Venous thromboembolism in orthopedic surgery: Global guidelines

Venous thromboembolism (VTE) is a severe complication that can occur after major orthopedic procedures. As VTE-related morbidity and mortality are a significant concern for both medical professionals and patients, and preventative measures are typically employed. Multiple organizations, including the American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS), have developed guidelines for VTE prophylaxis specifically in patients undergoing joint replacement procedures. However, recently, the International Consensus Meeting (ICM) was convened, which brought together over 600 experts from 68 countries and 135 international societies. These experts, spanning a range of medical disciplines including orthopedic surgery, anesthesia, cardiology, hematology, vascular, and internal medicine, conducted a comprehensive review of the literature using a strict Delphi process to generate practical recommendations for VTE prophylaxis across all types of orthopedic procedures. This review article summarizes some of the recommendations of the ICM

Patient Demographics and Reported Outcomes in Funded versus Non-funded Studies Assessing Thromboprophylaxis after Total Joint Arthroplasty: A Systematic Review

Background: There are numerous studies discussing thromboprophylaxis after total joint arthroplasty (TJA), which have varying conclusions. The purpose of this study was to investigate if industry funding of the study impacted patient demographics and overall reported outcomes of studies evaluating venous thromboembolism (VTE) prophylaxis after TJA. Methods: Electronic searches were completed for Ovid, PubMed, and Embase. Studies were included if: (1) published in the English language between 2000 and 2016 (2) including patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) (3) evaluating prevention and control of VTE with at least one thromboprophylactic agent. Results: There were 57 studies included in this systematic review. There was no overall drug effect between reporting outcomes, patient demographics, and level of funding. There were no significant differences between patient age, BMI, or revision exclusions between funded and non-funded studies. However, funded studies reported less pulmonary embolisms (PE) compared to non-funded studies. Funded studies also reported fewer events of major bleeding and less 90-day mortality than non-funded studies. Conclusion: It appears that the reported outcome of studies evaluating a drug as prophylaxis against VTE differs depending on the status of funding. Studies funded by industry report better outcome with less PE, less major bleeding, and less mortality compared to non-funded studies

Bilateral Femoroacetabular Impingement: The Fate of the Asymptomatic Hip

Introduction: The objective of this study was to evaluate the incidence of bilateral femoroacetabular impingement (FAI) in a consecutive group of patients and to evaluate the fate of the asymptomatic hip with FAI. Method: Between 2004 to 2016, 652 patients presented with hip pain arising from underlying FAI. Diagnosis of FAI was made based on clinical symptoms and imaging. 557 patients (646 hips) were included for the final analysis. Of these, 170 patients had bilateral radiological diagnosis of FAI. Of these, 88 patients presented with bilateral hip symptoms. The remaining 82 patients had unilateral hip symptoms. Of these 82 patients, 8 patients decided to have surgery on both hips under the same anesthesia. The remaining 74 patients decided to have the contralateral asymptomatic hip with FAI observed. Results: Of the cohort with bilateral FAI and an asymptomatic hip, 60 patients became symptomatic at an average 2.1 years follow-up. Of these 60 patients 43 patients needed surgical intervention. Binary logistic regression model identified that reduced neck shaft angle, increased lateral CE angle and increased alpha angle, younger age as predictors for developing symptoms in the contralateral hip. Discussion: Based on this study it appears that the incidence of bilateral FAI is common. The majority of patients with unilateral symptomatic FAI and radiographic evidence of bilateral FAI become symptomatic relatively quickly and require surgical intervention in the contralateral hip

Is intraoperative bleeding control useful after tourniquet release in arthroscopic anterior cruciate ligament reconstruction?

BackgroundArthroscopic anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery, and rehabilitation is very important to achieve successful postoperative results. Postoperative hemarthrosis causes pain and limitation of movement, which prolongs the rehabilitation period. For these reasons, various strategies are used to reduce hemarthrosis in patients undergoing ACL reconstruction. This study aimed to evaluate the effect of bleeding control after releasing the tourniquet in ACL reconstruction surgery on the amount of hemarthrosis and pain in the postoperative period.MethodologyA total of 60 patients who underwent arthroscopic single-bundle ACL reconstruction were enrolled in this prospective randomized control study. Bleeding control with the radiofrequency (RF) probe after releasing the tourniquet was done at the end of the arthroscopic ACL reconstruction in 30 patients (coagulation group) while bleeding control was not done for the other 30 patients (control group). Both groups were compared in terms of the degree of hemarthrosis using the Coupens and Yates classification in the early postoperative period and the degree of pain using the Visual Analog Scale (VAS) score and postoperative complications.ResultsIn both groups, isolated ACL reconstruction was performed in 10 patients, additional partial meniscectomy in three patients, and additional arthroscopic meniscus repair in 17 patients. There was no statistically significant difference between the coagulation and control groups in terms of VAS (p > 0.05) and the degree of hemarthrosis (p > 0.05). Although the duration of tourniquet application was similar in both groups (p = 0.78), the duration of anesthesia was significantly longer in the coagulation group (p = 0.001). There was no significant difference between the groups in terms of postoperative complications.ConclusionsBleeding control with the RF probe after tourniquet release does not yield superior outcomes. More research with larger populations is needed to confirm these findings

Venous Thromboembolism in Orthopedic Surgery: Global Guidelines

Venous thromboembolism (VTE) is a severe complication that can occur after major orthopedic procedures. As VTE-related morbidity and mortality are a significant concern for both medical professionals and patients, and preventative measures are typically employed. Multiple organizations, including the American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS), have developed guidelines for VTE prophylaxis specifically in patients undergoing joint replacement procedures. However, recently, the International Consensus Meeting (ICM) was convened, which brought together over 600 experts from 68 countries and 135 international societies. These experts, spanning a range of medical disciplines including orthopedic surgery, anesthesia, cardiology, hematology, vascular, and internal medicine, conducted a comprehensive review of the literature using a strict Delphi process to generate practical recommendations for VTE prophylaxis across all types of orthopedic procedures. This review article summarizes some of the recommendations of the ICM

Cementless modular total hip arthroplasty with subtrochanteric transverse shortening osteotomy for high hip dislocations

Background: Performing a total hip arthroplasty for a high hip dislocation is technically demanding and presents several challenges, with appropriate evaluation of the bone morphology of the hip and proper implant selection being critical for successful outcomes. Objective: The purpose of our study was to evaluate the clinical and radiographic outcomes of cementless modular total hip arthroplasty for the treatment of high hip dislocations with sub-trochanteric transverse shortening osteotomy. Methods: Sixty-eight hips with a high hip dislocation, were treated using a sub-trochanteric transverse shortening osteotomy and cementless modular total hip arthroplasty, retrospectively reviewed. Hip function was assessed using the Harris hip score, with hip abduction strength evaluated using the Trendelenburg test. Radiographic assessment included the measurement of leg length discrepancy, identification of implant loosening, localization of the hip center, and union at the osteotomy site. Results: The mean follow-up period was 12.9 (range 5.2–16.8) years. The mean Harris hip score improved from a pre-operative score of 48.6 ± 3.6 to 82.4 ± 4.2 (p < 0.05). The hip was within the true acetabulum in all patients, postoperatively. Osteotomy union was achieved in 67 of the 68 hips (98.5%) in a mean latency of 12.5 ± 0.6 weeks. The mean length of femoral shortening was 66.5 ± 4.5 mm, with a mean pull-down length of the proximal part of 35.5 ± 3.5 mm. Conclusion: For the treatment of high hip dislocations with satisfactory clinical outcomes, the modular stem offers an adjustable anteversion angle to restore sufficient rotational stability and the transverse osteotomy provides sufficient compression pressure across the osteotomy site to facilitate union. Trial registration It was a retrospective study and approved by Istanbul Research and Training Hospital institutional Ethics Review Board (772-05/02/2016)

Tricuspid Valve Repair

For the previous years, the tricuspid valve (TV), has been studied relatively less than the other heart valves diseases both about pathophysiology, management, surgical intervention, and treatment. However, recent advances in assessment and management of the TV disease have led to redirect the interest in this “forgotten valve.” Surgeons often had believed that quick solutions for the left ventricle problems would also improve the secondary tricuspid regurgitation (STR). Every active surgeon has been preferred this quick solution in his whole surgery life many times. Medical treatment options aims to improve the underlying disease and the right ventricle failure. TV surgery have proven to yield good outcomes in surgery indicated patients. For patients who are not available for surgery, trans catheter intervention may be an alternative. Due to limited data, the best surgical techniques are still in question, with no clear answer, particularly for STR. Key factor in determining prognosis, timing for intervention and longer-term outcome is the right ventricular function at the time of prognosis

Comparison of results of conservative method and plate fixation method for the treatment of Ruedi/allgower type 1 Pilon fractures

The aim of this study was to compare the results of cast application and plate fixation in the management of Ruedi/Allgower type I Pilon fracturesPatients and methods: Forty-two patients (24 females, 18 males) with Ruedi/Allgower type I Pilon fractures were retrospectively reviewed. Sixteen patients (Group 1) (10 females, 6 males; mean age 43 years; range 18-56) had been treated with cast application and 26 patients (Group 2) (14 females, 12 males; mean age 37.7 years; range 19-52) had been treated with plate fixation. All patients were diagnosed with X-ray. Radiologic examinations were made using Ovadia and Beal’s criteria. Long term functional results of foot and ankle were evaluated according to the Tenny and Wiss citeria. The mean follow-up period was 28 months (range 12-44) in Group 1 and 31 months (range 16-46) in Group 2.Results: Mean reduction quality score was 12 points in Group 1, and 10 points in Group 2. The difference between the groups was statistically significant (p<0.05). Mean long term functional results of foot and ankle scored 84 and 86 in Group 1, and Group 2, respectively (p>0.05). Time to union was not different between both groups (p>0.05).Conclusion: Although the quality of reduction obtained with cast application was not as satisfactory as plate fixation; good results could be obtained in both groups regarding long term functions