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ABSTRACT: The purpose of this study was to evaluate the effectiveness of a collagen/thrombin and autologous platelet hemostatic agent in preventing blood loss during primary total knee arthroplasty. This prospective, double-blinded, randomized study was designed to enroll a total of 100 patients. Patients were randomized 1:1 to either the treatment arm (standard hemostasis plus study product) or the control arm (standard hemostasis alone). Transfusion requirements, as determined by a blinded investigator using standardized criteria, were significantly lower in the treatment group (no blood transfusions) compared with the control group (5 transfusions; P = .007). These data support the addition of the study product to prevent blood transfusions after primary total knee arthroplasty.
The Journal of arthroplasty 10/2011; 27(5):695-702. · 1.79 Impact Factor
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ABSTRACT: In the study reported here, we analyzed the complications associated with anticoagulation in total joint arthroplasty patients treated for venous thromboembolism (VTE) in the early postoperative period. Twenty-nine consecutive cases from a 1-year period were identified and retrospectively reviewed. VTE treatment, which in most instances (79%) consisted of a heparin drip, was begun a mean of 2.3 days after surgery. Patients received a mean (SD) of 4.4 (5.0) units of packed red blood cells. There were no differences in bleeding parameters with respect to timing of initiation of anticoagulation. Local and systemic bleeding complications were common. The proportion of patients who were transfused was significantly (P<.0001) higher for VTE patients than for control patients, and transfused VTE patients received significantly (P = .0004) more blood products. In total joint arthroplasty patients, VTE treatment began 2.3 days after surgery and had a high incidence of complications related to bleeding.
American journal of orthopedics (Belle Mead, N.J.) 08/2011; 40(8):E148-51.
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ABSTRACT: Thromboembolic disease is a common complication of total hip arthroplasty. The purpose of this study was to compare a new mobile compression device with low-molecular-weight heparin with regard to their safety and effectiveness for the prevention of venous thromboembolic disease.
Patients who had a total hip arthroplasty were randomized to receive prophylaxis with a mobile compression device or low-molecular-weight heparin for ten days. Use of the compression device began intraoperatively, and the patients in this group could receive 81 mg of aspirin daily after the surgery. The first injection of the low-molecular-weight heparin began between twelve and twenty-four hours after the surgery. After ten to twelve days, all patients underwent bilateral lower-extremity duplex ultrasonography to screen for deep venous thrombi in the calf and thigh. Any clinical symptoms of pulmonary embolism were evaluated with spiral computed tomography lung scans. Bleeding events and utilization of (i.e., compliance with) prophylactic treatment in both groups were documented. Clinical evaluation to look for evidence of deep venous thrombi and pulmonary emboli was performed at twelve weeks postoperatively.
Four hundred and ten patients (414 hips) were randomized; 392 of these patients (395 of the hips) were evaluable with regard to the safety of the intervention and 386 patients (389 hips) were evaluable with regard to its efficacy. Demographics were similar clinically between the groups. The rate of major bleeding events was 0% in the compression group and 6% in the low-molecular-weight heparin group. The rates of distal and proximal deep venous thrombosis were 3% and 2%, respectively, in the compression group compared with 3% and 1% in the heparin group. The rates of pulmonary embolism were 1% in the compression group and 1% in the heparin group, and there were no fatal pulmonary emboli. Within the twelve-week follow-up period, two events (one deep venous thrombosis and one pulmonary embolus) occurred in one patient in the compression group following negative findings on duplex ultrasonography on the twelfth postoperative day. There was no difference between the groups with regard to the prevalence of venous thromboembolism.
When compared with low-molecular-weight heparin, use of the mobile compression device for prophylaxis against venous thromboembolic events following total hip arthroplasty resulted in a significant decrease in major bleeding events.
The Journal of Bone and Joint Surgery 03/2010; 92(3):527-35. · 3.27 Impact Factor
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ABSTRACT: Tapered cementless femoral fixation provides a reliable option for routine primary total hip arthroplasty (THA). The use of hydroxyapatite (HA)-coated stems is increasing as a result of mounting evidence that HA may improve the reliability of bone osseointegration and improve overall THA outcomes. These trends are based on a growing body of literature that supports both the theoretical and clinical rationale of this approach. There is solid clinical evidence that the combination of tapered geometry with an HA coating increases the likelihood of reliable femoral fixation. A comprehensive review of this literature evaluating the clinical use of cementless femoral components that use an HA coating is presented, and reveals that HA-coated stems have significantly improved proximal femoral fixation with less stress shielding and superior osseous remodeling. Although these advantages have not been shown to significantly increase long-term durability, there is sufficient data to support the routine use of HA-coated, tapered cementless femoral stems in THA.
The Journal of Arthroplasty 07/2007; 22(4 Suppl 1):71-4. · 2.38 Impact Factor
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ABSTRACT: The dislocating hip is functionally impairing and leads to patient dissatisfaction. The etiology is multifactorial and may include component malpositioning, soft tissue laxity, and component or anatomical impingement. Initial treatment of dislocation usually consists of closed reduction followed by the use of an abduction pillow or brace or a knee immobilizer, although evidence to support these actions is limited. Operative intervention is generally reserved for patients with more than 2 dislocations and should aim to correct the cause of dislocation using a simple algorithm. Proper component positioning is key to prevention of further dislocation, but other tools include modular implants, jumbo heads, and increased offset. Finally, constrained acetabular components may be considered if a patient fails one of the above surgical options.
The Journal of Arthroplasty 07/2007; 22(4 Suppl 1):86-90. · 2.38 Impact Factor
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ABSTRACT: The performance of, and periprosthetic bone response to, a tapered, titanium (Ti6Al4V), hydroxyapatite-coated femoral hip prosthesis was evaluated at minimum of 10 years of follow-up. Data were prospectively collected on 147 consecutive primary hip arthroplasties performed in 133 patients by a single surgeon during a 2-year interval. Clinical and radiographic analyses of 96 hips in 86 patients were independently performed by 2 surgeons who were not involved in the care of these patients. There were no cases of aseptic loosening of the femoral component. Subsidence and stress shielding occurred in 5% and 2% of cases, respectively, and was not clinically significant. In all 15 hips that required revision of the acetabular component, the femoral component was found to be well fixed, without any occurrence of distal osteolysis. This femoral design provided reliable osseointegration that was durable at a mean of 11.5 years of follow-up.
The Journal of Arthroplasty 02/2007; 22(1):1-7. · 2.38 Impact Factor
