The Journal of arthroplasty
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Metal-on-metal resurfacing of the hip is a bone sparing arthroplasty that may be an option when a head-sparing nonarthroplasty option fails. We present the first published report of 5 cases of failed free vascularized fibular graft treated with modern hip resurfacing arthroplasty. ⋯ There were no femoral neck fractures or revisions. A vascularized fibular bone graft does not prevent good early results with hip resurfacing but may add technical complexity owing to its position within the femoral head and neck.
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The success of hip resurfacings in the older population is still to be determined, although it has been an attractive option in the much younger patients with arthrosis of the hip. We present a 95-year-old active, independent patient who underwent a Birmingham hip resurfacing at 88 years of age. More than 7 years after surgery, the original components are still in situ, and the patient is pain-free with a very active lifestyle at the age of 95 years. Hip resurfacings are not without risks, and we highlight the evolution of strict selection criteria for patients older than 65 years who may be suitable candidates for hip resurfacing arthroplasty.
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In 12 patients undergoing a revision hip arthroplasty after a failed metal-on-metal primary hip arthroplasty, the effectiveness of intraoperative cell salvage (ICS) in removing metal ions was investigated. Samples of blood collected during surgery were filtered using 2 ICS devices. ⋯ The Co-to-Cr ratio before and after filtration was similar. At the present time, these salvage systems should be used with caution in the patient undergoing revision of metal-on-metal bearing surfaces.
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Despite the prevalence of studies relating to hip and knee arthroplasties, no Canadian studies exist in the literature regarding patients' perceptions and concerns prior to undergoing these procedures. A 32-question, 5-point Likert scale questionnaire was developed and administered to a Canadian cohort. ⋯ Results consistently showed complications arising from surgery, ways to reduce pain after surgery, and ability to walk properly again as the 3 top concerns for patients whether stratified by age, sex, residential status or joint replacement type. Other results discussed include resources used by patients to become better informed about joint arthroplasty, differences in Western Ontario and McMaster Universities Index of Osteoarthritis scores between groups, and significant differences in patient concerns as determined by ridit analyses.
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The use of aspirin for venous thromboembolism (VTE) prophylaxis after major orthopaedic surgery is controversial. The hypothesis of the present study is that aspirin will decrease the rate of operative site bleeding without increasing thromboembolic events when aspirin is used for VTE prophylaxis after major orthopaedic surgery. ⋯ The operative site bleeding relative risks of VKA, LMWH, and pentasaccharides versus aspirin, are 4.9, 6.4, and 4.2, respectively. A pooled analysis of RCTs supports the use of aspirin for VTE prophylaxis after major orthopaedic surgery.