Aspirin for thromboprophylaxis after primary lower limb arthroplasty: early thromboembolic events and 90 day mortality in 11,459 patients.

AIMS: The aim of this study was to present data on 11 459 patients who underwent total hip (THA), total knee (TKA) or unicompartmental knee arthroplasty (UKA) between November 2002 and April 2014 with aspirin as the primary agent for pharmacological thromboprophylaxis. PATIENTS AND METHODS: We analysed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) then compared the 90-day all-cause mortality with the corresponding data in the National Joint Registry for England and Wales (NJR). RESULTS: The incidence of PE was 0.6% after THA, 1.47% after TKA and 1.2% after UKA. The 90-day mortality was 0.39% after THA and 0.44% after TKA. No deaths occurred after UKA. The main causes of death were ischaemic heart disease and respiratory failure. PE was responsible for only 18% of deaths. There was a decline in 90-day mortality, from 0.64% between 2002 and 2007, to 0.21% between 2008 and 2013 after THA, and from 0.47% to 0.39% after TKA for the corresponding period. The standardised mortality ratio (SMR) declined from 86.5 (confidence interval (CI) 63.0 to 137.7) to 39.7 (CI 31.2 to 54.3) p = 0.024. The incidence of proximal DVT was 0.3%. TAKE HOME MESSAGE: With individualised risk assessment and as part of a multimodal approach, Aspirin is safe to use as the main thromboprophylactic agent in primary arthroplasty. It is not associated with an increased incidence of symptomatic DVT, PE or death.

Age as a predictive factor for in-patient admission following day-case shoulder arthroscopic sub-acromial decompression - a district general hospital audit.

INTRODUCTION: Admission following day-case surgery can be problematic for both the patient and the health service. The purpose of this study was to identify any factors predictive of admission following arthroscopic sub-acromial decompression (ASAD) of the shoulder planned as day-case procedures. PATIENTS AND METHODS: A postal questionnaire provided data for 27 patients undergoing ASAD as a day-case procedure between June 2002 and June 2004. RESULTS: Eighteen (66.7%) questionnaires were returned. Of respondents, 38.9% (mean age, 58 years) felt the procedure required in-patient admission due to postoperative pain. These patients had an older mean age than those (61.1%) content with a day-case procedure (mean age, 49 years; P = 0.04). Of patients 55 years and older, 67% felt that the procedure should have an in-patient admission due to postoperative pain compared to 11% of patients under the age of 55 years (P = 0.04). CONCLUSIONS: Patient age may be useful as a predictor of the likelihood of postoperative admission for pain control following day-case shoulder surgery and should be taken into account when planning day case lists.

Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement: a prospective, randomised controlled trial.

We performed a randomised, controlled trial involving 150 patients with a pre-operative level of haemoglobin of 13.0 g/dl or less, to compare the effect of either topical fibrin spray or intravenous tranexamic acid on blood loss after total knee replacement. A total of 50 patients in the topical fibrin spray group had 10 ml of the reconstituted product applied intra-operatively to the operation site. The 50 patients in the tranexamic acid group received 500 mg of tranexamic acid intravenously five minutes before deflation of the tourniquet and a repeat dose three hours later, and a control group of 50 patients received no pharmacological intervention. There was a significant reduction in the total calculated blood loss for those in the topical fibrin spray group (p = 0.016) and tranexamic acid group (p = 0.041) compared with the control group, with mean losses of 1190 ml (708 to 2067), 1225 ml (580 to 2027), and 1415 ml (801 to 2319), respectively. The reduction in blood loss in the topical fibrin spray group was not significantly different from that achieved in the tranexamic acid group (p = 0.72).

The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement: a preliminary study of 1000 cases investigating postoperative stability.

Ensuring the accuracy of the intra-operative orientation of the acetabular component during a total hip replacement can be difficult. In this paper we introduce a reproducible technique using the transverse acetabular ligament to determine the anteversion of the acetabular component. We have found that this ligament can be identified in virtually every hip undergoing primary surgery. We describe an intra-operative grading system for the appearance of the ligament. This technique has been used in 1000 consecutive cases. During a minimum follow-up of eight months the dislocation rate was 0.6%. This confirms our hypothesis that the transverse acetabular ligament can be used to determine the position of the acetabular component. The method has been used in both conventional and minimally-invasive approaches.

Comparison of gait kinematics in patients receiving minimally invasive and traditional hip replacement surgery: a prospective blinded study.

Minimally invasive (MI) total hip replacement (THR) supposedly provides improved ambulation in the immediate post-operative period. This study used a prospective blinded design to analyse early post-operative walking ability using gait analysis. Seventeen patients were available for full analysis with nine having had the MI technique and eight having the standard incision (SI) technique. Patients were blinded as to the incision used, as were all physiotherapists and assessors. Differences in temporal-spatial variables and joint kinematics measured 1 day pre-operatively, 2 days post-operatively and 42 days (6 weeks) post-operatively were compared between groups. There was no significant difference in velocity, step length of the affected or unaffected leg, stride length or stance phase duration between the MI and SI groups between any of the timepoints tested. There was no significant improvement in the gait kinematics of the MI group compared to the SI group either 2 days post-operatively or 6 weeks post-operatively. Contrary to previous studies, there was no improvement in early post-operative gait for those patients who received THR using the minimally invasive technique.

The early management of severe tibial pilon fractures using a temporary ring fixator.

BACKGROUND: The management of pilon fractures of the distal tibia is fraught with complications. Poor initial management leads to a poorer outcome. Protection of the soft tissue envelope is paramount and to achieve this objective early fracture reduction, restoration of leg length and elevation are important principles in the management of severe injuries. Reduction and restoration of length can be achieved through ligamentotaxis by various methods but the most commonly employed are calcaneal traction or bridging external fixation. OBJECTIVE: We describe our method for the early management of these injuries using a simple semicircular bridging frame.