Remzi Tozun

Indomethacin for prevention of heterotopic ossification after total hip arthroplasty

Twenty-four patients (29 hips) undergoing total hip arthroplasty were routinely given 75 mg of indomethacin daily for 4 weeks after operation and reviewed radiographically for heterotopic ossification (HO) for a minimum of 6 months. A comparison group of 25 patients (27 hips) without indomethacin treatment was formed and studied in the same manner. This group of patients received the usual postoperative analgesic treatment, which is diclofenac sodium twice daily parenterally for 5-10 days. The indomethacin group also received the same treatment. In the indomethacin group no patient had grade II, III, and grade IV HO and the incidence of grade I HO was 31% (nine patients). In the comparison group one patient (3%) had grade I, three (11%) grade II, and eight (30%) grade III HO. These findings suggested that indomethacin effectively prevented higher grades of HO following total hip arthroplasty. Two patients not included in the study had gastrointestinal bleeding and recovered after withdrawal of the drug.

Delayed Acute Sciatic Nerve Palsy as a Complication of Bridging Chemothromboprophylaxis Following Hip Hemiarthroplasty

Sciatic nerve palsy is a recognized complication of hip arthroplasty1,2. The prevalence is low, ranging from 0% to 3.7%1. Delayed-onset acute sciatic nerve palsy due to hematoma formation is rarely seen. Recently, with the increased use of strong anticoagulants for thromboprophylaxis, an increase in the prevalence of sciatic nerve palsy secondary to local hematoma formation has been reported3. We report the case of a patient who developed complete sciatic nerve palsy over the course of a few hours on the fifth day after hip arthroplasty as a result of local bleeding secondary to bridging chemoprophylaxis with use of low-molecular-weight heparin. The patient discussed in this report was informed that data concerning her case were to be submitted for publication, and she provided consent. A seventy-year-old woman presented to our emergency department with a right intertrochanteric hip fracture. The orthopaedic examination revealed external rotation posture of the lower extremity, painful and limited range of motion of the right hip, and weakness on the right side of the body. The patient had a height of 1.65 m (65 in) and a weight of 70 kg (154 lb). Medical conditions included atrial fibrillation, mild hypertension, and cerebrovascular embolism. The patient had been followed by a cardiologist for three years because of a history of thromboembolism and was taking Coumadin (warfarin), amlodipine besylate, and metoprolol succinate. She was not taking any other antithrombotic medications, such as aspirin or clopidogrel, for the treatment of vascular disease. The preoperative neurological examination revealed weakness of the right upper and lower extremities. The international normalized ratio was 2.23. The Coumadin was stopped, and low-molecular-weight heparin (enoxaparin sodium, 60 mg; two times per day) was started, as recommended by the consulting cardiologist. When the international normalized ratio was decreased to 1.55 …

Dual-mobility bearings for patients with abductor-trochanteric complex insufficiency

Introduction: The purpose of this study was to summarise the performance of dual-mobility cup systems for revision total hip arthroplasty in patients with abductor-trochanteric complex deficiency. Methods: We prospectively followed 17 patients (20 hips) with a mean age of 64.5 years (range 33-89 years) who underwent acetabular reconstruction with dual-mobility cups for aseptic loosening in 12 hips, infection treatment as second or single stage in 6 hips, and instability in 2 hips. All of the patients had abductor insufficiency. We evaluated the clinical Harris Hip scores (HHS) and radiographs for migration, loosening, and osteolysis. The survival of the components was calculated according to Kaplan-Meier survivorship analysis, and failure was defined as any dislocation, acetabular component or total hip revision for any reason. Results: The mean duration of follow-up was 38.1 months (range 24-98 months). There were 2 (12.5%) revisions for cemented cup migration after 11 months and 19 months respectively. There were no dislocations. At the last follow-up, the mean HHS increased from 42 points preoperatively to 86 points. The cumulative survival rate of the dual-mobility cup system was 93% (95% confidence interval 88-98.7%) at 5 years, with any revision as the end point. Conclusion: Dual-mobility cups may provide excellent stability in patients with abductor-trochanteric complex insufficiency.

Total Hip Arthroplasty in Patients with Hemophilia

The most common clinical manifestation of hemophilia is arthropathy secondary to repeated intra-articular bleeding and chronic synovitis. In patients with hemophilia, 80–85% of the bleeds occur into the joints [1, 2]. The articular bleeding can cause synovial hypertrophy, and a vicious circle of chronic synovitis develops with rebleeding. The blood in the joint makes the synovial tissue become catabolically active, and inhibits synthesis of the cartilage matrix. The blood has also a direct harmful effect on cartilage irrespective of the synovial changes [3]. The articular problems in patients with hemophilia begin in the early years of life. If untreated, this condition is followed by degenerative changes, and a stiff or painful joint will result. Hemophilic arthropathy is a disabling condition that may cause chronic pain and immobilization, and impair the quality of life of the hemophiliac patient. Prophylactic therapy can slow the natural course of hemophilic arthropathy. However, due to its excessive cost, prophylaxis is only possible in a small proportion of patients with hemophilia.