Proximal deep venous thrombosis and pulmonary embolus following total joint arthroplasty.

It has been proposed that prevention of deep venous thrombosis (DVT) will lead to a reduction in pulmonary embolism (PE). This retrospective comparative study examines the association between symptomatic proximal DVT (occurring at or proximal to the popliteal fossa) and PE in total joint arthroplasty (TJA) patients. We evaluated 1031 patients with DVT symptoms and 428 with PE symptoms. A total of 227 patients were evaluated for both. No statistically significant association found between developing PE and DVT within 90 days after TJA (P=0.94). Our findings raise into question the mechanical propagation theory. Formation of DVT and PE may be independent events in patients undergoing TJA. Evaluating the efficacy of thromboprophylaxis using DVT as end point may not reflect its efficacy for prevention of PE.

The multifaceted etiology of acetabular labral tears.

Acetabular labral tears have been the focus of much attention in recent years. With the increased use of hip arthroscopy and magnetic resonance arthrography, the infrequent labral tear has proved to be more prevalent than previously thought. The majority of labral tears occur due to an underlying anatomic abnormality. Anatomic abnormalities that can lead to labral tears include femoracetabular impingement, acetabular retroversion, abnormal femoral head, Legg Calvé Perthes, slipped capital epiphysis, capsular laxity, and dysplasia of the hip. Tears in the labrum may lead to the advancement of osteoarthritis. Optimal management of a labral tear may involve addressing underlying anatomic abnormalities in addition to the labral tear itself.