scholarly journals Unstable total hip replacement: why? Clinical and radiological aspects

2020 ◽  
Vol 30 (2_suppl) ◽  
pp. 37-41
Author(s):  
Loris Perticarini ◽  
Stefano M P Rossi ◽  
Francesco Benazzo
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Major Complication ◽  
The United States ◽  
Hip Surgery ◽  
Joint Disease ◽  
Radiographic Evaluation ◽  
Related Factors ◽  
Total Hip ◽  
Surgeon Experience

Introduction: Dislocation after total hip arthroplasty (THA) is the most common cause of revision hip surgery in the United States, ahead of aseptic loosening and infection, and is responsible for considerable economic cost related to frequent readmission and/or revision surgery. The aim of this article is to identify the clinical and radiological factors related to the unstable total hip replacement. Methods: We performed a literature search to assess current strategies to define clinical and radiological characteristics of dislocation after primary THA using the PubMed platform. The characteristics related to THA instability were divided into patient related factors, implant related factors and surgeon experience. Results: Patient-related factors for instability identified are: age; inflammatory joint disease; prior hip surgery; preoperative diagnosis; comorbidity; ASA score; presence of spino-pelvic abnormality; and neurological disability. Gender, simultaneous bilateral THA and restrictive postoperative precautions do not influence rate of THA dislocation. Implant related factors identified are: surgical approach; component malposition; femoral head size; and the use of dual-mobility or constrained solution. Surgeon experience also reduces the rate of dislocation. Discussion: Dislocation is a major complication of THAs, and causes include patient-derived factors, surgical factors, or both. It is imperative to determine the cause of the instability via a complete patient and radiographic evaluation and to adjust the reconstruction strategy accordingly.

Heparin and Factor XaI Levels in Patients Undergoing Hip Surgery

1975 ◽  
Author(s):  
Duncan P. Thomas ◽  
S. Sagar ◽  
V. V. Kakkar
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Subsequent Development ◽  
Hip Surgery ◽  
Factor X ◽  
Preoperative Level ◽  
Total Hip ◽  
Vein Thrombosis ◽  
The Mean ◽  
Plasma Heparin

Plasma heparin and activated Factor X inhibitor (Xal) levels were measured in 25 patients undergoing total hip replacement. Blood samples were taken before, during and for 5 days after operation. In patients receiving heparin prophylaxis, over 50% of samples taken four hours after a subcutaneous injection of 5,000 units had no detectable plasma heparin; in none of the remaining samples did the level exceed 0.04 units per ml. In patients who developed deep vein thrombosis (DVT) postoperatively, as detected by 125-I-labelled fibrinogen and confirmed by venography, the mean preoperative level of Factor XaI was 73.5% (S. E. M.±6.9). In those patients who did not develop DVT, the mean preoperative level was 101.5% (S. E.M.±4.3) (P > 0.01).It is concluded that a regimen of 5,000 units 8-hour’ly does not give sustained plasma heparin levels after total hip replacement, which may in part explain the reduced effectiveness of low-dose heparin in preventing DVT in patients undergoing hip surgery. Low levels of Factor XaI in the immediate preoperative period correlated well with the subsequent development of thrombosis in these patients.

scholarly journals Antibiotic Dispensing Before and After Primary and Revision Total Hip Replacement: An Australian Orthopaedic Association National Joint Replacement Registry Linkage Study

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Aarti Gulyani ◽  
Richard De Steiger ◽  
Paul Smith ◽  
Nicole Pratt ◽  
Katherine Duszynski ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Joint Replacement ◽  
Hip Replacement ◽  
Major Complication ◽  
Antibiotic Use ◽  
Suppressive Therapy ◽  
Total Hip ◽  
Post Surgery ◽  
Number Of Patients ◽  
Before And After

IntroductionInfection is a major complication following joint replacement (JR) surgery. However, little data exist on baseline use of antibiotics following primary JR and how use changes with subsequent revision surgery. Objectives & ApproachOur study objectives were to describe community use of antibiotics before and after primary total hip replacement (THR) and change in use pre and post revision procedure. Registry data were linked with national medication dispensing data using probabilistic record linkage. Patients with THR for osteoarthritis in a private hospital between 1999 and 2017 were included. Three groups were analysed: patients with primary procedures revised for infection, revised for non-infection reasons and those not revised. Rate of antibiotic dispensing/month was calculated as number of patients dispensed at least one antibiotic in a given month divided by number of patients at-risk. ResultsThere were 102,577 patients included in the non-revised group, 3,156 revised for non-infection and 520 revised for infection. Prior to primary THR, baseline antibiotic dispensing rate was 9-11%/month in all groups. Post-primary rates were similar (10-11%) for non-revised and revised non-infection patients but higher (16-17%) for revised-infection patients. In 1, 6 and 12 months preceding revision for infection, antibiotic use was 55%, 27% and 22%, respectively. For patients revised for non-infection, antibiotic use was 21%, 14%, 13%, respectively. One-month following revision for infection, 82% of patients were dispensed antibiotics, remaining high (38%) at 6-months and 28% at 12-months. In the revision non-infection group, antibiotic use was 48% first month post-surgery, reducing rapidly to 15% at 6-months. Conclusion / ImplicationsNon-revision and revision non-infection patients had similar antibiotic dispensing before and after surgery. Revision infection patients however, maintained higher antibiotic dispensing post-primary, pre and post revision. This may reflect either ongoing infection, need for long-term suppressive therapy or reluctance of treating physicians to terminate treatment.

Coagulation Activation Markers in the Prediction of Venous Thrombosis after Elective Hip Surgery

1997 ◽  
Vol 77 (02) ◽  
pp. 267-269 ◽  
Author(s):  
E Cofrancesco ◽  
M Cortellaro ◽  
A Corradi ◽  
F Ravasi ◽  
F Bertocchi
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
International Study ◽  
Hip Surgery ◽  
Coagulation Activation ◽  
Activation Markers ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

Summary Background. Despite prophylaxis, deep vein thrombosis (DVT) after hip surgery continues to occur frequently. Thus it would be helpful if before surgery patients at higher risk of DVT could be identified and more adequate prophylaxis given. As part of an international study on the prevention of DVT after total hip replacement, we investigated whether preoperative levels of three coagulation activation markers, prothrombin fragment F1+2 (F1+2), thrombin-antithrombin III complexes (TAT) and D-dimer, correlate with results of postoperative venography. Methods. 159 patients undergoing total hip replacement were randomized to receive 10, 15 or 20 mg desirudin bid or 5000 IU unfractionated heparin tid immediately before surgery and then for 11 days, until bilateral venography was performed. Preoperative F1+2, TAT and D-dimer plasma levels were measured using ELISA procedures. As no difference among anticoagulant treatments or in the interaction between treatments and DVT was detected for any of the three variables, results are reported as pooled data. Findings. The frequency of DVT was 18.8% in the low (0.75-1.33 nM) vs 65.7% in the high third of distribution (1.77-3.47 nM) of F1+2 (p ˂.001), 27.3% in the low (2.00-2.50 μg/1) vs 57% in the high third (5.10-61.00 μg/l) of TAT (p = .042), and 29.4% in the low (39-59 μg/1) vs 57.1% in the high third (129-651 μg/1) of D-dimer (p = .051). Interpretation. Preoperative F1+2, TAT and D-dimer levels are associated with the risk of development of DVT after total hip replacement.

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