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.

In certain cases of lower limb problems, the combined approach of Plastic and Orthopedic surgeons offers specific advantages. One stage operation, quicker recovery, less hospital stay and reduced cost is some to mention. We present our experience including both chronic and emergency cases that we applied the combined approach. The use of muscle flaps mainly, provided smooth postoperative course especially in patients that were at increased risk of skin necrosis due to previous operation scars or infection.

Using this approach cases such as revision knee arthroplasty or trauma had much better results

The preoperative recognition of this particular group of patients at increased risk and the planned combined intraoperative approach are the most important steps in order to avoid complications. Our choices were pedicle and free muscle flaps. We present our experience in treating patients following this regime with encouraging results overall