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Patient Blood Management and Hip/Knee Surgery

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An Interview With Michael R. Pagnotto, MD

Michael R. Pagnotto, MD, is a fellowship-trained specialist in hip and knee replacement surgery with Tri-State Orthopaedics & Sports Medicine. Dr. Pagnotto performs surgery at UPMC Passavant and UPMC St. Margaret.

What is your surgical specialty?

I specialize in the treatment of hip and knee arthritis. I focus on total hip and knee replacement arthroplasty, partial knee replacement, and revision hip and knee surgeries.

Why are you interested in reducing the use of blood transfusions for your patients?

I use a comprehensive program with my patients to help minimize the use of blood transfusions following hip and knee surgery. I believe that by providing this program for patients who undergo total hip and/or knee arthroplasty, the patients may benefit by having fewer complications and perhaps reduced hospital stays, and avoiding potential risks of transfusions.

What techniques are used to limit blood loss?

The first step in preventing blood transfusions postoperatively is a thorough preoperative evaluation. My patients are tested preoperatively and if they are found to be anemic, we treat the anemia prior to proceeding with elective surgery.

At the time of surgery, I use intravenous tranexamic acid to minimize the intraoperative and postoperative blood loss. Multiple prospective randomized trials have demonstrated the efficacy and safety of using tranexamic acid at the time of surgery to reduce the need for blood transfusions.

Intraoperatively, meticulous technique is used to work efficiently and safely to minimize blood loss, and when appropriate, cell salvage is used to capture the patient’s blood and return it to them during the procedure. Tourniquets are also used to minimize intraoperative blood loss during knee surgery.

What is your position on treating patients who refuse blood products?

I always respect my patients’ wishes regarding blood products and any treatment decision, and we discuss nonoperative and operative treatment options. There are a number of nonoperative treatments available for hip and knee arthritis. We will try the conservative treatment modalities first, including anti-inflammatory medications, injections, and physical therapy when appropriate.

If and when a nonoperative treatment fails, and the patient continues to want to proceed with surgery, we clearly document what blood products are or are not acceptable to them. The UPMC Center for Bloodless Medicine and Surgery works closely with the surgical and medical teams to make sure we are respecting the patient’s wishes and doing everything possible to minimize the risks of perioperative blood loss.

How can I schedule an evaluation?

Call 412-369-4000 to schedule an appointment. Patients are seen in our North Hills, Seven Fields, Fox Chapel, and Robinson office locations.