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      Prevention of early complications following total hip replacement


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          Total hip arthroplasty (THA) has been quoted as “the operation of the century”, owing to its efficacy and the substantial improvements evidenced with respect to functional patient outcomes and quality of life. However, early postoperative complications are often inevitable, hence it is imperative to take every step to prevent them and minimise morbidity and mortality. This manuscript focuses on the most common early complications following THA, namely venous thromboembolism (VTE), prosthetic joint infection, periprosthetic fracture, instability, and leg length inequality. It aims to outline effective risk stratification strategies and prevention measures that could apply to the wider Orthopaedic community.

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          Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

          This article discusses the prevention of venous thromboembolism (VTE) and is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do or do not outweigh risks, burden, and costs. Grade 2 suggestions imply that individual patient values may lead to different choices (for a full discussion of the grading, see the "Grades of Recommendation" chapter by Guyatt et al). Among the key recommendations in this chapter are the following: we recommend that every hospital develop a formal strategy that addresses the prevention of VTE (Grade 1A). We recommend against the use of aspirin alone as thromboprophylaxis for any patient group (Grade 1A), and we recommend that mechanical methods of thromboprophylaxis be used primarily for patients at high bleeding risk (Grade 1A) or possibly as an adjunct to anticoagulant thromboprophylaxis (Grade 2A). For patients undergoing major general surgery, we recommend thromboprophylaxis with a low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH), or fondaparinux (each Grade 1A). We recommend routine thromboprophylaxis for all patients undergoing major gynecologic surgery or major, open urologic procedures (Grade 1A for both groups), with LMWH, LDUH, fondaparinux, or intermittent pneumatic compression (IPC). For patients undergoing elective hip or knee arthroplasty, we recommend one of the following three anticoagulant agents: LMWH, fondaparinux, or a vitamin K antagonist (VKA); international normalized ratio (INR) target, 2.5; range, 2.0 to 3.0 (each Grade 1A). For patients undergoing hip fracture surgery (HFS), we recommend the routine use of fondaparinux (Grade 1A), LMWH (Grade 1B), a VKA (target INR, 2.5; range, 2.0 to 3.0) [Grade 1B], or LDUH (Grade 1B). We recommend that patients undergoing hip or knee arthroplasty or HFS receive thromboprophylaxis for a minimum of 10 days (Grade 1A); for hip arthroplasty and HFS, we recommend continuing thromboprophylaxis > 10 days and up to 35 days (Grade 1A). We recommend that all major trauma and all spinal cord injury (SCI) patients receive thromboprophylaxis (Grade 1A). In patients admitted to hospital with an acute medical illness, we recommend thromboprophylaxis with LMWH, LDUH, or fondaparinux (each Grade 1A). We recommend that, on admission to the ICU, all patients be assessed for their risk of VTE, and that most receive thromboprophylaxis (Grade 1A).
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            Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030

            The volume of primary total joint arthroplasty (TJA) procedures has risen in recent decades. However, recent procedure growth has not been at previously projected exponential rates. To anticipate the future expense of TJA, updated models are necessary to predict TJA volume in the U.S.
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              Economic burden of periprosthetic joint infection in the United States.

              This study characterizes the patient and clinical factors influencing the economic burden of periprosthetic joint infection (PJI) in the United States. The 2001-2009 Nationwide Inpatient Sample was used to identify total hip and knee arthroplasties using International Classification of Diseases, Ninth Revision, procedure codes. The relative incidence of PJI ranged between 2.0% and 2.4% of total hip arthroplasties and total knee arthroplasties and increased over time. The mean cost to treat hip PJIs was $5965 greater than the mean cost for knee PJIs. The annual cost of infected revisions to US hospitals increased from $320 million to $566 million during the study period and was projected to exceed $1.62 billion by 2020. As the demand for joint arthroplasty is expected to increase substantially over the coming decade, so too will the economic burden of prosthetic infections. Copyright © 2012. Published by Elsevier Inc.

                Author and article information

                SICOT J
                SICOT J
                EDP Sciences
                30 November 2021
                : 7
                : ( publisher-idID: sicotj/2021/01 )
                : 61
                [1 ] Department of Trauma and Orthopaedic Surgery, University College London Hospitals London NW1 2BU UK
                [2 ] Mayo Clinic Rochester MN 55905 USA
                [3 ] Melbourne Orthopaedic Group Windsor Victoria 3181 Australia
                [4 ] Monash University Windsor Ontario N9B 3P4 Australia
                [5 ] Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires Buenos Aires Argentina
                [6 ] Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University 137 South LiYuShan Road Urumqi Xinjiang 830054 China
                [7 ] Harvard Medical School, Harvard University Boston MA 02115 USA
                [8 ] University College London, Division of Surgery and Interventional Science Gower Street London WC1E 6BT UK
                Author notes
                [* ]Corresponding author: andreasfontalis@ 123456gmail.com
                Author information
                sicotj210046 10.1051/sicotj/2021060
                © The Authors, published by EDP Sciences, 2021

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 06 May 2021
                : 29 October 2021
                Page count
                Figures: 0, Tables: 4, Equations: 0, References: 87, Pages: 10
                Review Article
                Special Issue: "SICOT Education Academy Collection" Guest Editor: H. Said

                hip arthroplasty,early complications,prevention strategies,education,risk stratification


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