Return to work and sports after total hip replacement.

INTRODUCTION: Expectations of patients requiring total hip replacement have become higher than in the past and are often well beyond pain relief and improved mobility. Return to work and sporting activity are important factors to be considered when advising patients preoperatively. The objective of this study was to analyse the return to sports and work rates in patients still in employment and to analyse potential influencing factors. MATERIALS AND METHODS: Patients under the age of 65 who had a total hip replacement performed at a university teaching hospital were identified from the local arthroplasty database and contacted. Pre and postoperative levels of sporting activity and work were recorded. We also recorded the time point at which they returned to these activities. RESULTS: 285 total hip replacements were carried out on 239 patients. At the time of follow-up 170 of the patients were working. The mean length of time to return to work was 13.9 weeks (SD 7.7). 78 % returned to work without any restrictions, 18.6 % in heavy manual jobs. The mean time taken to return to sports or similar physical activities was 18.8 weeks (SD 8.8) weeks. Those with a lower body mass index returned to work and sporting activities faster. CONCLUSIONS: Our data show that the majority of patients undergoing total hip replacement can expect to return to work and sporting activities within 4-6 months. Activities at work are often initially limited and physical performance may not fully return to the expected level. Patients with a high body mass index take longer to return to work and sporting activities.

A study of thromboprophylactic practices of Scottish orthopaedic surgeons in patients undergoing total hip replacements. Should practice change with new guidelines?

Despite increasing scientific investigation, the best method for preventing postoperative thromboembolism in patients undergoing a total hip replacement (THR) remains unclear. National Institute for Health and Clinical Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the prevention of thromboembolism have caused much controversy. We surveyed Scottish surgeons regarding their thromboprophylaxis prescribing after THR. Questionnaires were sent to all Scottish orthopaedic consultants. They were asked about routine pharmacological and mechanical prophylaxis in patients undergoing a THR. Comparison was made with a previous survey done in 2003. The response rate was 75%. The survey showed an increased use of pharmacological prophylaxis from 93% to 100%. This was due to the increased use of aspirin from 51% to 64%. The use of low molecular weight heparin has remained constant at 51%. No surgeons routinely use warfarin, un-fractionated heparin or fondaparinux. Use of graded compression stockings has increased from 59% to 70%. In conclusion, there is increasing evidence that patients undergoing THR should receive extended prophylaxis for up to 35 days. Oral agents such as dabigatran and rivaroxaban have offered a new option for oral extended prescribing. The results in change of practice must be closely audited.

The epidemiology of fractures of the hand and the influence of social deprivation.

This study investigates the relationship between the epidemiology of hand fractures and social deprivation. Data were collected prospectively in a single trauma unit serving a well-defined population. The 1382 patients treated for 1569 fractures of the metacarpals or phalanges represented an incidence of hand fracture of 3.7 per 1000 per year for men and 1.3 per 1000 per year for women. Deprivation was not directly associated with the incidence of hand fracture. Common mechanisms of injury are gender specific. Fractures of the little finger metacarpal were common (27% of the total) and were associated with social deprivation in men (P = 0.017). For women, fractures where the mechanism of injury was unclear or the patient was intoxicated and could not recall the mechanism showed a clear association with deprivation. Affluent patients were more likely to receive operative treatment. Social deprivation influences both the pattern and management of hand fractures.