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Clinical Research: Adult Reconstruction Surgery
Selected Abstracts 2008-2009
Richard H. Rothman, MD, PhD
William J. Hozack, MD
Peter F. Sharkey, MD
Alvin Ong, MD
Javad Parvizi, MD, PhD
William V. Arnold, MD, PhD
Matthew S. Austin, MD
Fabio Orozco, MD

One-stage bilateral total joint arthroplasty: a prospective, comparative study of total hip and total knee replacement.
Peak, El, Hozack WJ, Sharkey PF, Parvizi J, Rothman RH.
Orthopedics. 2008 Feb;31(2):131

This prospective study compared the incidence of minor and major complications in 50 patients (100 joints) undergoing bilateral total knee arthroplasty (TKA) with 50 patients (100 joints) undergoing bilateral total hip arthroplasty (THA). Gender, comorbidities, American Society of Anesthesiologists scores, and body mass indices were similar in both groups. There was no difference in preoperative hemoglobin, operative time, anesthetic management, postoperative surveillance, and hemoglobin at discharge. However, the need for allogenic blood transfusion, despite preoperative autologous blood donation and retransfusion, was high for both groups (34% for bilateral TKA and 20% for bilateral THA). Bilateral THA patients had lower rates of total major and minor complications than bilateral TKA patients. Although cementless bilateral THA and cemented bilateral TKA can be performed efficiently and with relative safety in a select group of patients, the high rate of minor complications and in particular the need for allogenic transfusion in both groups is concerning and should be discussed with patients before surgery.

Deep Venous Thrombosis Prophylaxis for Total Joint Arthroplasty: American Academy of Orthopaedic Surgeons Guidelines.
Parvizi J, Azzam K, Rothman RH.
J Arthroplasty. 2008 Oct;23(7 Suppl):2-5.

The orthopedic community continues to face a challenge with regard to the prevention of thromboembolism after total joint arthroplasty. The first and foremost issue facing surgeons is how to select the best agent or modality that is effective in preventing the untoward consequences of thromboembolism without causing other complications that can have dire consequences. Other challenges include the uncertainty regarding the dose and duration of various agents, the value of mechanical prophylaxis alone, and the exact end points that should be used to measure the efficacy of prophylaxis. This article discusses some of the recent developments in prevention and management of thromboembolism after total joint arthroplasty, in particular highlighting the guidelines that were developed by American Academy of Orthopedic Surgeons.

Hypoxemia after total joint arthroplasty: a problem on the rise.
Austin L, Pulido L, Ropiak R, Porat M, Parvizi J, Rothman RH.
J Arthroplasty. 2008 Oct;23(7):1016-21.

Total joint arthroplasty (TJA) is categorized as a major risk factor for thromboembolic complications. The importance of hypoxemia during the postoperative period is subject of controversy. This prospective study elucidates the incidence and etiology of hypoxemia after TJA. Furthermore, we intended to assess the predictive value of clinical findings in identifying the etiology of hypoxemia after TJA. Of 1971 patients, 78 (4.0%) experienced an acute episode of hypoxemia during their hospitalization after TJA. Hypoxemia as the initial presenting sign, predicted major complications, defined as life-threatening if left untreated, in 32% of the hypoxic population. These diagnoses included pulmonary embolism, pulmonary edema, and pneumonia. Tachypnea was the only independent factor associated with pulmonary embolism. Our study presents the incidence and etiology of hypoxemia after TJA, and we recommend a heightened appreciation for the hypoxemic patient.
© 2010 Thomas Jefferson University Hospital Department of Orthopaedic Surgery.