The number of arthroplasties being performed
increases each year. Patients undergoing an arthroplasty are at
risk of venous thromboembolism (VTE) and appropriate prophylaxis
has been recommended. However, the optimal protocol and the best
agent to minimise VTE under these circumstances are not known. Although
many agents may be used, there is a difference in their efficacy
and the risk of bleeding. Thus, the selection of a particular agent relies
on the balance between the desire to minimise VTE and the attempt
to reduce the risk of bleeding, with its undesirable, and occasionally
fatal, consequences. Acetylsalicylic acid (aspirin) is an agent for VTE prophylaxis
following arthroplasty. Many studies have shown its efficacy in
minimising VTE under these circumstances. It is inexpensive and
well-tolerated, and its use does not require routine blood tests.
It is also a ‘milder’ agent and unlikely to result in haematoma
formation, which may increase both the risk of infection and the
need for further surgery. Aspirin is also unlikely to result in persistent
wound drainage, which has been shown to be associated with the use
of agents such as low-molecular-weight heparin (LMWH) and other
more aggressive agents. The main objective of this review was to summarise the current
evidence relating to the efficacy of aspirin as a VTE prophylaxis
following arthroplasty, and to address some of the common questions
about its use. There is convincing evidence that, taking all factors into account,
aspirin is an effective, inexpensive, and safe form of VTE following
arthroplasty in patients without a major risk factor for VTE, such
as previous VTE. Cite this article:
Impingement is a major part of the pathological complex of degenerative osteoarthritis of the elbow. It can be seriously disabling causing symptoms of pain, locking, swelling and reduced range of motion. Various surgical techniques, both arthroscopic as well as open, have been described which aim to remove the offending osteophytes and loose bodies in an attempt to improve elbow function. Our study includes thirteen patients with a mean age of the 54 years (34 to 68) who underwent debridement arthroplasty of the elbow for degenerative arthritis using a modification of the Outerbridge-Kashiwagi trans-olecranon technique. This approach allows excision of posterior osteophytes, adequate clearance of the olecranon fossa, removal of anterior coronoid osteophytes and loose bodies via a trans-olecranon fenestration and when required permits decompression of the ulnar nerve in the cubital tunnel. At a mean follow-up of 37 months (3 to 96) the Mayo scores improved by a mean of 36 points with performance indices being rated as excellent in 5, good in 5 and fair in 3. Pain scores improved by a mean of 4 grades (2 to 8). The mean improvement in the flexion-extension arc was 28 (0 to 55). There was one complication of transient ulnar nerve neuritis, which responded to non-operative measures. Though limited by the lack of a control group we were able to show the effectiveness and reliability of our technique in producing lasting benefit in improving range of motion and relieving pain in degenerative osteoarthritis of the elbow.
