Novel oral anticoagulant (NOAC) use in Australia has increased significantly since their introduction to the Pharmaceutical Benefits Scheme (PBS). Currently, there are no specific guidelines regarding recommencement of NOAC therapy post-operatively for patients concurrently on a NOAC and undergoing arthroplasty. To address this gap in the literature, the aim of this study was to compare the clinical and patient-reported outcomes in a patient cohort recommencing a therapeutic dose of NOAC within 24 hours of total hip or knee arthroplasty. Data was retrieved from a prospective registry (ACTRN1262000079698) containing hip and knee arthroplasties. Cases were labelled based on whether they presented on a therapeutic dose of NOAC prior to surgery or not. Descriptive statistics were used to summarise patient outcomes. Of 291 patients undergoing 331 primary arthroplasties, 9.3% were undertaking NOAC therapy prior to their surgery. In the NOAC cohort, there was a 34.5% adverse event rate, however on closer analysis of each event, it was found that none of these events were complications in relation to NOAC use. This was compared to 15.6% of the comparison cohort who experienced a range of complications, some involving bleeding events. PROMs improved to a similar degree amongst both groups. This study showed that recommencing therapeutic doses of NOACs in patients post hip and knee arthroplasty within 24 hours was safe. These findings will help guide larger scale analysis to better inform clinical guidelines pertaining to hip and knee arthroplasty.
Hip fractures are common injuries in the elderly, with significant mortality and morbidity from several factors. Many of these patients have cardiac disease, and some develop cardiac complications which may increase mortality. Troponin T is a marker of myocardial injury but can be raised in other conditions. Patients over 60 years old admitted with hip fracture during the study period had their troponin T measured on admission and following surgery. Assay was performed after the patient had completed their treatment. We report the results of this study one year after the last patient was admitted. 108 patients were recruited. The average age was 84 years; 86% were female. This study found that 27% of hip fracture patients had some increase in the troponin T levels in the peri-operative period. This increase was not associated with an increase in early mortality, but there was an increase in one-year mortality for those with an increase in troponin T (45% versus 22%, p=0.03). These findings indicate that the routine measurement of troponin T after a hip fracture is unnecessary.
To develop a novel modification of an existing technique Using trigonometry a procedure for accurately measuring the rotational alignment of the proximal femur was devised. This technique was performed on the fracture table with standard image intensification views and required a series of simple calculations. With the knowledge of the proximal rotational geometry of the femur the fractures were fixed according to normative data of femoral neck anteversion. The clinical correlation was then assessed. The development of the technique was successful. It was clinically practical and was associated with accurate rotational alignment in patients after intramedullary nailing of femoral fractures. This method was seen to be a useful adjunct to current nailing techniques with both educational and clinical benefits. The described technique has clinical application and may help surgeons avoid rotation al malalignment when undertaking intramedullary nailing of fractures of the femur.
