Safety and efficacy of hyperosmolar irrigation solution in shoulder arthroscopy.
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 < .05), and a significantly lower immediate postoperative visual analog scale pain score (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).


CONCLUSIONS
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.
Champion Orthopedics, Augusta, GA, USA.
Nicholas M
NM
Capito
Department of Orthopaedics, University of Missouri-Columbia, Columbia, MO, USA.
James L
JL
Cook
Department of Orthopaedics, University of Missouri-Columbia, Columbia, MO, USA.
Bernardo
B
Yahuaca
Department of Pharmacy, Medical College of Georgia, Augusta, GA, USA. Electronic address: ncaps4@gmail.com.
Marie D
MD
Capito
Department of Orthopaedics, University of Missouri-Columbia, Columbia, MO, USA.
Seth L
SL
Sherman
Department of Orthopaedics, University of Missouri-Columbia, Columbia, MO, USA.
Matthew J
MJ
Smith
D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D000070636:Rotator Cuff Injuries / Q000601:surgery*; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012785:Shoulder Joint; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
D012462:Saline Solution, Hypertonic
Shoulder arthroscopy; cartilage; fluid extravasation; hyperosmolar; irrigation solution; rotator cuff