Thromboprophylaxis and Outcomes for Total Joint Arthroplasty in Congenital Bleeding Disorders: A Single-Center Experience.

Total joint arthroplasty (TJA) improves the quality of life for patients with end-stage osteoarthritis but is associated with an increased risk of venous thromboembolism (VTE), thus pharmacologic thromboprophylaxis is recommended for most patients. Patients with congenital bleeding disorders may develop severe arthropathies due to repeated hemarthroses and derive similar benefit from TJA as the general population. No guidelines for pharmacologic thromboprophylaxis in this population exist, however, as the risks and benefits are not well defined. We undertook the current study to assess the safety and efficacy of pharmacologic VTE prophylaxis in patients with congenital bleeding disorders undergoing TJA. We retrospectively reviewed the medical records of patients with bleeding disorders who underwent TJA at our academic institution between 1987 and 2012. We identified 28 patients who underwent 38 TJA procedures. Low-molecular-weight heparin (LMWH) was administered in 29 procedures (76%) and was discontinued early in 3 procedures (2 patients) due to nonjoint bleeding. No symptomatic VTE was identified, and no joint or deep wound infections were seen. Twenty-two patients accounting for 31 procedures were contacted to discuss their experience with TJA. All reported decreased pain, and 97% reported improved function after the surgery. Impressively, 97% stated that they would choose to have the surgery again. These results confirm the benefit of TJA in patients with congenital bleeding disorders and end-stage arthropathies and suggest that LMWH thromboprophylaxis is safe. No patient in our cohort developed symptomatic VTE, whether or not thromboprophylaxis was administered, thus necessity of thromboprophylaxis remains an unanswered question.

Uncemented total knee arthroplasty: 2-year follow-up of 100 knees with a rotating platform, cruciate-retaining design.

Review of the literature shows mixed results regarding uncemented total knee arthroplasty (TKA). To our knowledge, there are no reports of results for uncemented TKA that incorporates a cruciate-retaining and rotating platform design. It is theorized that these design features could decrease the stress at the bone-implant interface. This study reports results on 100 uncemented TKAs at a minimum of 2-year follow-up. Average Knee Society clinical score improved from 52.9 to 95.1; average Knee Society functional score improved from 60.5 to 82.0. Ninety-eight percent of patients had excellent and 2% had good results based on Knee Society scores. There was 99% implant survival; 1 patient required revision of a loose tibial component after a motor vehicle accident. The promising short-term results support the continued use of this implant and suggest a prospective randomized study comparing cemented vs uncemented TKA of this design is warranted.

Dissociation of the modular femoral stem from the metaphyseal sleeve during reduction of a total hip arthroplasty dislocation.

Dissociation of components in a modular total hip arthroplasty system has been described. We describe the case of dissociation at the interface between the femoral stem and the proximal metaphyseal sleeve during attempts to reduce a dislocation. Open reduction was required for successful treatment of this rare complication.

Primary total hip arthroplasty using a modular proximally coated prosthesis in patients older than 70: two to eight year results.

Patients older than 70 years who underwent primary total hip arthroplasty using a modular proximally porous-coated femoral stem with an ingrowth hemispherical acetabular component were evaluated. This included 135 hips in 122 patients, with an average 5-year follow-up period. This study included 96 patients (107 hips) still living; 26 patients (28 hips) patients had died, and 8 patients were lost to follow up. In this study, 93% of patients had little or no pain, and 95% were extremely or very satisfied with the operation. Mean Harris Hip score was 83, with a Short Form-36 (SF-36) physical component and mental component summary score of 41 and 51, respectively. Osteolysis surrounding the femur was seen in 8 hips (7%) and around the acetabulum in 6 hips (5%). No components were loose or required revision.