Introduction Venous thromboembolic disease is a serious complication of total hip replacement (THR). Use of low-molecular-weight heparin (LMWH) has been shown to reduce the occurrence of
Recently, the International Consensus Statement Group reported that mechanical prophylaxis with foot-pumps should be considered “Grade A” recommendation for prevention of
Recently released New Zealand guidelines recommend that HRT should be stopped for at least 30 days prior to elective surgery and withheld for 90 days following surgery. Less than 3% of surgeons appeared to be routinely following this recommendation. Most manufacturers of combined oral contraceptive pills recommend stopping the medication for at least four weeks prior to elective surgery. Only 25% of surgeons routinely practice in accordance with these recommendations.
Mechanical prophylaxis with foot-pumps provides an interesting alternative to chemical agents in the prevention of thomboembolic disease following major orthopaedic surgery procedures. Recent studies have suggested that simultaneous use of graduated compression stockings (GCS) may hinder the pneumatic compression effect of foot pumps. The hypothesis of this prospective study was that the use of foot-pumps without GCS does not affect the efficacy of DVT prophylaxis, and improves patient compliance. 846 consecutive patients admitted at a single institution undergoing total hip (THR) or knee replacement (TKR) were included in the study. The A-V Impulse System® foot-pump units (Orthofix Vascular Novamedix, Andover, UK) was used in all patients. Forty-six patients discontinued the use of foot-pumps, leaving 400 patients who received foot-pumps in combination with GCS and 400 patients with foot pumps alone. Eleven patients of the stocking group (2.7%) and 9 patients of the no-stockings group (2.3%) developed postoperative symptomatic DVT (p=0.07). DVT was more frequent in TKR (10 of 364; 2.7%) than in THR (10 of 436; 2.3%). Non-fatal pulmonary embolism occurred in 4 patients out of 20 with symptomatic DVT, 2 each of the stockings and no stockings groups. The foot pump discontinuation rate of patients treated with stockings was 7%, versus 4% of patients treated without stockings (p<
0.05). In conclusion, management of patients with foot-pumps without GCS does not reduce efficacy of DVT prophylaxis after THR and TKR, and improves patient compliance.
We aimed to examine the characteristics of deep venous flow in
the leg in a cast and the effects of a wearable neuromuscular stimulator
(geko; FirstKind Ltd) and also to explore the participants’ tolerance
of the stimulator. This is an open-label physiological study on ten healthy volunteers.
Duplex ultrasonography of the superficial femoral vein measured
normal flow and cross-sectional area in the standing and supine
positions (with the lower limb initially horizontal and then elevated).
Flow measurements were repeated during activation of the geko stimulator
placed over the peroneal nerve. The process was repeated after the
application of a below-knee cast. Participants evaluated discomfort
using a questionnaire (verbal rating score) and a scoring index
(visual analogue scale).Objectives
Methods
Abstract. INTRODUCTION. A paucity of literature exists regarding efficacy of lateral unloader bracing in treatment for pathologies effecting the lateral compartment of the knee. We evaluate patient outcomes following customised lateral unloader bracing (cLUB) in treatment of lateral compartment osteoarthritis (LCOA), lateral tibial plateau fractures (LTPF) and spontaneous osteonecrosis of knee (SONK). METHODS. Institutional study approval was obtained. All patients undergoing cLUB between January 2013 and January 2021 were included, and prospectively followed-up. Visual Analogue Scales (VAS), Oxford Knee Scores (OKS) and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed at brace fitting and final follow-up. Brace compliance, complications and surgical interventions were also collected. Statistical analysis utilised paired t-test. RESULTS. 71 patients (LCOA n=47, LTPF n=21, SONK n=3) were analysed. VAS, OKS and KOOS scores show significant improvements after bracing (p<0.05). Brace compliance was 90.5%. One patient developed a
Purpose. Topical application of tranexamic acid (TXA) to bleeding wound surfaces reduces blood loss in patients undergoing some major surgeries, without systemic complications. The objective of this study was to determine if TXA applied topically reduced postoperative bleeding and transfusion rates after primary total hip arthroplasty (THA) and primary bipolar hemiarthroplasty (BA). Methods. We retrospectively compared 77 patients undergoing hip arthroplasty surgery in which tranexamic acid was routinely used, to a group of 70 patients from a similar time frame prior to the introduction of tranexamic acid use. In the former group 40 patients had THA and 37 patients BA; in the latter group 35 patients underwent THA and 35 patients BA. In both THA and BA, the joint was bathed in TXA solution (at a concentration of 3.0 g TXA per 100 mL saline) at three points during the procedure. The primary outcome was blood loss calculated from the difference between the preoperative hemoglobin level and the corresponding lowest postoperative value or hemoglobin level prior to transfusion. Results. Postoperative transfusions decreased significantly with TXA, dropping from 50.0% to 27.5%, and from 63% to 48%, in the THA and BA groups, respectively. We also found significant reductions in hemoglobin loss and blood loss of 8 g/dL and 336 mL respectively for THAs and 6 g/dL and 176 mL respectively for BAs following the introduction of tranexamic acid. There was no difference in the rates of
Surgery for pelvic or acetabular fractures carries a high risk of
Introduction: Unstable Lisfranc (tarsometatarsal) joint injuries are increasingly being treated by open reduction and internal fixation. Hypothesis: A good outcome is achievable by anatomical reduction and internal fixation of these injuries. Methods: This was a retrospective outcome-analysis involving 21 patients. Six were treated non-operatively. There sere eight ligamentous and seven ligamentous/osseous injuries. The patients’ outcomes were assessed with the use of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and the long-form Musculoskeletal Function Assessment (MFA) score. Results: The average follow-up was11 months. One patient developed a post-operative infection, and another developed a
Aims: In major orthopedic surgery, fondaparinux provided a major benefit over enoxaparin, with an overall venous thromboembolsim (VTE) risk reduction of >
50% and similar safety profile regarding clinically relevant bleeding (leading to death or reoperation, or occurring in critical organ). The aim of the present study was to analyze this superior efficacy according to patients and surgery characteristics. Methods: In four phase III trials, the primary efficacy outcome was the VTE incidence up to day 11, defined as
Aims: Whether the use of elastic stockings (ES) on top of pharmacological thromboprophylaxis is beneficial remains debated. In a worldwide phase III program including 7344 patients in major orthopaedic surgery, fondaparinux, the first synthetic selective factor Xa inhibitor, demonstrated a substantial benefit over enoxaparin in preventing venous thromboembolism (VTE); risk reduction >
50% without increasing clinically relevant bleeding. The aim of this study was to evaluate the influence of ES on this superior efficacy of fondaparinux. Methods: In all four randomized, double-blind trials, comparing a once daily 2.5 mg s.c. injection of fondaparinux to enoxaparin, the primary efficacy outcome was VTE up to day 11, defined as
A consecutive group of 150 patients undergoing primary TKA performed by a single surgeon using single prosthesis were studied prospectively. The purpose of this study was to compare the clinical and radiographic results of TKA in obese and non-obese patients. The patients were categorized into two groups: non-obese (body mass index (BMI <
30 kg/m2) and obese (BMI >
30 to 40 kg/m2). The Primary outcome measures: SF-12 and WOMAC scores were used as generic outcome measures, and the Knee Society scores were used to assess clinical outcome of TKA. The scores were done pre-operatively and at 1, 3 and 5 years post-operatively. Secondary outcome measures included patellar position, anterior knee pain, infections, revision rates,
On the basis of observations made in recent years, it can be inferred that the incidence of venous thromboembolism (VTE) in Japan is as high as that in Western countries. Since 2007, the use of fondaparinux for the prophylaxis of VTE following lower-limb orthopedic surgery has been approved for Japanese patients. This study was performed with an aim to investigate the safety and efficacy of fondaparinux for the prevention of VTE following hip surgery in Japanese patients. From June 2007 to August 2008, we evaluated 141 consecutive patients (148 hips; average age, 65.6) undergoing total hip replacement (THR), consisted of cementless minimally invasive surgery, and hip fracture surgery (HFS), consisted of open reduction and internal fixation or bipolar hemiarthroplasty. We mainly used 2.5 mg of fondaparinux for a period extending up to 14 days. We estimated the symptomatic VTE and asymptomatic
Introduction: The increasing utilization of total hip arthroplasty and the increasing life expectancy have brought an increasing incidence of revision hip arthroplasty. With severe acetabular, revision surgery with the use of standard cemented or press-fitted components is inadequate for fixation. In these cases the use of proximal femoral allograft can restore the deficiency. Purpose: To present a new technique and preliminary results of revision total hip arthroplasty using proximal femoral allograft prosthetic composites for massive ace-tabular bone loss. The technique uses the natural vector of forces in the intertrochanteric region in an opposite direction at the acetabular defect. Methods: From June 2000 to July 2001, seven patients underwent reconstruction of massive acetabular defects with proximal femoral allograft bone. The etiologies for bone loss were infection in 2 patients, aseptic loosening in 4 and acetabular protrusion in 2 patients. In 4 hips there were also femoral defects that was reconstructed with allograft. The average age of the patients was 69.8 years. All patients were wheel chair bound prior to surgery. Harris Hip Score was used to assess preoperative and follow-up function level. Results: Harris Hip Score improved significantly in all patients. All patients are ambulatory at follow-up. Complications included 2 dislocation and 2
Background: Data on thromboembolic complications (TEC) following major orthopaedic surgery are generally obtained retrospectively from registries or prospectively from large industry-sponsored international multicentre trials. However, the results may differ from those observed in unselected patients in routine operations performed by orthopaedic surgeons. The purpose of the ESMOS study was to describe the number and time of onset of serious symptomatic arterial and venous TEC within 90 days after surgery in an unselected population of patients undergoing total hip replacement (THR). Patients and methods: A total of 500 (430 primary THR and 70 revision THR) consecutive patients were included in the study performed between January 2004 and May 2005 in Frederiksborg County (Denmark). They were to be followed for 90 days after surgery. Patients were interviewed before surgery for medical history and on days 5 (while in hospital) and 90 (by telephone call) for signs and symptoms of acute myocardial infarction (AMI), pulmonary embolism (PE),
The purpose of this study was to examine the efficacy and safety of carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) on blood loss and inflammatory responses after primary total hip arthroplasty (THA), and to investigate the influence of different administration methods of CSS on perioperative blood loss during THA. This study is a randomized controlled trial involving 200 patients undergoing primary unilateral THA. A total of 200 patients treated with intravenous TXA were randomly assigned to group A (combined intravenous and topical CSS), group B (topical CSS), group C (intravenous CSS), or group D (placebo).Aims
Methods
The primary aim of this study was to identify independent predictors associated with nonunion and delayed union of tibial diaphyseal fractures treated with intramedullary nailing. The secondary aim was to assess the Radiological Union Scale for Tibial fractures (RUST) score as an early predictor of tibial fracture nonunion. A consecutive series of 647 patients who underwent intramedullary nailing for tibial diaphyseal fractures were identified from a trauma database. Demographic data, comorbidities, smoking status, alcohol consumption, use of non-steroidal anti-inflammatory drugs (NSAIDs), and steroid use were documented. Details regarding mechanism of injury, fracture classification, complications, and further surgery were recorded. Nonunion was defined as the requirement for revision surgery to achieve union. Delayed union was defined as a RUST score < 10 at six months postoperatively.Aims
Methods
The August 2012 Foot &
Ankle Roundup360 looks at: calcaneocuboid distraction arthrodesis with allograft for acquired flatfoot; direct repair of the plantar plate; thromboembolism after fixation of the fractured ankle; weight loss after ankle surgery; Haglund’s syndrome and three-portal endoscopic surgery; Keller’s procedure; arthroscopy of the first MTPJ; and Doppler spectra in Charcot arthropathy.
Over recent years hip arthroscopic surgery has
evolved into one of the most rapidly expanding fields in orthopaedic surgery.
Complications are largely transient and incidences between 0.5%
and 6.4% have been reported. However, major complications can and
do occur. This article analyses the reported complications and makes recommendations
based on the literature review and personal experience on how to
minimise them.