Thromboembolic complications following lower limb arthroplasty are reported to be high. The aim of this of this study is to ascertain the incidence of symptomatic venous thromboembolic disease following lower limb arthroplasty without Pharmacological thrombo prophylaxis. Retrospective review was undertaken of 752 patients following total hip or total knee replacement between January 1st 2002 and June 30th 2005. Fifty one patients were considered high risk and received thrombopharmacologal prophylaxis with Clexane and Warfarin. Information on all patients was obtained from medical records, computerised information system, general practitioners and patients themselves to produce a complete picture of the three months immediately following the index arthroplasty. All patients who presented with calf symptoms suggestive of venous thrombosis, respiratory distress or died in that three months were investigated. Two patients were lost to follow up. All others had full documentation. Twenty-nine patients presented with calf related symptoms and after ultrasound investigation nine (five THR, four TKR) were confirmed to have venous thrombosis and were treated. One of these patients developed tense haemarthrosis while on treatment. Twelve other patients presented with respiratory symptoms. Eight (six THR two TKR) were confirmed to have pulmonary embolism on either VQ scan or spiral CT. Four of these on VQ scan were low probability. All patients were treated for thromboembolic disease and while on treatment one patient developed persistent wound discharge and infection. Of the 51 patients treated with pharmacological prophylaxis one developed a DVT and five developed wound problems, one of which was major. Two patients died during the three month period, but neither was related to thromboembolic disease. From the 699 patients the symptomatic DVT rate was 1.1%. Symptomatic pulmonary embolism rate was 1.5% including the low probability of VQ scans. There was no mortality from thromboembolism in this study. These results compare favourably with the recent literature. Our department has a policy to select patients for thromboembolic prophylaxis based on high risk factors. All other patients are fully informed of this risk and are treated with elevation, avoidance of swelling, early supervised and regular mobilisation. Our result from this study substantiate our policy for selection of patients for thromboembolic prophylaxis.
Osteoporosis is common in elderly patients and is commonly associated with fractures of the neck of the femur. It is known that this condition is not treated optimally by orthopaedic services around the world. We aim to examine the level of osteoporosis treatment in this fracture and how effective we were in improving treatment for osteoporosis. We retrospectively examined hospital documents from patients admitted between 1 January and 31 December 2004 with femoral neck fracture. All notes were retrieved and were complete. We examined the medications on admission, the place of residence, place of discharge, frequency of DEXA scanning and medications. One hundred and twenty patients were admitted with fracture of the neck of the femur. This group consisted of 23 males with an average age of 76.7, 97 females with an average age of 83.7. Seventy five of these patients were admitted from home, 45 from a rest home. Four patients died prior to treatment, one refused treatment and subsequently died in a hospice. Osteoporotic medications on admission showed that 13 patients were on Bisphosphonate, 6 on Vitamin D and twelve on calcium supplements. Only 14 patients had had DEXA scans prior to admission. On admission eight patients were on no medications of any sort, 53 were on 1–4 medications, 53 were on 5–9 medications and 6 were on greater than 10 medications. On discharge from orthopaedic of the 120 patients 13 were on Bisphosphonate, six on Vitamin D, 13 on calcium supplements. Six patients were on no medications, 47 on 1–4 medications, 55 on 5–9 medications, nine on greater than 10 medications. On discharge from geriatric service, to which 69 patients had been referred 25 were on Bisphosphonate, 13 on Vitamin D, 18 on calcium supplements. One patient was on no medication. 20 were on 1–4 medications, 41 on 5–9 medications and seven on greater than 10 medications. Fifty four had had DEXA scans. We found that the rate of treatment of osteoporosis in the community remains poor with no improvement while in the orthopaedic service. On discharge from the geriatric service significant improvement in osteoporotic medication occurred but there was also an increased in polypharmacy. Further work on the investigation and treatment of osteoporosis in this country is required.
The aim was to determine the knowledge patients have about Total Hip Joint Replacement, their expectations from it and to evaluate the degree of disability from their hip and co-morbidities. A total of eighty questionnaires were posted to two groups of patients. The survey consisted of open ended questions. They were also requested to complete Hospital for Special Surgery Hip Replacement Expectation Survey. Patients awaiting a Total Hip Joint replacement were assessed using Harris Hip Score and Index for Coexistent Disease. Response rate was 81%. Average Harris hip score of 44.96 for the group on the waiting list for THJR.16 of 29 patients fell between mild to severe ICED. Questions to ascertain patient’s knowledge of THJR its risks and complications were open ended. 32–67% either expressed being unaware or answered incorrectly to these questions. Analysis of the Expectation survey revealed that over 75%of patients in both groups rated 15 of the 18 items as being an important expectation. The three items rated low/not applicable in expectation were related to employment, sexual activity and use of support for mobilizing. This survey reveals a population waiting for a THJR possessing inadequate and unacceptable levels of knowledge about it while having high expectations of improvement in their quality of life. Unmet expectations can form grounds for complaints and even recourse to medico legal action. The expectations of the patients waiting for a THJR should be discussed and realistic goals set.
The purpose of this study is to review the current treatment of Colles fractures by long term follow up and to compare these results with a similar paper published in 1965 by G.B. Smail. And secondly, to evaluate the degree of bone density in these patients and to see what, if any, treatment is being received in those with evidence of osteopenia. The records and radiographs of 82 patients treated at Hutt Hospital between January 1997 and January 1998 were reviewed. Of these, thirty-two attended for re-examination. Subjective measures of pain, appearance and functional limitations were recorded, as were complications and whether the wrist had reached a stable state. Anterior-posterior and lateral radiographs of both wrists were taken, from which measurements of residual dorsal tilt and shortening of radius were made. Of the thirty two patients that presented for re-examination twenty went on to have bone density measurements. When comparing results from two similar studies, spaced thirty seven years apart, subjective findings show that from a functional and appearance perspective there appears to be little difference between the two cohorts. With respect to pain, patients treated in 1997 complained of a lot less residual pain compared to those treated in 1960. Objectively, the range of movement in the wrist joint was once again found to be similar in the two cohorts, as was the range of movement in shoulder, elbow appeared to be similar. Finger movement was difficult to compare. Radiologically the degree of ventral dorsal tilt does not correlate with range of movement at the wrist. Bone density scan results suggest that the majority of patients with evidence of osteoporosis are not been treated appropriately. Overall conclusion is that the outcome for treatment of Colles’s fractures has not changed significantly in the past thirty seven years.
