Prostheses of the Hip Joint in Orthopaedics and Traumatology - Thromboembolic Complications

Overview

The authors compare two basic groups of patients subjected to hip joint replacement on account of injury or elective indication (coxarthritis). The groups were further divided by the mode of prevention - unfractionated heparin (UFH) or low molecular heparin (LMWH) enoxaparine.The groups were monitored from the aspect of frequency of thromboembolic complications (clinical, Doppler, phlebography) surgical stress, associated diseases. Furthermore the authors investigated acute stage proteins (fibrinogen, orosomucoid, CRP) as well as prealbumin and transferrin in the group is 42 days and particular attention was pait do basic thromboembolic complications.Among basic results we are presenting the less favourable general characteristic of the group with injuries (in particular age, associated diseases, obesity). In elective operations during UFH administration deep venous thrombosis occurred in 15.5%, proximal venous thrombosis in 11.1%, when administering LMWH this occurred in 13.3% and 2.2% resp. In the group of injuries UFH deep venous thrombosis occurred in 20%, proximal venous thrombosis in 17.7% and when using LMWH in 13.3% and 6.7% resp.In the group of elective operations there was no death by the 42nd day after operation, in injuries there were seven deaths by the 10th day (4x post-mortem examination confirmed pulmonary embolism, always after prevention with UFH). There is also a dramatic difference in the survival of patients to the 42nd day when prevention with UFH is used - 17 patients died, incl. 3 who died from pulmonary embolism. After prevention with LMWH during the same period none of the patients died.Ten-day monitoring of acute stage proteins provides evidence of the great stress and risk of surgery and combination of injury and surgery. Thrombocyte levels had after prevention with LMWH a relatively more favourable course.Markers of the catabolism and protein metabolism also confirm this load.Finally we confirm the favourable effect of prophylaxis with low molecular heparins. We emphasize the confirmed great stress suffered by the organism in operations of the hip joint, in particular after injuries in this region. We assume that comprehensive monitoring is necessary in every patient, not only to assess the load but also with regard to possibly modified prevention or treatment and we wish to emphasize the long-term persistence of the risk of developing a thromboembolic complication.We also wish to present the first information on a new generic preparation - a pentasaccharide which is very effective in the prevention of TE complications.

Key words:
prostheses of the hip joint - thromboembolic complications - orthopaedics - traumatology.