Bo Sahlstedt

Thromboembolism after Total Hip Replacement: Role of Epidural and General Anesthesia

The effects of continuous epidural anesthesia and of general anesthesia on the incidence of thromboembolism following total hip replacement were studied. Sixty patients were randomly allotted to one of two groups receiving either epidural or general anesthesia. Epidural anesthesia (N = 30) consisted of 0.5% bupivacaine with epinephrine intraoperatively; for pain relief in the postoperative period (24 h), 0.25% bupivacaine with epinephrine was given every 3 h. General anesthesia (N = 30) consisted of controlled ventilation with N2O-O2 and intravenous fentanyl and pancuronium bromide; postoperatively, narcotic analgesics were given intramuscularly on demand for pain relief. Significantly lower frequencies were found following epidural anesthesia than after general anesthesia in deep venous thrombosis involving the popliteal and femoral veins (13% and 67%, respectively), deep venous thrombosis involving both calf and thigh veins (40% and 77%), and pulmonary embolism (10% and 33%). Possible explanations for these differences include increased circulation in the lower extremities, less tendency for intravascular clotting to occur, and more efficient fibrinolysis in association with continuous epidural anesthesia. The decrease in blood loss associated with epidural anesthesia with lower transfusion requirements also might play a role. Epidural analgesia prolonged into the postoperative period, in addition to other appropriate thromboprophylactic measures, should be of value in patients undergoing operations associated with a high risk of thromboembolic complications.

Comparison of the uncemented Cone and the cemented Bimetric hip prosthesis in young patients with osteoarthritis: An RSA, clinical and radiographic study

Background There is no consensus as to whether uncemented or cemented femoral stems should be used in younger patients. We compared the uncemented Cone stem to the cemented Bimetric stem in young patients with osteoarthritis. Patients and methods We randomized 45 relatively young patients (< 65 years old, mean age 54 years) with osteoarthritis to either an uncemented Cone stem or a cemented Bimetric stem. All patients were followed for 2 years. Outcome was assessed by the Merle d’Aubigné score, conventional radiography and repeated radio-stereometric analysis (RSA). We also followed 81 Cone stems for 8 (7–12) years with revision as endpoint. Results The clinical outcome was excellent. No patient had postoperative thigh pain. The migration was small. The Bimetric stem was stable during the whole observation period, while the Cone stem subsided and rotated to retroversion during the first 3 months post-operatively, and then remained stable. In the follow-up study of 81 Cone stems, 1 stem was revised. Interpretation We conclude that both the cemented Bimetric stem and the uncemented Cone stem are stable and give excellent clinical results after 2 years in relatively young patients with osteoarthritis. Although designed for CDH hips, the Cone stem appears to be suitable also for patients with osteoarthitis. ▪

Arthrography as a Guide in the Treatment of Congenital Clubfoot: Findings and Treatment Results in a Consecutive Series

Simultaneous arthrography of the talocrural and talonavicular joints performed on 32 out of a consecutive series of 48 congenital clubfeet revealed a talar dysplasia that varied considerably both in type and degree.This great variability meant that no simple and practically useful classification could be made on the basis of arthrographic findings. It indicated, further, that the deformation forces varied correspondingly. Each case therefore has to be analysed separately and treated individually.The primary treatment was conservative in all cases, but 28 feet were later operated upon because of unsatisfactory correction or recurrence. the operations varied in extent from lengthening of the tendo Achillis to extensive soft-tissue procedures, in some cases combined with correction osteotomy through the neck of the talus and the calcaneus. the results were relatively good, but the investigation showed that in many cases the talar dysplasia places a definite limit on the achievable result.Arthrography is not ...

Extension Deficit and Lateral Instability in Degenerative Disease of the Knee

During the period October 1975-June 1977, 70 Marmor knee arthroplasties were performed. The operative procedure provided a good opportunity to study the anatomical conditions in vivo. The causes of extension deficit and lateral instability of the knees were analysed in a prospective investigation. Thirty-seven out of 69 knees had an extension deficit exceeding 10 degrees preoperatively. At operation a bony impediment to extension was found in 32 of these 37 knees, and by removal of this obstruction the extension deficit was relieved in 31 of the knees. At radiography a bony impediment was demonstrated preoperatively as a cause of an extension deficit in 29 of the 32 knees. No false positive diagnosis was made radiographyically. Varus or valgus instability exceeding 5 degrees was observed preoperatively in 42 of the the 70 knees. Lateral stability was achieved in all knees at operation by compensating for the intra-articular loss of cartilage and bone with the Marmor module system. Macroscopically intact collateral ligaments were found in all knee joints even in those severely affected by rheumatoid arthritis. All knees except three showed lateral stability 1 year postoperatively.

Effects of Tocainide, an Oral Analogue of Lidocaine, on Thromboembolism after Total Hip Replacement

In an investigation of deep venous thrombosis and pulmonary embolism, where neither dextran nor other antithrombotic drug prophylaxis was employed, 30 patients subjected to total hip replacement under general anaesthesia were randomly allotted to one of two groups. One group (n=15) received tocainide, an oral analogue of lidocaine, as a means of preventing thromboembolism; the other group (n=15) served as a control. In patients given tocainide the frequency of deep venous thrombosis involving the femoral veins, as observed at phlebography, was 60% (9 of 15), and in the control group 73% (11 of 15). The frequency of pulmonary embolism, as determined by pulmonary perfusion lung scanning, was 20% (3 of 15) in the the tocainide group and 33% (5 of 15) in the control group. It was concluded that tocainide administration had no effect as an antithromboembolic agent. Phlebography revealed that the pattern of deep venous thrombosis after total hip replacement was characterized by a high frequency of isolated thigh vein thrombi in the operated leg, probably related to the surgical procedure. A finding of possible clinical significance was that patients given tocainide had a significantly lower intraoperative blood loss than control patients.

A clinical method for measuring the distribution of segmental flexion mobility in the cervico-thoracic spine.

The aim of this study was to evaluate the validity and the repeatability of a new technique to assess segmental flexion mobility in the cervico-thoracic spine between segments C7 and T5. The new technique is referred to as the Cervico-Thoracic-Ratio (the CTR-technique). The radiological evaluation of skin distraction measurements showed that validity was high for the CTR-technique. A high correlation between vertebral flexion mobility and skin distraction was recognized individually and for the whole group. The evaluation of repeatability was found to be high for intratester and fair for intertester repeatability. The CTR-technique may become a valuable complement to other methods for assessing segmental flexion mobility in patients suffering from neck-shoulder pain in clinical practice.