Venous thromboembolism rates after hip and knee arthroplasty and hip fractures.

BACKGROUND: The ideal thromboprophylaxis regime following lower limb arthroplasty and proximal femur fractures remains controversial. Guidelines disagree on the type of chemical prophylaxis, its dose or duration. This article describes a method of monitoring venous thromboembolism (VTE) rates following Total Hip (THA), Total Knee Arthroplasty (TKA) and surgery for hip fractures (NOF#). METHODS: Over 3 years, all patients investigated for VTE were analysed using Picture Archiving Communications System (PACS). All positive scans were then cross-referenced using PACS and local registry data to see if they had undergone THA, TKA or NOF# in the preceding 90 days. Mortality data were obtained from the national administrative database, Hospital Episode Statistics. RESULTS: Five thousand seven hundred eighty-eight patients underwent investigation for VTE and there were 29 diagnoses of PE and 24 of DVT. There was a 0.77% rate of symptomatic DVT after THA, 0.05% after TKA and 0.55% after NOF #. The rate of confirmed symptomatic PE for THA was 0.46, 0.27% for TKA and 0.96% for NOF #. Mortality at one-year post-THA was 0.6, 0.6% for TKA and 25.9% after NOF#. All patients contacted either remained within the catchment area for the minimum 90 postoperative days or died within the catchment area. CONCLUSIONS: The 90 day post-operative prevalence of symptomatic VTE of 1.2, 0.3 and 1.5% in THA, TKA and NOF # respectively are similar to other studies using symptomatic and imaging positive VTE as their endpoint. The study uses a method of collecting data which can be utilised in centres where PACS is available.

Custom-made endoprosthetic reconstruction of the distal humerus for non-tumorous pathology.

Eight patients underwent custom-made endoprosthetic elbow reconstruction between 1989 and 2006 either for failed primary total elbow replacements or following complex fracture complications. A functional assessment using the Toronto Extremity Salvage (TES) score was performed. Patients were followed for a mean of 46.1 months (range : 25 to 88). One patient who presented with an infected periprosthetic fracture around a total elbow replacement, failed two-stage reconstruction and underwent excision arthroplasty. The remaining seven patients were available for functional follow-up. Average flexion deformity was 15 degrees (range: 7 to 35) and average flexion arc was 85 degrees (range : 70 to 130). The mean TES score was 67.3 (range: 36.6 to 95.9). Custom made endoprosthetic reconstruction allowed for a satisfactory outcome in all but one of these eight patients with severe bony destruction around the elbow in the absence of tumour infiltration.

Making strong cords from surgical sutures.

The authors present a simple and cost effective technique of preparing strong cords from surgical sutures. The technique requires suture material, a drill, a clip and it takes less than a minute to prepare. The mechanical strength of the cord obtained by this method was compared to the mechanical strength of a single suture. Cords containing eight thicknesses of the suture material failed at slightly under eight times the single suture strength. A loop made out of cords of number 2 Vicryl or Dexon failed at loads of more than 1000 N. The authors have found these cords extremely useful and effective for reconstruction of the dislocated acromio-clavicular joint and also for the fixation of trans-femoral osteotomies.