Current Evidence and Expert Opinion on Thromboprophylaxis After Total Knee and Hip Replacement.

An effective anticoagulant provides a balance between the risk for venous thromboembolism (VTE) and bleeding and is crucial in achieving optimal clinical outcomes in patients undergoing total hip replacement (THR) and total knee replacement (TKR) surgeries. We performed a review of the literature on thromboprophylaxis for patients undergoing total hip or knee replacement. This review article summarizes current guidelines and evidence for anticoagulation along with the expert opinion about pharmacological VTE prophylaxis, particularly non-Vitamin K antagonist oral anticoagulants (NOACs), for patients after total hip or knee replacement. Aspirin for VTE prophylaxis after TKR/THR has been controversial and most of the evidence is reported from observational research. Although the guidelines do not recommend any specific thromboprophylaxis agent, available evidence suggests that NOACs are as effective as low molecular weight heparins (LMWHs) in preventing VTE. Oral administration and the lack of dose monitoring make NOACs easy to use in outpatient settings in cases with challenging treatment compliances. They can be used for two weeks after TKR and five weeks after THR - six weeks after TKR and THR to cover the at-risk period for VTE post-discharge. Owing to the lack of evidence for a head-to-head comparison of NOACs, an anticoagulant with better efficacy and safety may be suggested in special patient populations (elderly, obese patients, or those with renal dysfunction). The expert opinion on pharmacological VTE prophylaxis provided in this article could address some gaps in the management of anticoagulation in patients with total hip or knee replacement.

Arthroplasty in young adults: options, techniques, trends, and results.

Total knee arthroplasty (TKA) has been established as a very successful and commonly performed procedure for primary and secondary osteoarthritis, and also for inflammatory arthropathies of the knee in all age groups and both genders. It has predominantly been used as a procedure in the age group of patients 65 years and above. Consequently, the literature is replete with data relevant to various issues associated with TKA in the above 65 years age group population. Although there is reasonable clarity and consensus on the broad parameters of the use of TKA in the above 65 years age group (older), this cannot be said for the same issue as relevant to the below 65 years age group (young adults). Over the last 2 decades there has been an increasing tendency toward the use of TKA in young adults, with some countries reporting a 5-fold increase in the last 10 years [1]. The present article is designed to review the most recent literature specific to this subject and assess it vis-à-vis various issues as listed in the subsequent text, with the aim of highlighting evolving thoughts and trends, which could be useful for decision making by clinicians practicing in the community.

Periprosthetic femoral fracture after a well-fixed revision total knee arthroplasty treated with in situ effective lengthening of prosthesis.

The increasing number of total knee arthroplasties implies a greater likelihood of periprosthetic fractures and need for successful treatment options. We report a case where in situ effective lengthening of the stem of a well-fixed indwelling prosthesis by a custom-made intramedullary nail with taper-lock coupling provided a successful alternative to the established internal fixation techniques involving prosthesis exchange. We believe that effective lengthening of indwelling prosthesis by a custom-made intramedullary nail is an effective option for treating periprosthetic femoral fractures in selected cases, where an attempt of removing well-fixed implant would result in unacceptable bone loss at the joint level.

Range of movements of lower limb joints in cross-legged sitting posture.

Cross-legged sitting posture is integral to activities of daily living in Eastern and Asian cultures. This posture has not been studied or defined in any significant detail from an orthopedic view point. The movements of right lower limb joints were measured in cross-legged sitting posture in 44 volunteers from the Indian population with no prior history of problems related to the knee or hip joint. Flexion at the hip joint ranged from 82 degrees to 100 degrees , with a mean of 91 degrees . Abduction at the hip joint ranged from 19 degrees to 57 degrees , with a mean of 39 degrees . The external rotation ranged from 42 degrees to 58 degrees , with a mean of 49 degrees . Flexion at the knee ranged from 126 degrees to 142 degrees , with a mean of 135 degrees . Equinus at the ankle ranged from 17 degrees to 34 degrees , with a mean of 29 degrees . The resultant data would be useful in understanding kinematics of the knee and hip in the healthy and post-total joint arthroplasty population. The data could be used for design features of prosthetic joints, surgical technique, and rehabilitation protocols. Such data have not been available hitherto in any relevant published literature.