The relationship of the factor V Leiden mutation or the deletion-deletion polymorphism of the angiotensin converting enzyme to postoperative thromboembolic events following total joint arthroplasty

BACKGROUND: Although all patients undergoing total joint arthroplasty are subjected to similar risk factors that predispose to thromboembolism, only a subset of patients develop this complication. The objective of this study was to determine whether a specific genetic profile is associated with a higher risk of developing a postoperative thromboembolic complication. Specifically, we examined if the Factor V Leiden (FVL) mutation or the deletion polymorphism of the angiotensin-converting enzyme (ACE) gene increased a patient's risk for postoperative thromboembolic events. The FVL mutation has been associated with an increased risk of idiopathic thromboembolism and the deletion polymorphism of the ACE gene has been associated with increased vascular tone, attenuated fibrinolysis and increased platelet aggregation. METHODS: The presence of these genetic profiles was determined for 38 patients who had a postoperative symptomatic pulmonary embolus or proximal deep venous thrombosis and 241 control patients without thrombosis using molecular biological techniques. RESULTS: The Factor V Leiden mutation was present in none of the 38 experimental patients and in 3% or 8 of the 241 controls (p = 0.26). Similarly there was no difference detected in the distribution of polymorphisms for the ACE gene with the deletion-deletion genotype present in 36% or 13 of the 38 experimental patients and in 31% or 74 of the 241 controls (p = 0.32). CONCLUSIONS: Our results suggest that neither of these potentially hypercoaguable states are associated with an increased risk of symptomatic thromboembolic events following total hip or knee arthroplasty in patients receiving pharmacological thromboprophylaxis

A Modified Technique for the Treatment of Severe Adolescent Hallux Valgus: A Modification of the First Metatarsal Double Osteotomy

Adolescent hallux valgus is a deformity of childhood that is often difficult to treat conservatively because of its progressive nature and surgically because of its high risk of complications. Despite numerous procedures described, there is still little consensus on the best technique available for deformity correction. One of the standard procedures to address severe adult hallux valgus was described by Peterson and Newman in 1993. This procedure involved an excision of the medial eminence, an extra-articular distal closing wedge osteotomy to correct the hallux valgus, and a proximal transverse opening wedge osteotomy to correct the metatarsus primus varus. Although good outcomes have been reported, this approach is not without its own complications, including first metatarsophalangeal joint stiffness, avascular necrosis of the first metatarsal head, and painful pin removal. This paper presents a modification to the first metatarsal double osteotomy surgical technique (used by the principal investigator) to address severe adolescent hallux valgus. This technique avoids the complications associated with the traditional Peterson double osteotomy technique, whereas optimizing patient outcomes.Level of EvidenceLevel IV—Technique paper/case series with no control group. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence