Hip Function Was Not Associated with the Incidence of Preoperative Deep Vein Thrombosis in Patients Undergoing Primary Total Hip Arthroplasty

The prevalence of preoperative deep vein thrombosis (DVT) has been reported to be relatively high in patients undergoing total hip arthroplasty. We investigated the prevalence of DVT, the association between hip function and preoperative DVT, and the effect of a history of surgery in patients who underwent primary total hip arthroplasty. We retrospectively analyzed the cases of the patients who underwent primary total hip arthroplasty between April 2013 and February 2020 at our institution. We evaluated the prevalence of preoperative DVT based on the results of the patients’ ultrasound screening. We performed univariate and multivariate analyses to investigate the association between the incidence of DVT and patient factors including age, sex, hip function, medical histories, and American Society of Anesthesiologists Physical Status classification. We analyzed 451 patients (494 hips). The prevalence of DVT was 14.2% (64 patients). The multivariate analysis demonstrated that increased age was an independent significant risk factor for DVT. The prevalence of preoperative DVT was relatively high among patients who underwent primary total hip arthroplasty. Preoperative DVT tended to be more prevalent in older patients. Hip function was not associated with the incidence of DVT

Unexpected dislocation following accurate total hip arthroplasty caused by excessive hip joint laxity during myasthenic crisis: a case report

[Background] Dislocation following total hip arthroplasty is mainly caused by malposition. However, the coexistence of neuromuscular disorders is also considered a risk for dislocation due to excessive hip joint laxity. To minimize risk of dislocation, preoperative planning using combined anteversion has been widely used. The recommended combined anteversion angle (the total of cup and stem anteversion angles) is 50 ± 10°. [Case presentation] A 33-year-old Japanese woman underwent elective total hip arthroplasty due to osteonecrosis of the femoral head associated with corticosteroid pulse therapy for myasthenia gravis. Intraoperatively, no tendency of dislocation was found when simulating an evoking position under general anesthesia. In postoperative X-ray and computed tomography scans, cup inclination, cup anteversion, and stem anteversion angles were 37°, 13°, and 35° respectively. The resulting combined anteversion was 48°, which was set as the target along with accurate placement. Her postoperative course was normal and she was discharged without adverse events. Three months postoperatively, due to worsening of myasthenic weakness in her lower extremities while resting, she tended to raise her left limb up using both hands for sitting up. An anterior dislocation occurred when her legs were in a figure-of-four position. She was brought to an emergency department, and reduction of dislocation was performed. It was inferred that myasthenic crisis in the affected limb enabled excessive passive motion due to joint hyperlaxity. At the end of 2016, elective total hip arthroplasty on the contralateral side was performed. Cup anteversion, stem anteversion, and the combined anteversion angles were 27°, 24°, and 51° respectively. We instructed her to exercise care during passive leg movement, which may worsen her myasthenic condition. She returned to a normal life and was able to walk long distances without a cane. No recurrence of dislocation was seen at final follow-up. [Conclusions] Even if accurate component orientation is attained in total hip arthroplasty, patients with neuromuscular disorders such as myasthenia gravis have a potential risk of muscle weakness in the affected limb. Therefore, physicians’ instructions and patients’ careful attention are required to prevent dislocation due to excessive hip joint laxity under conditions of motor weakness

Foveal Intraretinal Fluid Localization Affects the Visual Prognosis of Branch Retinal Vein Occlusion

We investigated whether baseline foveal intraretinal fluid (IRF) localization affects the visual prognosis of branch retinal vein occlusion (BRVO). Fifty eyes from 50 patients were included in this retrospective study. We classified the eyes with IRF involving and not involving the central foveola on the vertical optical coherence tomography (OCT) image at the initial visit into both-sides (n = 17) and one-side IRF (n = 33) groups, respectively. Multiple regression analyses demonstrated that not only the baseline logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) but also the IRF localization significantly correlated with the 12-month logMAR BCVA (p = 0.04 and p = 0.001, respectively), indicating that eyes with better baseline logMAR BCVA and one-side IRF have a significantly better visual prognosis in BRVO. The foveal ellipsoid zone band was significantly more disrupted (p < 0.001) in the both-sides IRF (47.1%) group than in the one-side IRF (3.0%) group. No eyes with decimal BCVA less than 0.5 were detected in the one-side IRF group at 12 months. Thus, baseline foveal IRF localization on vertical OCT images can be considered a novel biomarker for the visual prognosis of BRVO

Direct Photocoagulation for Treating Microaneurysms with Hyperreflective Ring in Eyes with Refractory Macular Edema Associated with Branch Retinal Vein Occlusion

Microaneurysms (MAs) with hyperreflective rings are sometimes detected in eyes with refractory macular edema (ME) associated with branch retinal vein occlusion (BRVO) for more than 12 months after onset when examined using optical coherence tomography (OCT). We proposed that these MAs could result in refractory ME secondary to BRVO and hypothesized that OCT-guided direct photocoagulation of MAs could result in a reduction in refractory ME. Eleven eyes (from eleven different patients) with refractory ME associated with BRVO for more than 12 months following initial treatment were included. The mean number of MAs in each eye at baseline was 3.5 ± 2.0 (range, 1–8). The mean central subfield thickness, central macular volume, and parafoveal macular volume significantly decreased 6 months following initial direct photocoagulation when compared with those at baseline (baseline = 378.7 ± 61.8 μm, post-treatment = 304.2 ± 66.7 μm, p = 0.0005; baseline = 0.3 ± 0.049 mm3, post-treatment = 0.24 ± 0.053 mm3, p = 0.001; and baseline = 2.5 ± 0.14 mm3, post-treatment = 2.28 ± 0.15 mm3, p = 0.001, respectively). Moreover, the mean best-corrected visual acuity significantly improved 6 months following initial direct photocoagulation when compared with that at baseline (baseline = 0.096 ± 0.2 logarithm of the minimum angle of resolution (logMAR), post-treatment = 0.0077 ± 0.14 logMAR, p = 0.031). Direct photocoagulation could be suggested as a treatment option for refractory ME associated with BRVO in MAs with a hyperreflective ring on OCT