The decreased bone mass or local osteoporosis at the proximal femur is often recognized in patients of rheumatoid arthritis (RA). In total hip arthroplasty (THA), the cancellous bone will be lost when rasping technique is applied for the preparation of stem insertion. In addition, cutting or elongation for contracted muscles around the hip joint can be required to insert the stem. To avoid these problems, the non-broaching, non-rasping impaction technique for the stems was applied in THA for the patients with RA. We report clinical and radiographic results of this method. In surgery, the femoral neck was cut and prepared without using a box chisel, reamer or broaches, instead, a series of trial stems were used with the method of impaction technique. After impaction of cancellous bone with the final size of the trial stem, the stem is fixed by bone cement without taking any cement mantle. Full weight bearing was allowed for all patients from the next day of the surgery. We investigated short-term clinical and radiographic results and the incidence of complication that was related to this technique. Post-operative radiological results with the minimum follow-up of 12 months after surgery were analyzed in 31 joints (25 cases) with this technique. The mean age at the time of surgery was 66.3 years (46∼82). The mean duration after surgery was 62 months (14∼108).Introduction
Materials and Methods
Prophylaxis against venous thromboembolism after elective total hip replacement is routinely recommended. Our preference has been to use mechanical prophylaxis without anticoagulant drugs. A randomised controlled trial was performed to evaluate whether the incidence of post-operative venous thromboembolism was reduced by using pharmacological anticoagulation with either fondaparinux or enoxaparin in addition to our prophylactic mechanical regimen. A total of 255 Japanese patients who underwent primary unilateral cementless total hip replacement were randomly assigned to one of three postoperative regimens, namely injection of placebo (saline), fondaparinux or enoxaparin. There were 85 patients in each group. All also received the same mechanical prophylaxis during and after the operation, regardless of their assigned group. The primary measurement of efficacy was the presence of a venous thromboembolic event by day 11, defined as deep-vein thrombosis detected by ultrasonography, documented symptomatic deep-vein thrombosis or documented symptomatic pulmonary embolism. The duration of follow-up was 12 weeks. The rate of venous thromboembolism was 7.2% with the placebo, 7.1% with fondaparinux and 6.0% with enoxaparin (p = 0.95 for the comparison of all three groups). Our study confirmed the effectiveness and safety of mechanical thromboprophylaxis without the use of anticoagulant drugs after total hip replacement in Japanese patients.
