Intermittent Pneumatic Compression for the Prevention of Venous Thromboembolism after Total Hip Arthroplasty

BACKGROUND: Venous thromboembolism (VTE) is a relatively common and potentially life threatening complication after major hip surgery. There are two main types of prophylaxis: chemical and mechanical. Chemical prophylaxis is very effective but causes bleeding complications in surgical wounds and remote organs. On the other hand, mechanical methods are free of hemorrhagic complications but are less effective. We hypothesized that mechanical prophylaxis is effective enough for Asians in whom VTE occurs less frequently. This study evaluated the effect of intermittent pneumatic compression (IPC) in the prevention of VTE after major hip surgery. METHODS: Incidences of symptomatic VTE after primary total hip arthroplasty with and without application of IPC were compared. A total of 379 patients were included in the final analysis. The IPC group included 233 patients (106 men and 127 women) with a mean age of 54 years. The control group included 146 patients (80 men and 66 women) with a mean age of 53 years. All patients took low-dose aspirin for 6 weeks after surgery. IPC was applied to both legs just after surgery and maintained all day until discharge. When a symptom or a sign suspicious of VTE, such as swelling or redness of the foot and ankle, Homans' sign, and dyspnea was detected, computed tomography (CT) angiogram or duplex ultrasonogram was performed. RESULTS: Until 3 months after surgery, symptomatic VTE occurred in three patients in the IPC group and in 6 patients in the control group. The incidence of VTE was much lower in the IPC group (1.3%) than in the control group (4.1%), but the difference was not statistically significant. Complications associated with the application of IPC were not detected in any patient. Patients affected by VTE were older and hospitalized longer than the unaffected patients. CONCLUSIONS: The results of this study suggest that IPC might be an effective and safe method for the prevention of postoperative VTE.

Low-heat Treated Intercalary Autograft Reconstruction in Limb Salvage of Primary Malignant Bone Tumor / 대한정형외과학회잡지

PURPOSE: This study evaluated the effectiveness of a low-heat treated intercalary autograft reconstruction in primary malignant bone tumors mainly involving the diaphysis. MATERIALS AND METHODS: Twenty patients who had primary malignant bone tumors underwent a low-heat treated intercalary autograft reconstruction between May 1987 and May 2004. The mean age was 24 years, and the mean follow up was 59.8 months. Osteosynthesis between host bone and low-heat treated autograft was carried out using plates and screws (n=7), rigid IM nails (n=6), plates and flexible IM nails or K-wires (n=4), and rigid IM nail and plate (n=3). Intramedullary cement augmentation was performed in 10 patients but the primary bone graft on the host-graft junction was not performed. RESULTS: The mean segmental excised bone length was 152 mm. One patient died from acute cardiac arrest unrelated to the tumor but there was no local recurrence and metastasis. Host graft union was achieved in 18 patients after a mean of 8.5 months after surgery. Complications were observed in 7 patients (35%), including 3 fractures, 2 nonunions, and 2 infections. The mean functional outcome was 82% (24.6). CONCLUSION: A low-heat treated intercalary autograft is a simple, economic and best fitting reconstruction system with a low rate of ultimate failure in carefully selected patients. However, a long term study will be needed to evaluate the graft incorporation and possibility of bone resorption.

Alumina-on-Alumina THAin Active Patients Younger than 40 Years Old: A 5-Year Minimum Follow-Up Study / 대한정형외과학회잡지

PURPOSE: Alumina-on-alumina bearing surfaces in total hip arthroplasties (THAs) are an attractive alternative coupling and may be a promising option for young active patients. This study evaluated the results of contemporary primary alumina-on-alumina cementless THAs performed in patients younger than 40 years. MATERIALS AND METHODS: This study evaluated the results in a consecutive series of 72 alumina-on-alumina THAs performed in 61 patients who were younger than 40 years old (average, 30 years; range, 18-39 years) after a minimum 5-year follow-up (average, 69 months; range, 60-83 months). RESULTS: The mean Harris hip score was 97.2 points at the latest follow-up. All the hips showed radiographic evidence of a bone ingrown prosthesis. No radiological loosening was found and no revision was required for either the stems or the cups. Ceramic wear was not detected in the 24 hips where differentiation of the femoral head was possible on radiographs, and no periprosthetic osteolysis was observed. A ceramic fracture after a major motor vehicle accident and an impingement-associated ceramic liner edge fracture for an inadequate abductor muscle tone occurred. During the follow-up period, no other ceramic fractures occurred as a result of normal everyday activity. CONCLUSION: From the viewpoints of wear, osteolysis, and implant fixation, the results of the contemporary alumina-on-alumina THAs performed in younger active patients were encouraging at the 5-year minimum follow up. However, in order to minimize the possibility of modern ceramic failure, a careful preoperative patient evaluation to determine the proper indication for ceramic bearings, and meticulous surgical techniques are recommended.