Clinical decision support tools are software that match the input characteristics of an individual patient to an established knowledge base to create patient-specific assessments that support and better inform individualized healthcare decisions. Clinical decision support tools can facilitate better evidence-based care and offer the potential for improved treatment quality and selection, shared decision making, while also standardizing patient expectations. Predict+ is a novel, clinical decision support tool that leverages clinical data from the Exactech Equinoxe shoulder clinical outcomes database, which is composed of >11,000 shoulder arthroplasty patients using one specific implant type from more than 30 different clinical sites using standardized forms. Predict+ utilizes multiple coordinated and locked supervised machine learning algorithms to make patient-specific predictions of 7 outcome measures at multiple postoperative timepoints (from 3 months to 7 years after surgery) using as few as 19 preoperative inputs. Predict+ algorithms predictive accuracy for the 7 clinical outcome measures for each of aTSA and rTSA were quantified using the mean absolute error and the area under the receiver operating curve (AUROC).Introduction
Methods
Blood loss after TKA varied, but not uncommon with up to 1500 ml or a decrease in hemoglobin of 3–4 g/dL. In addition to improving prosthetic alignment, computer-assisted TKAs also contribute to reduced operative blood loss and systemic emboli. These observations imply that navigation TKAs may cause less microvascular endothelial damage than conventional TKAs. Cell adhesion molecules (CAMs) have been employed as markers for endothelial or vascular damage. We hypothesized serum levels of CAMs in patients receiving navigation TKAs may be different from those receiving conventional TKAs. A prospective comparative study, enrolling 87 patients with osteoarthritic knees was conducted. There were 54 navigation TKAs and 33 conventional TKAs. Levels of cell adhesion molecules (CAM) in sera and hemovac drainage were measured by ELISA before and 24 hours after the surgery. Hb and Ht were checked pre- and post-operatively. The blood loss was calculated though the formula by Nadler and Sehat et al.Introduction
Material and Methods
D-dimer is one of the useful laboratory tests to evaluate the incidence of venous thromboembolism (VTE) after the total knee arthroplasty (TKA). The most recent guideline for the prophylaxis of VTE points out the surgical procedure itself is a major risk factor for developing VTE. Only a few literatures discuss the relationship of surgical procedures and the risk of venous thromboembolism. We therefore prospectively compare the difference of the perioperative plasma D-dimer levels between the patients undergoing navigation and convention TKA. Two hundred consecutive total knee arthroplasties were performed between September 2011 and March 2013. The patients were randomised according to their registration to the orthopaedic clinic. Ninety-six patients (100 knees) underwent a navigation-assisted TKA and ninety-four patients (100 knees) had a conventional TKA. No intramedullary violation was done in the navigation-assisted TKA, while the intramedullary femoral guiding was adapted in the conventional group. Pre-operative and post-operation day 1 plasma D-dimer levels were recorded and evaluated using Mann-Whitney U test. There was no difference in the demographic data and pre-operative D-dimer between the two groups (p=0.443). Significantly lower D-dimer levels on the post-operative day 1 were noted in the navigation group, when compared with the conventional group. (6.0 ± 4.4 mg/L vs 11.3 ± 9.6 mg/L, p = 0.000). We demonstrated that lower D-dimer level is developed after the navigation-assisted TKA than the conventional one. Less incidence of VTE is expected and the finding may help to explain the fact that less systemic emboli in the navigation assisted TKA.
