The Journal of arthroplasty
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A 69-year-old man underwent a total knee arthroplasty. Spinal anesthesia was attempted, but when unsuccessful, a general anesthesia was given. The surgery and rehabilitation were uneventful until postoperative day 3 when a pulmonary embolism was diagnosed. ⋯ He developed a spinal hematoma and was paralyzed. The literature has no recommendations for using enoxaparin at therapeutic doses after regional anesthesia. There is no previous report to suggest that a patient 72 hours after surgery is still at risk from a neuraxial hematoma.
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Modular femoral necks in total hip arthroplasty are promoted as giving the surgeon more options during surgery and as being safe. We report a case of fatigue fracture in the modular neck of a femoral implant 3 1/2 years after implantation. The probable design errors leading to product failure are discussed.
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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.