Hip international : the journal of clinical and experimental research on hip pathology and therapy
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Infection is a devastating complication of total hip arthroplasty (THA). Risk factors have been recognised and prevention is possible. ⋯ Available data in the current literature is of poor quality and there is a lack of data comparing different techniques. Referral of patients to dedicated departments with the appropriate facilities may be more appropriate.
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Total hip arthroplasty (THA) can be challenging in Jehovah's Witnesses because of the potential for blood loss. Because these patients will not accept blood transfusions, multiple strategies to prevent blood loss have been developed. The purpose of this study was to report implant survivorship, clinical outcomes, radiographic outcomes, morbidity, and mortality of Jehovah's Witnesses undergoing primary THA. ⋯ Excellent clinical outcomes were found for Jehovah's Witness undergoing total hip arthroplasty using a comprehensive blood management protocol. We believe that the use of a specialised blood management protocol involving a team approach to preoperative evaluation, appropriate anaesthesia, and surgical and postoperative management was responsible for minimising complications. Total hip arthroplasty is safe and efficacious in this patient group if proper preoperative safeguards are utilised.
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Randomized Controlled Trial
Single tranexamic acid dose to reduce perioperative morbidity in primary total hip replacement: a randomised clinical trial.
Although prophylactic tranexamic acid (TXA) is a safe, low-cost option to reduce bleeding in patients undergoing total hip replacement (THR), its optimal dose and duration is unknown. We compared the safety and effectiveness of TXA given as either a single injection or continuous infusion in THR patients, hypothesising that a second TXA dose would not offer any clinical advantages over the single injection. ⋯ The 30 mg/kg TXA single shot was as safe as continuous infusion. As it is also less cumbersome, we recommend it as part of routine care in THR patients.
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In total hip replacement surgeons can choose from a various number of approaches, from posterior, lateral or direct anterior. Excellent results can be achieved with all approaches and there is no evidence for the use of a specific approach. Minimally invasive operating techniques might further contribute to that success. Early rehabilitation and functional outcome can be improved by the introduction of evidence based clinical pathways irrespective to the used approach.
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Total hip replacement is the treatment of choice for the patient suffering from end-stage hip osteoarthritis. Excellent long-term results have been published. In the presence of deformities due to congenital hip dislocation, total hip replacement is, in most of the cases, a difficult task, since the technique of performing such an operation is demanding and the results could vary. This paper presents our experience and preferred strategies focusing on challenges and surgical techniques associated with reconstructing the dysplastic hip.