Introduction

We studied the safety and efficacy of multimodal thromboprophylaxis (MMP) in patients with a history of venous thromboembolism (VTE) undergoing total hip arthroplasty (THA). MMP includes discontinuation of procoagulant medications, VTE risk stratification, regional anesthesia, an intravenous bolus of unfractionated heparin before femoral work, rapid mobilization, the use of pneumatic compression devices, and chemoprophylaxis tailored to the patient's risk.

The role of surface finish on the survivorship of cemented stems is controversial. The purpose of this study is to prospectively evaluate the mid-term clinical and radiographic performance of a cohort of patients who underwent total hip replacement with two identical cemented femoral stems differing only in surface finish (VerSys, Zimmer, Warsaw, IN). 64 total hip replacements with a rough stem and 138 total hip replacements with a satin finish stem were followed clinically and radiographically for 4 to 7 years. All surgeries were performed by one surgeon. The groups had similar demographics, diagnosis, length of follow up, cement mantle quality and alignment. The preoperative and postoperative Hospital for Special Surgery Hip Score at last follow up was not significantly different among the two groups. Five hips in the rough group and none in the satin group developed aseptic loosening (p=0.0009). The femoral bone-cement interface revealed progressive radiolucent lines or osteolysis in 8 out of 64 rough stems and in 3 out of 138 satin stems (p=0.01). There were progressive radiolucencies or osteolysis in 44 out of possible 448 Gruen zones in the rough surface group and in 8 out of possible 966 Gruen zones in the satin finish group (p< 0.001). A rough, textured stem is more likely to fail at intermediate follow-up than a satin surface stem. We recommend that the surface of cemented stems should be satin or polished, with a Ra of less than 20 microinches.

Backside wear is generated at the non-articulating surfaces of modular acetabular cups. We compared the backside wear of retrieved liners from cementless non-modular and modular cups of first and second generation designs. We match paired for time in situ, patient age and weight, 9 retrieved Harris Galante type 1 liners, 9 Harris Galante type 2, 9 Trilogy, and 9 liners from a modern two-piece preassembled cup (Implex). The average time in situ was 2.5 years (1 to 7). The backside was divided in quadrants and each one examined under a 10x binocular loupe and rated with a score from 0 (absence of wear) to 3 (severe backside wear) for a total ranging from 0 to 12. Among 36 quadrants in the HG1 group there were 3 rated 1, 23 rated 2, and 10 rated 3. In the HG2 group, there was 1 quadrant rated 0, 16 rated 1, 14 rated 2, and 5 rated 3. In the Trilogy group, there were 6 quadrants rated 0, 27 rated 1, and 3 rated 2. In the Implex group, there were 15 quadrants rated 0, 21 rated 1. The average total backside wear score was 8.4; 7.3; 3.7; and 2.3 respectively. The HG cups demonstrated more severe backside wear than the Trilogy and Implex (HG1 vs Trilogy and HG1 vs Implex: p< 0.001; HG2 vs Trilogy and HG2 vs Implex: p< 0.02). There was a tendency towards less backside wear in the Implex cup when compared to the Trilogy (p=0.04). The difference between the HG1 and HG2 was not significant. Despite the limitations imposed by the small sample studied, the presence of multiple screw holes in the Harris-Galante retrievals, and sub-optimal matching for sex, height, and varied indication for revision, we detected significant reduction in the backside wear of modern modular and non-modular acetabular cups when compared to first generation modular designs.