No abstract

BackgroundWarfarinised patients frequently present for total knee arthroplasty (TKA). Current practice of heparin ‘bridging’ is potentially cumbersome and hazardous. The research question is if cessation of warfarin is necessary for TKA.MethodsThe study design was a retrospective case–control series of 61 warfarinised patients and 61 control patients undergoing TKA. TKA was performed by the senior author using a medial parapatellar approach without tourniquet. The target perioperative international normalised ratio (INR) for warfarinised patients was 2–2.2. Primary outcomes were changes in haemoglobin, transfusion requirements and complication rates.ResultsThere was no statistically significant difference between control and warfarin group in mean perioperative Hb (g/L) (pre-op 140 vs 141, day 0 115 vs 115, day 1 108 vs 111, P = 0.63), transfusion rates (14.75% vs 9.83%, P = 0.58), total complication rate (9.8% vs 9.8%, P = 0.75), demographics, range of motion or length of stay. There was a statistically significant higher use of the re-infusion drain in the warfarinised group (47.5% vs 24.6%, P = 0.014).ConclusionThis study supports the hypothesis that warfarin cessation is non-essential in patients undergoing TKA. This data is applicable to a patient group using re-infusion drains. Limitations of this study are typical of a small non-controlled observational study.

No abstract

Background: Aseptic loosening of hip prostheses may lead to implant failure and necessitate revision surgery. Metal-on-metal hip articulation has characteristics that may minimize prosthesis loosening when compared with other forms of hip articulation. The purpose of the present prospective study was to identify early problems that may contraindicate the use of the 'prosthesis femorale modulaire' (PFM) metal-on-metal prosthesis. Methods: The preliminary results of 57 metal-on-metal total hip arthroplasties performed by one surgeon (RR) from 1994 to 1996 in Lismore, New South Wales, are presented here. Data were obtained using patient questionnaires, physical examination and by examination of radiographs. Results: A total of 87.6% of patients had an excellent or good outcome, according to the Harris rating system, at the latest review. The two patients with poor results had obvious alternative causes for their continuing symptoms. There was no radiological evidence of bone or prosthesis failure during the period of follow-up. Conclusions: The preliminary results are comparable with those of other authors who have examined the early results of metal-on-metal total hip arthroplasty.

No abstract