[Treatment of patellofemoral arthritis with patello-femoral arthroplasties]. / Behandling af patellofemoral artrose med en patellofemoral alloplastik.

INTRODUCTION: Patellofemoral arthritis is a common entity and patellofemoral arthroplasties have been performed since the 1970s. However, follow-up studies are few, and the optimal indication for the operation has yet to be established. This study concentrates on the gains in patient-reported quality of life parameters achieved by the operation. MATERIAL AND METHODS: Of 26 patients operated with 31 Richards Model Patella II patellofemoral arthroplasties, 17 patients with 20 arthroplasties were available for clinical review using two subjective/objective scoring systems and one patient administered self evaluation form median 7.7 years after the operation. RESULTS: The revision rate for the prosthesis was low (3%). A frequency of short-term complications of 15% and of later surgical procedures of 20% was observed. The American Knee Society Score showed 65% excellent or good, 20% fair and 35% poor results. The results of the patient administered KOOS showed significant improvements for the subcategories ''symptoms'', ''pain", ''activities of daily living" and ''quality of life". The worst results were seen among patients with pre-arthritic patellofemoral pain syndrome. CONCLUSION: 7-8 years after patellofemoral arthroplasty survival of the prosthesis is good. The clinical result is unpredictable. Most patients can expect a reduction in their level of pain and a higher level of daily living activities. The level of sports and recreational activities did not increase, even among younger patients. Patients with patellofemoral pain before radiological signs of arthritis are present in the joint cannot expect a measurable effect from the operation.

Low molecular weight heparin (Innohep) as thromboprophylaxis in outpatients with a plaster cast: a venografic controlled study.

INTRODUCTION: The aim of this study was to investigate the incidence of deep vein thrombosis (DVT) in patients immobilized in plaster cast and the possible efficacy of prophylaxis with low molecular weight heparin (LMWH). MATERIAL AND METHODS: The study was a randomized, assessor-blinded, open multicenter (three centers) study. All patients over 18 years of age with planned plaster cast on a lower extremity of at least 3 weeks were eligible for participation. Written informed consent was obtained from 300 patients and they were randomized to either 3.500 IU anti-Xa of tinzaparin (Innohep) subcutaneously once daily or no prophylaxis. On the day the cast was removed, ascending unilateral venography was performed. Two experienced radiologists, unaware of treatment, assessed the pictures independently. The radiologist had to obtain consensus as to whether DVT was present or not. RESULTS: 300 patients were included (148 in the treatment group and 152 in the control group). Ninety-five were subsequently withdrawn. DVT was diagnosed in 10/99 patients in the treatment group and in 18/106 patients in the control group. This difference is not significant (P=.15, chi(2) test) and the odds ratio was 0.55 (95% confidence interval=0.34-1.26). CONCLUSION: DVT in legs after plaster casting is a big problem, with an incidence of almost 20%. An effective prophylactic regime is required. Once-daily dose of 3.500 IU anti-Xa of tinzaparin was not sufficient.