We performed a randomised controlled study to compare heparin with the A-V Impulse System in the prevention of deep-vein thrombosis (DVT) in 132 consecutive patients undergoing total hip replacement. After the operation, all patients had compression stockings, 65 were treated with calcium heparin and 67 with the intermittent plantar pump. DVT was diagnosed by Doppler ultrasound and thermography, followed by phlebography. There were 23 cases of DVT (35.4%) in the heparin group, with 16 m& jor and seven minor thromboses. In the impulse pump group there were nine cases (13.4%) with three ma jor and six minor thromboses. The differences for all thromboses and for major thromboses were both significant at p < 0.005. In the heparin group there was one fatal pulmonary embolism and nine patients (13.8%) had excessive bleeding or wound haematomas, as against none in the impulse pump group.

The rationale for short stems in cementless total hip arthroplasty (THA) is proximal load transfer and absence of distal fixation resulting in preserved femoral bone stock and avoidance of thigh pain. We report a consecutive series of 65 THAs inserted mainly for osteoarthritis with the DePuy Proxima hip, a short, anatomic implant with a pronounced lateral flare. Patients were assessed preoperatively and postoperatively at 3, 6 and 12 months and annually thereafter, using the Harris Hip Score (HHS), the Oxford Hip Score (OHS) and standard radiographs. No thigh pain was reported. Ata mean follow-up of 1.7 years the HHS improved from a preoperative mean value of 51 to 91 and the OHS decreased from a mean value of 42.5 to 12.4. Complications included 1 intraoperative fracture,1 superficial infection, and 3 deep vein thromboses. The proximal medial edge of the resected femoral neck appeared rounded off in 49 cases whilst in 16 cases a further loss of medial cortical density was observed. Patient selection and surgical technique are crucial factors contributing to a successful outcome. The surgical technique is different from standard THA.

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Wrist fracture is the most common fragility fracture in perimenopausal and young postmenopausal women in USA and Northern Europe. Recent studies based on high-resolution imaging have shown microarchitectural deterioration of trabecular bone even in premenopausal women presenting with a wrist fracture. These fractures increase the risk of subsequent fractures, especially in the first 7 years. So, wrist fracture female patients must be appropriately screened and treated for osteoporosis in order to preserve bone quality and prevent future, more severe, fractures.

Femoral neck preserving stems have been developed to take advantage of the biomechanical properties of the femoral neck, and to optimise femoral anchorage and load distribution. The aim of this study was to report the clinical and radiological results in a group of 126 patients (150 hips), operated on for a total hip arthroplasty with the CFP stem. Clinical evaluation considered Harris Hip Score (HHS), thigh pain, Charnley classification, peri- and post-operative complications. Radiographic variables were stem sizing and alignment, femoral and acetabular osteolysis, the quality of cementation and restoration of the offset. The HHS at mean follow-up of 66 months was 83 points. We did not observe femoral or acetabular osteolysis, secondary malalignment or radiographic reactions, but only bone remodelling under the collar. The CFP stem must be used appropriately based on pre-operative planning (correct morphology and torsion of the femur). The surgical technique is straightforward if carried out step by step. We did not see any cases of significant limb length discrepancy.