The Journal of arthroplasty
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Total joint arthroplasty is a safe and successful procedure. However, numerous complications may present after elective arthroplasty. This study prospectively collected data on systemic and local in hospital complications after 15383 joint arthroplasties, which included 8230 total hip arthroplasties and 7153 total knee arthroplasties. ⋯ There were 109 major local complications, including 16 vascular injuries, 29 peripheral nerve injuries, 25 periprosthetic fractures, and 18 dislocations. Total joint arthroplasty, despite its success, can be associated with rare serious and life-threatening complications. This study provides a baseline of complications that can occur after elective joint arthroplasty.
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Comparative Study
Decreased venous thromboembolism with injectable vs oral anticoagulation after discharge for major orthopedic surgery.
The use of outpatient anticoagulation after major orthopedic surgery with oral or injectable anticoagulants is recommended by national guidelines. A retrospective analysis of medical and pharmacy claims data using the PharMetrics Patient-Centric Database Inc, Watertown, Mass, was conducted. After adjusting for covariates, patients receiving warfarin were approximately 30% more likely to experience a venous thromboembolism than those receiving an injectable anticoagulant (6.3% vs 4.8%; adjusted odds ratio, 1.3; 95% confidence interval, 1.1-1.5) by 30 days. ⋯ No significant differences in the incidence of major bleeding events between the cohorts were observed (incidence of major bleed <0.4%). These findings support the randomized controlled studies and expand the data to the real-world perspective. Clinicians should evaluate these data alongside the clinical trial data when selecting the safest and most effective prophylactic therapy for postdischarge anticoagulation.
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The effect of procedure duration on joint arthroplasty survivorship in the USA is unknown. We examined the association between procedure duration with primary total hip arthroplasty and total knee arthroplasty survivorship at 8 years in the Medicare population using 1997 to 2004 Medicare claims data. Procedure duration was determined using anesthesia time as a proxy. ⋯ Total knee arthroplasty procedures shorter than 90 minutes, between 150 and 180 minutes, and more than 240 minutes had significantly higher revision rates than those lasting 120 to 150 minutes. Total hip arthroplasty procedures lasting more than 240 minutes also had a significantly higher revision risk than those lasting 120 to 150 minutes. Our findings support the general belief that longer procedures are associated with the greater probability of complications.
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We retrospectively reviewed 54 patients (92 hips) who underwent cementless total hip arthroplasty for bony ankylosis in ankylosing spondylitis between September 1988 and 2002. The mean age of the patients was 25.5 years. The mean duration of follow-up was 8.5 years. ⋯ Heterotopic ossification was seen in 12 patients; reankylosis rate was 0%. Thirteen (14%) arthroplasties were revised because of aseptic loosening. Kaplan-Meier survivorship analysis with revision as end point revealed 98.8% survival at 5 years and 85.8% survival at 8.5 years follow-up.
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Randomized Controlled Trial Multicenter Study Comparative Study
Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: winner of the Dorr Award.
The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes study is a prospective, multicenter randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in previously independent patients. Primary outcomes were measured at 6, 12, and 24 months with the Short Form-36 (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Harris Hip Score and the Timed "Up & Go" Test. ⋯ Total hip arthroplasty patients also had superior WOMAC function scores (81.8 +/- 10.2 vs 65.1 +/- 18.1, P = .03). Significant differences in outcomes, without a significantly greater incidence of complications, suggest THA is a valuable treatment option for the active elderly hip fracture population.