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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Evidence for the usefulness of hydroxychloroquine as prophylaxis against thromboembolism after total hip replacement is examined. This agent causes reduction in red blood cell aggregation without prolonging the bleeding time in humans and, experimentally, reduces the size of the thrombus. There is a variably demonstrable reduction in platelet aggregation and blood viscosity in humans. After hip replacement, the venographic incidence of deep vein thrombosis is not influenced by hydroxychloroquine. The incidence of fatal pulmonary embolism appears to be reduced, but a controlled trial against placebo does not exist. There are no serious or irreversible side effects, and wound healing is not affected by the administration of this drug. Hydroxychloroquine remains the prophylaxis of choice in use at the Hip Center, Wrightington Hospital, England, 13 years after its introduction.
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PMID:Hydroxychloroquine and postoperative thromboembolism after total hip replacement. 305 57

The problem of treatment of a combination of failed hip arthroplasty secondary to resorption, osteoporosis, osteolysis, or fracture is unsolved. Twenty-seven such complicated hips, including four with previous infection, were treated by a femoral prosthesis driven into an intramedullary nail. The goal of stability, allowing immediate mobilization, was attained in virtually all patients. The oldest was 84 years of age and the mean age was 69.3 years. In the early postoperative period, one patient died of pulmonary embolism and one of myocardial infarction. Two infections were treated 25 and 11 months after implantation; these patients were free from pain and showed no signs of loosening of the implant. The mean time in the hospital for the infected patients was 60 days and for the noninfected patients was 23 days. Among 14 patients who were observed for at least ten months after surgery, freedom from pain was achieved in eight, significant alleviation of pain in five, and slight improvement in one. Five patients also became completely free from dependence on walking aids; seven used one or two canes. Two patients were dependent on crutches. Discrepancy in the length of the lower limbs was noted in seven patients. Six patients showed 1 cm shortening and one patient 2 cm. In six patients the Trendelenburg sign was negative, and in only three patients was it clearly positive. The mean Harris Hip Score in 14 patients observed for more than ten months after surgery was 82. Intramedullary nailing combined with a femoral component in total hip arthroplasties, where defects or fractures of the femur have occurred, give good fixation of the implant components and a satisfactory functional result.
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PMID:Hip arthroplasty with an extended femoral stem for salvage procedures. 649 25

Between Jan. 1, 1976 and Dec. 31, 1981, 257 patients (age range from 21 to 65 years) with osteoarthritis of one or both hips were treated with ceramic hip replacement (Mittelmeier type). The cause of the osteoarthritis was variable. Hip replacement was carried out for the following conditions: rheumatoid arthritis including ankylosing spondylitis, aseptic necrosis of femoral head including post-traumatic and idiopathic forms, osteoarthritis of unknown origin, osteoarthritis following dysplasia or subluxation of the hips and loosened cemented hip prosthesis. The operative technique is described. Full weight bearing is not permitted for 16 weeks postoperatively, but mobilization and isometric exercises begin 2 days after operation and isotonic exercises are introduced later. Complications included fracture of the femoral shaft during operation, fracture of the acetabulum, protrusion, dislocation and infection early after operation (within 16 weeks) and aseptic loosening and pulmonary embolism (after 16 weeks). The results with this new type of hip replacement are encouraging. Good results based on patient satisfaction were obtained in 79% and poor results in 13%.
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PMID:Uncemented total hip replacement. 662 46

Implantation of endoprostheses with bone cement is followed by alterations of the circulation. Intoxication, caused by the monomer of bone cement or pulmonary embolism by intramedullary contents constitute the two mostly accepted pathophysiological hypotheses. Because of the lack of pulmonary and circulatory physiological data a clinical decision concerning the value of the hypotheses was not possible until now. Hip prosthesis implantation was analyzed in 15 patients by measuring equipment controlled by an on-line-computer. The device allowed a high rate of data retrieval. The bone cement implantation syndrome reveals itself as cardiorespiratory sequelae of a disseminated pulmonary embolism which is originating in intramedullary contents, squeezed intravasal. Usual prophylactic methods are revisited.
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PMID:New clinico-pathophysiological studies on the bone cement implantation syndrome. 745 10

One hundred and two uncemented total hip arthroplasties using an anatomic femoral component were performed and followed postoperatively in 96 patients for an average of 35 months (range 24-44). Clinical assessment was performed by a Harris Hip Score (HHS) and standardized radiographs. The primary diagnoses were: osteoarthritis, 86 patients; traumatic arthritis 2; inflammatory arthritis 2; congenital hip dysplasia 5 and avascular necrosis 1. There were 44 males and 52 females. The purpose of this study was to prospectively study whether anatomically designed cementless femoral stems reduce the incidence of thigh pain and limp in the early period after total hip arthroplasty. The average pre-operative HHS was 47, the average pain score was 16 and average function score 25. At the last follow-up the average HHS was 93, average pain and limp at one year was 3.5% and was only slight to mild; this decreased to 1.9% at last follow-up. Radiographic findings included calcar rounding 75%, pedestal formation 40%, distal cortical hypertrophy 20% and incomplete radiolucencies in 35%. No endosteal erosions were seen. Heterotopic ossifications were present in 2 patients, one of which required excision. Complications consisted of dislocations treated closed, 3 intra-operative fractures without sequellae, 1 traumatic peri-operative fracture which required surgery without further complication and 1 pulmonary embolism. One patient required revision for leg length discrepancy. There were no infections. The results of this study indicate that this cementless, anatomically designed femoral component can provide satisfactory, early pain relief and function in this younger, active patient population.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Anatomic cementless total hip replacement: design considerations and early clinical experience. 811 96

As part of the National Study of Primary Hip Replacement Outcome, 402 consultant orthopaedic surgeons from three regions were contacted by postal questionnaire which covered all aspects of total hip replacement (THR). There was a 70% response rate of which 71 did not perform hip surgery, a further 33 refused to take part, leaving 181 valid responses. Preoperative assessment clinics were used by 89% of surgeons, but anaesthetists and rehabilitation services were rarely involved at this stage. Of respondents, 99% used routine thromboprophylaxis, with 79% using a combination of mechanical and chemical methods. Of surgeons, 84% routinely used stockings, whereas 95.5% used chemical prophylaxis, 63% employed low molecular weight heparins. Theatre facilities were shared with other surgical specialties by 6% of surgeons and 18% regularly used body exhaust suits for THR. Antibiotic loaded cement was used by 69% of surgeons, the majority (65%) used a single brand of normal viscosity cement with 9% using reduced viscosity formulations. Modern cementing techniques were commonly used at least in part, 87% used a cement gun and 94% a cement restrictor for femoral cementing. On the acetabulum, 47% pressurised the cement. In all, 36 different femoral stems and 35 acetabular cups were in routine use, but the majority of surgeons (55%) used Charnley type prostheses. Of the surgeons, 57% performed only cemented THR, while 3% exclusively used uncemented THR. Of consultants, 21% followed up their patients to 5 years, the majority discharge patients within the first year. Of concern is a large proportion of surgeons using low molecular weight heparins despite a lack of evidence with regard to reducing fatal pulmonary embolism, and also the small number of surgeons using prostheses of unproven value. Third generation cementing techniques have yet to be fully adopted. The introduction of a national hip register could help to resolve some of these issues.
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PMID:Current practice in primary total hip replacement: results from the National Hip Replacement Outcome Project. 984 38

Results of total arthroplasty of the hip with acetabular protrusion with the use of Mecring cup in 21 patients (25 hips) aged 25-75 years (mean 62) are reported. Morsalised impacted autografts were used to fill acetabular defect in all cases. There were 14 rheumatoid arthritis patients, 4 cases of osteoarthritis and 3 cases of Otto-Chrobak disease. Mean follow-up was 2.5 years (range 6 months-5 years). All autografts were incorporated after 6-9 months. Only one loosening and migration of the cup occurred. One patient died because of pulmonary embolism. Harris Hip Score increased from 37 points (22-49) preoperatively to 81 points (65-89) at the latest follow-up. Incorporation of autografts reinforced acetabular bottom and prevented recurrence of protrusion. Bone remodeling indicates restoring normal biomechanics of the hip.
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PMID:[Mecring threaded cup in total arthroplasty of the hip with acetabular protrusion]. 985 52

Hip arthroplasty is a common surgical intervention in our hospital practice, involving high perioperative risk related to patients age and multiple concomitant diseases. Hemodynamic complications described vary from slight hypotension during surgery to heart failure and sudden death, particularly if the operation involves a cemented femoral component. Because of the type of patients undergoing such operations (elderly patients, with osteoporosis and scarce cardiopulmonary reserve), the unclear origin of complications and the lack of consensus on what constitutes adequate monitoring during surgery, hip arthroplasty is problematic for the specialists involved. We report on five deaths during cemented hip arthroplasty; after reviewing the case history and autopsy report of one, we believe the events leading to death were triggered by massive pulmonary embolism.
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PMID:[Heart arrest in cemented hip arthroplasty]. 1073 88

Hip fracture, which is often due to osteoporosis or other conditions affecting bone strength, can lead to permanent disability, pneumonia, pulmonary embolism, and/or death. Great effort has been directed toward developing noninvasive methods for evaluating proximal femoral strength (fracture load), with the goal of assessing fracture risk. Previously, computed tomographic scan-based, linear finite element (FE) models were used to estimate proximal femoral fracture loads ex vivo in two load configurations, one approximating joint loading during single-limb stance and the other simulating impact from a fall. Measured and computed fracture loads were correlated (stance, r=0.867; fall, r=0.949). However, precision for the stance configuration was insufficient to identify subjects with below average fracture loads reliably. The present study examined whether, for this configuration, nonlinear FE models could be used to identify these subjects. These models were found to predict fracture load within +/-2.0 kN (r=0.962). This level of precision is sufficient to identify 97.5% of femora with fracture loads 1.3 standard deviations below the mean as having below average fracture loads. Accordingly, 20% of subjects with below average fracture loads, i.e. those with the lowest fracture loads and likely to be at greatest risk of fracture, would be correctly identified with at least 97.5% reliability. This FE modeling method will be a powerful tool for studies of hip fracture.
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PMID:Improved prediction of proximal femoral fracture load using nonlinear finite element models. 1141 Mar 81

Elective total hip and total knee arthroplasty surgeries are associated with an extraordinarily high incidence of asymptomatic venous thromboembolism (VTE). Symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) is diagnosed in only 2%-4% of these patients. A number of studies have defined the incidence and time course of symptomatic thromboembolism after these procedures. Knee arthroplasty is associated with a very high incidence of asymptomatic calf vein thrombosis, with almost all symptomatic VTE events diagnosed in the first 21 days after surgery. Hip arthroplasty, however, is associated with a higher incidence of asymptomatic proximal thrombi and a modestly higher incidence of symptomatic VTE events, many diagnosed up to 6 or 8 weeks after hospital discharge. Extended medical thromboprophylaxis has been shown to reduce the incidence of symptomatic and asymptomatic VTE among hip arthroplasty patients but not among knee arthroplasty patients. Risk factors for VTE after knee arthroplasty are not well defined. Important risk factors that have been shown to be associated with the development of VTE after hip surgery include (1) a history of prior VTE, (2) obesity (body mass index > 25), (3) delay in ambulation after surgery, and (4) female sex. Factors associated with lower risk include (1) Asian/Pacific Islander ethnicity, (2) use of pneumatic compression among non-obese patients after surgery, and (3) extended thromboprophylaxis after hospital discharge.
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PMID:Risk factors for venous thromboembolism after total hip and knee replacement surgery. 1217 37


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