize transfusions. Therefore, our aim was to provide a broad overview of the widely used methods for reducing post-operative blood loss after total hip arthroplasty. These include antifibrinolytic agents, autologous blood transfusion drains, avoiding the use of drains, and modifications in drainage techniques. In addition, lowering the transfusion threshold is another method used to decrease the rates of allogeneic blood transfusion. Current evidence suggests that the use of some of these strategies-either alone, or in combination-may reduce the amount of blood loss and the need for allogeneic transfusions. However, further research is needed to create new, more standardized guidelines.


PubMed | Sinai Hospital of Baltimore Baltimore
Type: | Journal: Surgical technology international | Year: 2013

Because total knee arthroplasty is one of the most common orthopaedic procedures, it is important that the medical community continually strive for cost reductions. This prospective controlled trial aimed to determine if cost decreases could be achieved in non-navigated and navigated procedures by replacing traditional saws, cutting blocks, and trials with a specialized single-use system. Costs were lowered by an estimated $140.00-220.00 per surgery as a result of fewer instrument trays being reprocessed, and an estimated $75.00-330.00 per instrument case due to a 10-24-minute time savings during tray rewrapping. This study has positive financial implications for patients, hospitals, institutions, and third-party carriers.


PubMed | Sinai Hospital of Baltimore Baltimore, Rubin Institute for Advanced Orthopedics and Seton Hall University
Type: | Journal: Surgical technology international | Year: 2014

This section will complement other recent review articles of blood conservation in total hip arthroplasty. The purpose of this review was to provide a broad overview, as well as to evaluate the recent evidence on surgical intra-operative blood management strategies utilized for total hip arthroplasty. In this section, we specifically evaluated the use of bipolar sealants, patient positioning, wound compression, computer-assisted surgery, minimally invasive surgical approach, and cemented versus noncemented prostheses.

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