David Sochart

Evaluation of patient concerns before total knee and hip arthroplasty

The preoperative concerns of patients undergoing total knee or hip arthroplasty were evaluated in a cross-sectional study of 370 patients. Patients completed a questionnaire on 29 concerns, each rated on a scale of 1 (not concerned) to 4 (very concerned). Short Form 12 and Oxford hip or knee scores were also calculated. The results showed that the greatest concern for patients was cancellation of the surgery. This was followed by failure of the surgery to reduce pain, loss of a limb, and joint infection. Concerns regarding scar problems, nursing care, and preoperative tests were the lowest. Women showed statistically significant greater concerns in 9 areas. Younger patients (age, <65) showed increased concerns in 8 areas. Patients who had previously undergone joint arthroplasty were less concerned than those who had not undergone previous lower limb joint arthroplasty for 6 responses. They showed increased concern in 2 areas, nursing care and hospital food. Those undergoing total hip arthroplasty were more concerned about dislocation, dressing, and returning to work (all, P<.05). This study provides useful information for the preoperative counseling of patients and the production of preoperative literature.

A rare case of arterial avulsion presenting with occult blood loss following total hip arthroplasty: a case report.

IntroductionIatrogenic arterial damage during total hip replacement is a rare but potentially life- or limb-threatening complication. To the best of our knowledge, this is the first reported case of an avulsion injury to a posterior branch of the profunda femoral artery during primary hip arthroplasty.Case presentationWe describe the case of a 55-year-old Caucasian man who underwent a total hip replacement. The patients hemoglobin levels dropped postoperatively, but there was no obvious bleeding, hemodynamic instability, pulsatile mass, or limb ischemia. The patients hemoglobin levels continued to drop despite nine units of transfused blood. Three days after surgery, the patient underwent an angiography that showed an avulsion injury to a posterior branch of the profunda femoral artery. The avulsion was ligated and the hematoma was evacuated.ConclusionVascular damage may present in many ways including obvious bleeding, haemodynamic instability, a pulsatile mass, limb ischemia, and occult blood loss. Any of these signs in isolation or in combination could represent a vascular injury and an urgent angiogram should be considered.

Acute compartment syndrome risk in fracture fixation with regional blocks

Acute compartment syndrome is a surgical emergency that most commonly occurs after trauma or reperfusion after prolonged arterial occlusion. It is caused by a build-up of blood and oedema fluid within a closed muscle compartment, and can be limb and life-threatening. It is therefore imperative that a prompt diagnosis is made. The risk of developing this condition is <1% in patients with distal radius fractures and 4–5% in those with tibial diaphyseal fractures. Pain management is an important aspect of treatment following any fracture. Regional anaesthesia can be used during surgical fixation of the fracture and has the potential to reduce the need for specialist postoperative care and analgesia, as well as to shorten the length of hospitalisation. With this case report, we hope to highlight the potential risk of masking symptoms of compartment syndrome while using regional blocks, as this can cause a delay in diagnosis and treatment, leading to associated complications.

Traumatic Anterior Hip Dislocation in an Adolescent with an Associated Femoral Head âÂÂHill-Sachsâ Type Lesion

Traumatic hip dislocations are uncommon injuries in the paediatric population, requiring urgent reduction to reduce the risk of avascular necrosis. Amongst other associated injuries, fractures of the femoral head, neck or acetabulum can occur. We present the case of a 14 year old boy who sustained a traumatic anterior obturator type hip dislocation with an associated supero-lateral “Hill-Sachs” type indentation osteochondral fracture of the femoral head. He was managed conservatively and by six weeks, was mobilising fully weight bearing unaided. At 17 month follow-up, he remained fully mobile with no complaints. Radiologically, the defect in the femoral head persisted with no evidence of collapse from avascular necrosis. This type of osteochondral fracture associated with hip dislocation has been reported in the adult population, with varying reports of an increased risk of post-traumatic arthritis. The presented case highlights the important role of computed tomography (CT) in assessing these injuries. Furthermore, it brings to light a rare type of injury of the paediatric femoral head that warrants further long-term follow-up studies to determine the associated risk of avascular necrosis, hip instability and post-traumatic arthritis.

Early Periprosthetic Metastasis Following Total Hip Replacement in a Patient With Breast Carcinoma: A Case Report and Review of Literature

Early periprosthetic osteolysis following total hip replacement (THR) as a result of septic etiology has been well understood. Periprosthetic bone loss as a result of metastatic infiltration is an uncommon and infrequent cause of early, progressive loosening of joint replacement prosthesis. Proximal femur has been the most common site of involvement compared to acetabular prosthesis. The rarity of this clinical entity can lead to delay in definitive diagnosis and management, thus affecting the final outcome. Breast is the commonest site of carcinoma in female patients despite which not many cases of periprosthetic metastasis have been reported in the literature. We present the first case of extensive, isolated periacetabular bone destruction following a THR in a 59 years old female patient with a history of breast carcinoma. Patients with known primary malignancy should be screened thoroughly before operation and should be followed regularly after joint replacement surgery to detect any metastatic foci around the prosthesis. Keywords Periprosthetic metastasis; Total hip replacement; Breast carcinoma