Abstract
Background
Despite changes in techniques and management, little has been published comparing hip replacement surgery over a three-decade time span.
Aims
To document change in the practice of hip arthroplasty in a large elective orthopaedic centre.
Methods
A retrospective analysis of 100 patients in 1979 and in 1999 comparing demographics, surgical approaches, blood loss, transfusion requirements, morbidity and length of stay.
Results
In 1999, males predominated, spinal anaesthesia had largely superceded general anaesthesia, the anterolateral approach had replaced the trans-trochanteric approach, osteoarthritis remained the main aetiology and the Charnley prosthesis remained the implant of choice. Average blood loss was higher in 1999 compared to 1979 (1,378 vs 1,225ml) but all patients in 1979 were transfused with an average of 2.8 units while in 1999 one-third of patients were transfused with an average of 1.6 units (p<0.0001). Length of stay had fallen from 30.5 days in 1979 to 16.2 days in 1999 (p<0.0001). Thromboembolic complications fell from 13% to 2% (p=0.0083).
Conclusion
The incidence of deep venous thrombosis (DVT), pulmonary embolus (PE) and length of hospital stay has fallen. Blood loss had changed little but fewer patients receive blood transfusion.
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References
Charnley J. Arthroplasty of the hip: a new operation.Lancet 1961; 1: 1129.
Glassman AH, Engh CA, Bobyn JD. A technique of extensile exposure for total hip arthroplasty.J Arthroplasty 1987; 2 (1): 11.
McLaughlin J. The stracathro approach to the hip.J Bone Joint Surg 1984; 66 (Br): 30.
Dall D. Exposure of the hip by anterior osteotomy of the greater trochanter. A modified anterolateral approach.J Bone Joint Surg 1986; 68 (Br): 382.
Dall DM, Miles AW. Reattachment of the greater trochanter: the use of the trochanter cable-grip system.J Bone Joint Surg 1983; 65 (Br): 55.
Moore AT. The self-locking metal hip prosthesis.J Bone Joint Surg 1957; 39: 811.
Moore AT. The self-locking vitallium prosthesis in fresh femoral neck fractures. American Academy of Orthopaedic Surgeons instructional course lectures; vol 16, St Louis, 1959, Mosby yearbook.
McKee GK. Development of total prosthetic replacement of the hip.Clin Orthop 1970; 72: 85.
Müller ME. Total hip prosthesis.Clin Ortho 1970; 72: 46.
Franco JA, Baer H, Enneking WF. Airborne contamination in orthopaedic surgery: evaluation of laminar air flow and aspiration suit.Clin Orthop 1977; 122: 231.
Anglen AO. The efficacy of various irrigation solutions in removing slime producing staphs.J Orthop Trauma 1994; 8(5): 390.
Murray WR. Use of antibiotic-containing bone cement.Clin Orthop 1984; 190: 89.
Nelson CL, Bowen WS. Total hip arthroplasty in Jehovah’s Witnesses without blood transfusion.J Bone Joint Surg 1986; 68 (3) (Am); 350.
Toy PT, Kaplan EB, McAvay PA et al. Blood loss and replacement in total hip arthroplasty: a multicentre study. The preoperative autologous blood donation study group.Transfusion 1992; 32 (1): 63.
Data from De Puy International, Leeds, UK.
Callaghan JJ et al. Charnley total hip arthroplasty in patients less than fifty years old. A twenty to twenty-five-year follow up note.J Bone Joint Surg Am 1998; 80 (5): 704–14
Friedman BA. An analysis of surgical blood use in United States hospitals with application to the maximum surgical blood order schedule.Transfusion 1980; 19: 268.
Bierbaum BE, Callaghan JJ, Galante JO et al. An analysis of blood management in patients having a total hip or knee arthroplasty.
Johnson R, Green JR, Charnley J. Pulmonary embolism and its prophylaxis following the Charnley total hip replacement.Clin Orthop 1997; 127: 123–32.
Johnson R, Carmichael JHE, Almond HGA, Loynes RP. Deep venous thrombosis following Charnley arthroplasty.Clin Orthop 1978; 132: 24–30.
Salvati EA et al. Recent advances in venous thromboembolic prophylaxis during and after total hip replacement.J Bone Joint Surg Am 2000; 82: 252–70.
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Sheehan, E., Neligan, M. & Murray, P. Hip arthroplasty, changing trends in a national tertiary referral centre. Ir J Med Sci 171, 13–15 (2002). https://doi.org/10.1007/BF03168932
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DOI: https://doi.org/10.1007/BF03168932