The Journal of arthroplasty
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Of 263 patients who underwent total knee arthroplasty, 122 received adjusted low-dose warfarin and 141 received enoxaparin as deep vein thrombosis (DVT) prophylaxis. Three patients in the warfarin group and 3 in the enoxaparin group developed ultrasound-detectable DVT (P > .05). ⋯ Our data support earlier published reports suggesting that reductions, if any, in the incidence of DVT associated with enoxaparin are offset by a significant increase in bleeding complications as compared with adjusted-dose warfarin. We continue to use adjusted-dose warfarin as primary thromboembolic prophylaxis after total knee arthroplasty.
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The results of total hip arthroplasty in a group of patients with ankylosing spondylitis are described. Ninety-five arthroplasties were performed in 56 men and 2 women whose average age at operation was 38.9 years (standard deviation [SD], 11.6; range, 19.2-78.8). They were followed for an average of 135.4 months (SD, 81.6; range, 24.4-331.2). ⋯ Two of 3 dislocations were anterior dislocations. Nineteen arthroplasties were revised at an average of 162.0 months (SD, 49.6; range, 55.1-250.5) after the primary surgery; 9 of them had only the acetabular component revised because of aseptic loosening. Hyperextension of the hips is a common phenomenon that can lead to surgical error and predispose the prosthesis to anterior dislocation.
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Bone allografts were morcellized using 2 different milling machines (Tracer milling machine and Howex milling machine) producing bone chips with different ranges of sizes. In an in vitro model, each type of bone-graft was impacted with 2 different impaction forces. As the impaction force was released, there was a substantial and rapid recoil of the graft bed. ⋯ Most of the recoil occurred within the first 10 seconds. Using another similar in vitro model, the same 2 kinds of chips were impacted with 2 different impaction forces, and the subsidence of the 4 different graft beds was measured. There was less subsidence with the bigger type of bone chips and less with the harder impacted graft beds.
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We retrospectively reviewed all consecutive unilateral primary total hip arthroplasty (THA) procedures performed by 3 attending surgeons on the Arthroplasty Service at our institution from January 1, 1990, to December 31, 1993. All surgery was performed under a specific hypotensive epidural anesthesia protocol. Hypotensive epidural anesthesia at our institution provides a lower level of hypotension (mean arterial pressure of 50-60 mmHg) as compared to hypotensive anesthesia used more generally around the world (mean arterial pressure >70 mmHg). ⋯ Of the 11 patients with a late symptomatic PE, 10 had venograms in the hospital, and all 10 were negative for DVT. Overall, in the patients with a positive venogram, the incidence of symptomatic PE was 1.4% (3 of 210), whereas in the patients with a negative venogram, the incidence of symptomatic PE was 0.44% (8 of 1,827). At our institution, patients who undergo primary THA performed with hypotensive epidural anesthesia, postoperative aspirin, antithromboembolic disease stockings, and early ambulation have a low risk for thromboembolic disease.
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To determine the factors influencing surgeons' choice of implants for total hip arthroplasty (THA) and total knee arthroplasty (TKA), 650 surveys were mailed to all active members of the American Association of Hip and Knee Surgeons practicing in the United States; 364 surveys (56%) were completed and returned. Analysis revealed that the average number of total hip and total knee replacements performed by the respondents in 1997 was 81 and 97; there was substantial regional variation. The average number of hip implant and knee implant brands used by these surgeons in 1997 was 2.4 and 1.8. ⋯ Orthopaedic surgeons perceive that they are losing control of implant choice in THA and TKA. Cost of implants is one of the most significant factors influencing which implant is chosen. Patients (the true payors), however, overwhelmingly want their surgeons to choose the implant used at surgery, and they want quality, not cost, to be the primary determinant of this decision.