Hospital for Special Surgery 2011 Resident and Fellow Research Presentations Award-Winning Abstracts

Hospital for Special Surgery 2011 Resident and Fellow Research Presentations Award-Winning Abstracts Lewis Clark Wagner Award in Orthopaedic Excellence in Orthopaedic Clinical/Translational Research Recipient: Han Jo Kim, MD Title: The Efficacy of a Thrombin-Based Hemostatic Agent in Minimizing Blood Loss in Total Knee Arthroplasty—A Randomized Control Trial Han Jo Kim MD, M Robson Fraser MD, Barbara Kahn RN, Stephen Lyman PhD, Mark P. Figgie MD Introduction: Blood loss following total knee arthroplasty can lead to significant morbidity and transfusion requirements elevating healthcare costs. Efforts have been made to use hemostatic agents to minimize blood loss and decrease transfusion rates. Floseal (F) is a thrombin-based hemostatic agent with unknown efficacy in achieving these goals in total knee arthroplasty patients. Materials and Methods: We performed a prospective randomized controlled trial on F in patients undergoing total knee arthroplasty with the primary endpoint of assessing blood loss measured through drain output. Patient demographic information, operative side, diagnosis, intra-operative details, implant choice, hospital course, laboratory values, VAS pain scores, knee range ofmotion, adverse events, transfusion rates, and deviations from protocol were collected. Results: A total of 196 patients were enrolled, and 97 patients were randomized to receive Floseal leaving 99 in the nonFloseal (NF) group. The average age of enrollment was 71.7 with an average BMI of 29.95. There were no significant differences in drain output at 24 h between the F and NF groups (711 vs. 702 ml, respectively, p=0.823). No differences in starting hemoglobin laboratory values were noted between the groups (F=12.1 vs. NF=11.9, p=0.142); however, differences were noted in hemoglobin values on post-operative day 2 (F=10.6 vs. NF=10.0, p=0.001) and day 3 (F=9.9 vs. NF=9.5, p=0.017), which was no longer statistically significant on day 4 (F=9.6 vs. NF=9.4, p=0.76). No differences were noted in patient demographics, operative side, diagnosis, intra-operative details, implant choice, hospital course, laboratory values, and VAS pain scores, knee range of motion or transfusion rates. Complications occurred infrequently. In the acute post-operative period, there were two cases of cellulitis (F=1, NF=1), two deep venous thromboses (N=1, NF=1), and one paralytic ileus (NF=1) which resolved with conservative measures. At the 6-week follow-up, there was one death (unrelated to surgery), two suture abscesses with cellulitis (F=1, NF=1), and four patients who needed a manipulation under anesthesia to achieve improved range of motion (F=2, NF=2). There was no significant association between Floseal use and the occurrence of these adverse events. Conclusions: This study suggests that Floseal has no effect on blood loss measured by drain output when used in total knee arthroplasty. There were also no significant adverse events associated with its use. The use of Floseal is safe; however, its use as a hemostatic agent in total knee arthroplasty remains unclear. Level of Evidence: Level I Therapeutic Study; Randomized Control Trial Russell F. Warren Award for Excellence in Orthopaedic Basic/Translational Research Recipient: Sommer Hammoud, MD Title: Attaching Implants to Articular Cartilage: Functionalizing with a Collagen Adhesion Protein Sommer Hammoud, MD, Aliza A. Allon, PhD, Kenneth W. Ng, PhD, Brooke H. Russell, PhD, Casey M. Jones, PhD, Jose Rivera, BS, Timothy B. Neary, BS, Jeffrey Schwartz, PhD, Magnus Hook, PhD, Suzanne A. Maher, PhD Hospital for Special Surgery, New York, NY, USA; Princeton University, Princeton, NJ, USA; 3 Texas A&M University, College Station, TX, USA Introduction: Improving the interfacial strength between implants and articular cartilage can enhance the functional performance of treatments for focal cartilage defects. While various methods have been used to tackle this problem, many approaches are targeted at increasing the number of matrix-producing cells that can migrate to the interface [1]. Such approaches may help to reinforce the boundary between the implant and the host tissue as a function of time, but they do not address the problems associated with an initially unstable interface. We developed the concept of using an implant-bound collagen-binding Microbial Surface Component Recognizing AdhesiveMatrixMolecule, Collagen Adhesion protein, CNA, to create an immediate bond with articular cartilage. CNA has been shown to attach to collagen in solution [2] via a proposed “Hug” mechanism, whereby the N1 domain associates with the collagen fiber; collagen is wrapped by the N1–N2 linker HSSJ (2011) 7:290–294 DOI 10.1007/s11420-011-9220-5