Deep venous thrombosis after mini-posterior total hip arthroplasty in Japanese patients.

We conducted a retrospective study of the occurrence of deep venous thrombosis (DVT) following mini-posterior total hip arthroplasty (THA) in Japanese patients. From May 2004 to December 2009 mini-posterior THA was performed on 1659 cases, of whom 603 cases didn't receive anticoagulants (Group 1), 547 cases received 2.5 mg percutaneous injection of fondaparinux (a factor Xa inhibitor) daily for 7 days starting the day after surgery (Group 2), and 509 cases received 2000 IU percutaneous injection of enoxaparin (low-molecular-weight heparin) twice daily for 7 days starting the day after surgery (Group 3). The baseline characteristics were very similar in each group. All patients started walking the day after surgery, were advised to wear graduated compression stockings for six weeks after the operation, and used a foot pump for 3 hours a day postoperatively for several days. A week after surgery Duplex ultrasound with colour-flow Doppler imaging of the lower extremities was performed. The occurrence of DVT was significantly different between Groups 1, 2, and 3 (p<0.001): 57 cases (9.5%), 4 cases (0.7%), and 0 cases (0%), respectively. No patients of any group had clinically detected pulmonary emboli. In this study we showed that adding anticoagulants with foot pumps further reduced the incidence of DVT, which seldom occurs following less invasive mini-posterior THA combined with early mobilisation, foot pumps, and anticoagulants.

Primary repair of posterior cruciate ligament avulsion fracture: the effect of occult injury in the midsubstance on postoperative instability.

BACKGROUND: In the posterior cruciate ligament avulsion fracture, posterior instability cannot be completely restored by the anatomical reduction and fixation of an avulsed fragment. HYPOTHESIS: The occult midsubstance injury inside the posterior cruciate ligament may affect the residual posterior instability after anatomical reduction and internal fixation of the avulsed fragment. STUDY DESIGN: Prospective comparative clinical study. METHODS: Thirty-one patients were followed for a period of 2 to 8 years. Based on magnetic resonance images taken immediately after the injury, these patients were divided into 2 groups, the occult injury group (group O, 15 knees) and the uninjured group (group N, 16 knees). RESULTS: The side-to-side difference of the posterior knee instability was 3.2 mm in group O and 3.0 mm in group N. Approximately 60% of the knees examined showed mild posterior instability in both groups. There were no significant differences found between the 2 groups. CONCLUSION: The occult posterior cruciate ligament midsubstance injury does not significantly affect postoperative posterior instability of the knee. This fact did not support the hypothesis that has been commonly considered thus far. CLINICAL RELEVANCE: It is not necessary for orthopaedic surgeons to be overly apprehensive about occult midsubstance injury in the treatment of posterior cruciate ligament avulsion fracture.

Melorheostosis with occlusion of dorsalis pedis artery.

Melorheostosis is an unusual sclerotic dysplasia of bone. The case of a 51-year-old female patient with melorheostosis and occlusion of the dorsalis pedis artery is described. Although numerous vascular anomalies have been noted in patients with melorheostosis, occlusion of the dorsalis pedis artery has not been reported previously.