PubMed · 9741249
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J Stürup, J A Retpen. 1998-08-17. [Complications when using bone cements].. https://pubmed.ncbi.nlm.nih.gov/9741249/
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BACKGROUND: Numerous trials and meta-analyses have shown that extended out-of-hospital prophylaxis with low-molecular-weight heparin reduces asymptomatic and symptomatic venous thromboembolism after total hip arthroplasty. We hypothesized that knowledge of the results of screening tests may have resulted in overdiagnosis of symptomatic venous thromboembolism in many of these studies. The purpose of this analysis was to obtain an accurate estimate of the absolute risk reduction (ARR) of symptomatic venous thromboembolism after discharge from hospital in controlled studies that avoided this potential bias for overdiagnosis. METHODS: Articles were identified using MEDLINE, EMBASE, and the Cochrane Library databases (January 1980-April 2002). Studies were eligible if the assessment of symptomatic venous thromboembolism was standardized and performed independently of mandatory objective testing. RESULTS: Two studies (907 patients) were eligible for assessment of symptomatic venous thromboembolism, 5 studies (1917 patients) for symptomatic pulmonary embolism, and 7 studies (2425 patients) for fatal pulmonary embolism. In controls vs extended treatment groups, after hospital discharge, the frequency of symptomatic venous thromboembolism was 2.7% vs 1.1% (ARR, 1.56%; 95% confidence interval [CI], -0.21% to 3.3%; number needed to treat, 64); symptomatic pulmonary embolism was 0.36% vs 0% (ARR, 0.36%; 95% CI, -0.3% to 1.36%; number needed to treat, 278); and fatal pulmonary embolism was 0.09% vs 0% (ARR, 0.09%; 95% CI, -0.08% to 0.27%; number needed to treat, 1093). CONCLUSIONS: The absolute reduction in symptomatic venous thromboembolism attributed to extended prophylaxis in some studies and meta-analyses seems to have been overestimated.
BACKGROUND: No consensus exists as to whether to let patients bear weight or not after revision of a loosened hip prosthesis using morselized and impacted allograft bone and cement. In the original description of the method, the patients were advised not to bear weight for 3 months postoperatively. Theoretically, bone graft remodeling is enhanced by mechanical load, but an increased migration of the prosthesis within the graft can also be anticipated. In addition, practicing restricted weight-bearing is cumbersome for the patients. METHODS: The present study was initiated to evaluate the migration, as measured by radiostereometry analysis (RSA), in patients mobilized with unrestricted weight-bearing after a hip revision using the X-change Revision Instruments System. This group was compared with a previous series with restricted weight-bearing for the initial 3 months postoperatively. Seven stems and 12 sockets were evaluated by RSA over 2 years. Only patients without intraoperative complications were mobilized with unrestricted weight-bearing. RESULTS: All 7 stems migrated in the distal direction (median 2.6 mm; range 0.8-16.5 mm) and in the posterior direction (median 2.3 mm; range 0.7-22.1 mm). Eleven of the 12 sockets migrated in the proximal direction (median 2.5 mm; range 0.2-8.1 mm). The migration rate decreased gradually in all directions, but 3 stems and 5 sockets still migrated between the 1.5- and 2-year follow-ups. There were no significant differences in migration in any direction for either the stems or the sockets compared to the group with restricted weight-bearing. CONCLUSION: No increased migration occurred in the group free to bear weight as compared to restricted weight-bearing. We shall continue to allow unrestricted weight-bearing in cases where the femoral bone feels competent to withstand the initial load. It simplifies the postoperative mobilization, and we speculate that it might increase the remodeling of the graft.