Long-term outcome of total hip arthroplasty in patients with haemophilia.

INTRODUCTION: Besides the target joints (elbow, knee and ankle), the hip is one of the commonly affected joints in haemophilic arthropathy. Hip arthroplasty is the therapy of choice after failure of conservative treatment. There are only limited data on long-term results after primary total hip arthroplasty (THA). AIM: The aim of this retrospective study was to analyse clinical outcome and complication rate after total hip replacement in patients with severe haemophilic arthropathy. METHODS: Forty-three patients with haemophilia (PWH), one patient with von Willebrand disease and one patient with a Factor-VII-deficiency undergoing 49 total hip arthroplasties, were evaluated in a retrospective study. Harris hip score (HHS), range of motion (ROM), pain status (visual analogue scale, VAS) complication rate and patient satisfaction were assessed at a mean follow-up of 11.5 years (range: 3-32). RESULTS: HSS, ROM and VAS improved significantly combined with high patient satisfaction. In total, three (6.1%) periprosthetic infections and five (10.2%) aseptic implant loosenings occurred after THA leading to revision arthroplasty. In two (4.1%) cases, a pseudotumour and one (2.0%) periarticular ossification had to be resected after THA. CONCLUSION: Total hip replacement in PWH leads to a significant increase of function, reduction of pain and a high satisfaction. Due to the relatively high complication rate (infections and aseptic loosening) compared to patients without haemophilia, an individual assessment of the risk-benefit ratio from surgical and haemostaseological point of view is needed.

[Influence of Parkinson's Disease on the Perioperative Course of Patients after Lumbar Fusion Surgery]. / Der Einfluss des Morbus Parkinson auf den perioperativen Verlauf bei Patienten nach lumbaler Spondylodese.

BACKGROUND: The incidence of Morbus Parkinson (MP) increases with age. An increasing number of patients with MP in the orthopaedic patient population is expected. In the case of general surgery and trauma surgery MP in patients was identified as an important factor for perioperative morbidity. This study investigates the influence of MP on the perioperative course of patients after elective lumbar fusion. PATIENTS AND METHODS: A retrospective matched-pairs analysis with 17 patients in each group was conducted with patients treated in the department of spinal surgery in an orthopaedic university hospital for symptomatic degenerative lumbar spine disease without improvement after conservative therapy. The analysis compared the perioperative courses of patients with MP (MP) and patients without MP (no MP) concerning duration of hospital and intensive care treatment, duration for mobilisation, rehabilitation and occurrence of complications. RESULTS: The mean duration of inpatient treatment (MP 18.4 ± 11.6 d; no MP 14.7 ± 5.4 d), duration of intensive care (MP 1.7 ± 4.2 d; no MP 1,0 ± 1,9 d) and duration for mobilisation (MP 8.8 ± 12.46 d; no MP 5.0 ± 4.2 d) tend to be longer for MP patients. There was no statistically significant difference between both patient groups. A rehabilitative inpatient follow-up treatment was more frequent in patients with MP (MP n = 4; no MP n = 2). None of the two groups showed an increased occurrence of complications. CONCLUSION: While general surgery and trauma surgery patients show significant differences regarding duration of inpatient treatment, more frequent falls and more frequent rehabilitative inpatient follow-up treatments, patients after elective lumbar fusion show only a trend. Possibly the result is due to the underlying degenerative disease of the lumbar spine with spinal stenosis and gait disturbance in the MP group and as well in the control group. Therefore both groups suffered from impaired mobility. Additionally there was a high incidence of other comorbidities in the control group, which could have affected the results of this study. Another limitation is the number of the included patients. Although, this study showed no increased occurrence of complications, typical risk factors, like increased risk for airway complications, urinary tract infection and falls, should be considered for the treatment of MP patients.

[Post-surgical gout after total hip arthroplasty - a case report]. / Foudroyante Verlaufsform einer postoperativen Gicht nach Implantation einer Hüfttotalendoprothese - ein Fallbericht.

The following report deals with the case of a post-surgical gout after total hip arthroplasty. Before surgery, the patient was diagnosed with hyperuricaemia. Following the procedure, the patient developed superinfected gout tophi and several joint infections. Multiple surgeries were necessary to control the illness and to finally heal the infection. This study stresses pre-surgical hyperuricaemia as a severe illness and demonstrates a positive medical history of gout as a risk for post-surgical precipitation of uric acid. We hope to increase the surgeon's awareness of post-surgical gout symptoms in order to ensure adequate patient care.