Introduction

Although total hip replacement (THR) has been described as the operation of the century, there is still room for improvement. There is therefore continued effort for advanced implants and bearing surfaces, moreover so, for the younger patient with a longer life expectancy and increased needs.

Purpose: The report of a case o f a patient, who underwent a total hip arthroplasty and sustained cerebral hemorrhage due to low molecular weight heparin.

Case report: A 46-years-old woman had a total hip replacement due to secondary osteoarthritis after a congenital hip dislocation. She had a free medical record. Treatment with LMWH started the day of the surgery. The patient was dismissed from the hospital the sixth postoperative day, being well, and came back the ninth postoperative day, complaining of hypertension, headache and motor disturbances of her left upper limb. Neurological examination did not revealed any particular findings except reduced strength of her left upper limb. A brain CT scanning showed no significant findings, while her blood platelet count was126000 while immediately postoperatively was 180000 and preoperatively 220000. The following day the patient established a paresis of her left arm and the platelet count fell to 35000, while a new CT scan, revealed small hemorrhages in both parietal cortexes of the brain. LMWH was discontinued. The patient deceased the 11th postoperative day.

Conclusion: Heparin Induced Thrombocytopenia type II and hemorrhage due to LMWH is very rare but should be bared in mind from the orthopaedic surgeon who uses LMWH for DVT prophylaxis. Clinical suspicion mandates immediate discontinuation of the agent and consideration of an alternative anticoagulation therapy along with general support of the patient.

Purpose: The correlation of surgical wounds for total hip and knee replacements with the presentation or recurrence of skin disorders.

Materials-method: In 9 patients, 5 men and 4 women, operated for total knee replacement and 1 patient, a female, operated for total hip replacement, skin disorders appeared around their surgical wounds. The female patient with the THR sustained a herpes zoster in the operated buttock 8 months after surgery. 1 patient with leuke had an exaltation of symptoms the wounds of both operated knees. 6 patients, 2 men and 4 women, had increased growth of hair on both sides of the wound some months after the TKR, in contrast with the rest of their skin. 1 patient with psoriasis had increased local symptoms after a TKR compared with the non-operated side. Finally, 1 patient, 25 days after a TKR, sustained an exanthema around his wound.

Conclusion: Total joint replacement may rarely be the cause for the presentation or recurrence of skin disorders around the surgical wounds.

The aim of this study is the presentation of the results in 48 cases of revision THA with excessive proximal bone loss with the use of the Wagner cementless femoral stem

The bone loss classified with the AAOS system for proximal femoral bone deficiency in type I (17 patients), II (27 patients), and III (4 patients). We used the titanium alloy Wagner stem trying to achieve primary distal stabilisation because of its conical shape and its longitudinal ridges while we expected secondary proximal stabilization due to the osseointegration properties of the material. We didn’t use grafts.

The mean follow- up is 9, 6 years. The results are very satisfactory to excellent with marked pain relief, improvement of the walking ability and excessive bone restoration in the proximal part of the femur.

7 of the patients had a symptomless stem subsidence up to 16mm the first year with subsequent stabilization thereafter. One of the patients required a new revision the 7th postoperative year due to stem’s fracture in its distal part.

We conclude that the Wagner stem in these difficult THA revisions offers firm primary distal fixation, impressive proximal bone regeneration and satisfactory clinical outcomes without using grafts.