Osteonecrosis of the femoral head following cardiac transplantation has led to bilateral total hip arthroplasties in 2 patients. The clinical course and rejections of these patients are outlined. The pathological changes in the femoral heads suggested that the process leading to osteonecrosis in the cardiac transplant patient is the same as that following renal transplantation, both being due to immunosuppression probably related to steroid dosage. Successful joint replacement can be carried out in the cardiac transplant with careful monitoring of anesthesia. Both patients have done well, being followed for 14 and 6 months respectively.

Adult↗

PubMedDate not supplied

ASA-dipyridamole prophylaxis in elective total hip replacement.

A prospective, double-blind clinical study was performed to evaluate the combination of dipyridamole 225 mg/day and acetylsalicylic acid 1 gm/day prophylaxis of postoperative venous thromboembolism in elective total hip replacement. Patients were stratified according to age, and randomly assigned to receive drug or placebo. All patients were followed with 125I-labeled fibrinogen scanning for one week postoperatively, or until fully mobile. Venography was performed in 79/132 patients; in 36 patients the venogram was obtained to confirm a positive fibrinogen scan, in 43 patients an elective venogram was obtained on the seventh postoperative day to evaluate the operated thigh (a blind area for scanning). Thrombosis (by scan or venogram) was found in 17/68 (25%) in the control group, and in 23/64 (36%) in the treated group. Overall incidence was 40/132 (30%). Correlation of scan with venography was 90%. There were no clinically significant pulmonary emboli in either group. The combination of acetylsalicylic acid (ASA) and dipyridamole as given in this study is not effective prophylaxis in elective total hip replacement.

Administration, Oral↗

PubMedDate not supplied

The dashboard knee injury.

An in-depth study of 74 motor vehicle accidents involving 222 people revealed that 57 of the 153 people injured sustained 69 knee injuries from contact with the instrument panel. There were 51 mild, 10 moderate, and 8 severe knee injuries. Low force contact caused bruising, and more serious injuries occurred when a greater magnitude of force was applied. Injury was most severe when this force was concentrated in a small area and caused lacerations, fractured patella, and open wounds of the joint. Legs trapped under the dashboard with simultaneous rotational, varus, valgus, or frontal forces by the inertial motion of the body produced serious injuries similar to those recieved in sports. Degenerative arthritis was more likely to occur in the seriously injured knees, but generally was not predictable. Long-term disability might be mitigated by early diagnosis and treatment of the specific injury.

Accidents, Traffic↗