We report a retrospective review of the incidence of venous thromboembolism in 463 consecutive patients who underwent primary total hip arthroplasty (487 procedures). Treatment included both total hip replacement and hip resurfacing, and the patients were managed without anticoagulants. The
Tranexamic acid (TXA) has been used to reduce
blood loss during total hip arthroplasty (THA), but its use could increase
the risk of venous thromboembolic disease (VTE). Several studies
have reported that TXA does not increase the prevalence of deep
vein thrombosis (DVT), but most of those used routine chemical
Aims. Cementless primary total hip arthroplasty (THA) is associated with risks of bleeding and thromboembolism. Anticoagulants are effective as venous thromboprophylaxis, but with an increased risk of bleeding. Tranexamic acid (TXA) is an efficient antifibrinolytic agent, but the mode and timing of its administration remain controversial. This study aimed to determine whether two intravenous (IV) TXA regimens (a three-hour two-dose (short-TXA) and 11-hour four-dose (long-TXA)) were more effective than placebo in reducing perioperative real blood loss (RBL, between baseline and day 3 postoperatively) in patients undergoing THA who receive rivaroxaban as
Aims. The place of
Thromboprophylaxis after elective orthopaedic surgery remains controversial. Recent guidelines from the National Institute for Clinical Excellence (NICE) have suggested that low molecular weight heparin should be given to all patients undergoing total hip replacement. The British Orthopaedic Association is currently debating this guideline with NICE, as it is not clear whether published evidence supports this view. We present the early mortality in our unit after total hip replacement using aspirin as chemical
Aims. We studied the safety and efficacy of multimodal
There is currently limited information available
on the benefits and risks of extended
The recommendation that patients having a total hip replacement should receive pharmacological
This study reports the ten-year wear rates, incidence of osteolysis, clinical outcomes, and complications of a multicentre randomized controlled trial comparing oxidized zirconium (OxZr) versus cobalt-chrome (CoCr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) and highly cross-linked polyethylene (XLPE) liners in total hip arthroplasty (THA). Patients undergoing primary THA were recruited from four institutions and prospectively allocated to the following treatment groups: Group A, CoCr femoral head with XLPE liner; Group B, OxZr femoral head with XLPE liner; and Group C, OxZr femoral head with UHMWPE liner. All study patients and assessors recording outcomes were blinded to the treatment groups. The outcomes of 262 study patients were analyzed at ten years’ follow-up.Aims
Methods
In Africa the amount of joint replacement surgery is increasing, but the indications for operation and the age of the patients are considerably different from those in the developed world. New centres with variable standards of care and training of the surgeons are performing these procedures and it is important that a proper audit of this work is undertaken. In Malawi, we have pioneered a Registry which includes all joint replacements that have been carried out in the country. The data gathered include the age, gender, indication for operation, the prosthesis used, the surgical approach, the use of bone graft, the type of cement, pressurising systems and the
With increasing burden of revision hip arthroplasty (THA), one of the major challenges is the management of proximal femoral bone loss associated with previous multiple surgeries. Proximal femoral arthroplasty (PFA) has already been popularized for tumour surgeries. Our aim was to describe the outcome of using PFA in these demanding non-neoplastic cases. A retrospective review of 25 patients who underwent PFA for non-neoplastic indications between January 2009 and December 2015 was undertaken. Their clinical and radiological outcome, complication rates, and survival were recorded. All patients had the Stanmore Implant – Modular Endo-prosthetic Tumour System (METS).Aims
Methods
A typical pattern of blood loss associated with total hip arthroplasty (THA) is 200 ml intraoperatively and 1.3 l in the first 48 postoperative hours. Tranexamic acid (TXA) is most commonly given as a single preoperative dose only and is often withheld from patients with a history of thromboembolic disease as they are perceived to be “high-risk” with respect to postoperative venous thromboembolism (VTE). The TRanexamic ACid for 24 hours trial (TRAC-24) aimed to identify if an additional 24-hour postoperative TXA regime could further reduce blood loss beyond a once-only dose at the time of surgery, without excluding these high-risk patients. TRAC-24 was a prospective, phase IV, single centre, open label, parallel group, randomized controlled trial (RCT) involving patients undergoing primary unilateral elective THA. The primary outcome measure was the indirect calculated blood loss (IBL) at 48 hours. The patients were randomized into three groups. Group 1 received 1 g intravenous (IV) TXA at the time of surgery and an additional oral regime for 24 hours postoperatively, group 2 only received the intraoperative dose, and group 3 did not receive any TXA.Aims
Methods
We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty. We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty. Decision to perform internal fixation for B2 PFFs was based on specific radiological (polished femoral components, intact bone-cement interface) and clinical criteria (low-demand patient). Median follow-up was 36.4 months (24 to 60). Implant survival and mortality over time were estimated with the Kaplan-Meier method. Adverse events (measured with a modified Dindo-Clavien classification) and 90-day readmissions were additionally compared between groups.Aims
Methods
Intravenous dexamethasone has been shown to reduce immediate postoperative pain after total hip arthroplasty (THA), though the effects are short-lived. We aimed to assess whether two equivalent perioperative split doses were more effective than a single preoperative dose. A total of 165 patients were randomly assigned into three groups: two perioperative saline injections (Group A, placebo), a single preoperative dose of 20 mg dexamethasone and a postoperative saline injection (Group B), and two perioperative doses of 10 mg dexamethasone (Group C). Patients, surgeons, and staff collecting outcome data were blinded to allocation. The primary outcome was postoperative pain level reported on a ten-point Numerical Rating Scale (NRS) at rest and during activity. The use of analgesic and antiemetic rescue, incidence of postoperative nausea and vomiting (PONV), CRP and interleukin-6 (IL-6) levels, range of motion (ROM), length of stay (LOS), patient satisfaction, and the incidence of surgical site infection (SSI) and gastrointestinal bleeding (GIB) in the three months postoperatively, were also compared.Aims
Methods
We compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFFs) during primary total hip arthroplasty (THA) with matched controls. This retrospective cohort study compared 4831 hips with IOPFF and 48 154 propensity score matched primary THAs without IOPFF implanted between 2004 and 2016, which had been recorded on a national joint registry. Implant and patient survival rates were compared between groups using Cox regression.Aims
Patients and Methods
The aim of this study was to compare early functional and health
related quality of life outcomes (HRQoL) in patients who have undergone
total hip arthroplasty (THA) using a bone conserving short stem
femoral component and those in whom a conventional length uncemented
component was used. Outcome was assessed using a validated performance
based outcome instrument as well as patient reported outcome measures
(PROMs). We prospectively analysed 33 patients whose THA involved a contemporary
proximally porous coated tapered short stem femoral component and
53 patients with a standard conventional femoral component, at a
minimum follow-up of two years. The mean follow-up was 31.4 months
(24 to 39). Patients with poor proximal femoral bone quality were
excluded. The mean age of the patients was 66.6 years (59 to 77)
and the mean body mass index was 30.2 kg/m2 (24.1 to
41.0). Outcome was assessed using the Oxford Hip Score (OHS) and
the University College Hospital (UCH) hip score which is a validated
performance based instrument. HRQoL was assessed using the EuroQol
5D (EQ-5D).Aims
Patients and Methods
We describe our technique and rationale using
hybrid fixation for primary total hip arthroplasty (THA) at the Hospital
for Special Surgery. Modern uncemented acetabular components have
few screw holes, or no holes, polished inner surfaces, improved
locking mechanisms, and maximised thickness and shell-liner conformity. Uncemented
sockets can be combined with highly cross-linked polyethylene liners,
which have demonstrated very low wear and osteolysis rates after
ten to 15 years of implantation. The results of cement fixation
with a smooth or polished surface finished stem have been excellent,
virtually eliminating complications seen with cementless fixation
like peri-operative femoral fractures and thigh pain. Although mid-term
results of modern cementless stems are encouraging, the long-term
data do not show reduced revision rates for cementless stems compared
with cemented smooth stems. In this paper we review the conduct
of a hybrid THA, with emphasis on pre-operative planning, surgical
technique, hypotensive epidural anaesthesia, and intra-operative
physiology. Cite this article:
The aim of this study was to compare the rate of perioperative
complications following aseptic revision total hip arthroplasty
(THA) in patients aged ≥ 80 years with that in those aged <
80
years, and to identify risk factors for the incidence of serious
adverse events in those aged ≥ 80 years using a large validated
national database. Patients who underwent aseptic revision THA were identified in
the 2005 to 2015 National Surgical Quality Improvement Program (NSQIP)
database and stratified into two age groups: those aged <
80
years and those aged ≥ 80 years. Preoperative and procedural characteristics
were compared. Multivariate regression analysis was used to compare
the risk of postoperative complications and readmission. Risk factors
for the development of a serious adverse event in those aged ≥ 80
years were characterized.Aims
Patients and Methods
The number of patients undergoing arthroscopic surgery of the
hip has increased significantly during the past decade. It has now
become an established technique for the treatment of many intra-
and extra-articular conditions affecting the hip. However, it has
a steep learning curve and is not without the risk of complications.
The purpose of this systematic review was to determine the prevalence
of complications during and following this procedure. Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines were used in designing this study. Two reviewers systematically
searched the literature for complications related to arthroscopy
of the hip. The research question and eligibility criteria were
established Aims
Materials and Methods
The aim of this study was to examine the efficacy and safety
of multiple boluses of intravenous (IV) tranexamic acid (TXA) on
the hidden blood loss (HBL) and inflammatory response following
primary total hip arthroplasty (THA). A total of 150 patients were allocated randomly to receive a
single bolus of 20 mg/kg IV TXA before the incision (group A), a
single bolus followed by a second bolus of 1 g IV-TXA three hours
later (group B) or a single bolus followed by two boluses of 1 g
IV-TXA three and six hours later (group C). All patients were treated
using a standard peri-operative enhanced recovery protocol. Primary
outcomes were HBL and the level of haemoglobin (Hb) as well as the
levels of C-reactive protein (CRP) and interleukin-6 (IL-6) as markers
of inflammation. Secondary outcomes included the length of stay
in hospital and the incidence of venous thromboembolism (VTE).Aims
Patients and Methods