RESUMEN
When treating coxarthrosis, each treatment method including conservative treatment, osteotomy, or artificial joint replacement, has an optimal stage for treatment of the disease. Joint preservation surgery has a good result for cases in the early stage, but total hip arthroplasty (THA) is selected for advanced stage hip osteoarthritis, and in Japan, more than a 40000 THAs are performed each year. Good postoperative results lasting up to 15 years are reported today, but, on the other hand, postoperative problems still clearly exist. Deep venous thrombosis/pulmonary embolism (VTE/PTE) are given as perioperative problems, and postoperative dislocation and postoperative range of motion of the hip joint are given as the problems that most relate to ADL. These days, information about THA is abundant so that there is extensive demand for the procedure amongst patients, and elevated technique is demanded of the surgeon. The onset of postoperative VTE/PTE as a lethal complication and interest about its prevention have risen these days with the increase in the number of artificial joint replacements performed in Japan. This time, we introduce a postoperative THA rehabilitation schedule and report the results of our postoperative complication prevention efforts carried out in our hospital. When THA of late years is thought about, for a patient, it is natural that the long-term results are good, and the postoperative satisfaction degree from an early stage is the demand that it is necessary. In consideration of these things, the range of hip motion needed about the origin and preventing dislocation that were one element of long-term satisfaction since only a short-term of normal ADL movement was investigated, and this was viewed from the aspect of joint stability against postoperative dislocation by difference in the approach method of surgery. Finally, we also discussed the importance of early rehabilitation after surgery for the prevention of VTE/PTE as a serious complication of surgery.
RESUMEN
During the perioperative period after total hip arthroplasty (THA), much attention has been recently paid to deep venous thrombosis, yet there are few reports concerning stroke after THA and there is no such data at all in Japan at present. The purpose of this retrospective study was to elucidate the occurrence rate and the characteristics of stroke cases during the THA perioperative period. A total of 1,551 primary THAs performed between January 1999 and December 2008 were investigated. Cerebral infarction occurred in three patients (0.19%) during three weeks after THA. Concerning the related factors, one male had foramen ovale, one female had untreated diabetes and atrial fibrillation, and one female had severe stenosis of the internal carotid artery. Cerebral infarction occurred at Day 1 in one male, at Day 2 in one female, and at Day 5 in the other female, and they underwent anticoagulant therapy just after their diagnosis. In all three patients, motor paralysis fully improved and they came back to the THA rehabilitation program within Day 9. One male was discharged at 4 weeks, and another two females were discharged at 8 weeks. Because many people eating a more European diet are now getting older in Japan, prophylaxis for not only DVT but also stroke after THA should be emphasized.