MEDLINE Abstracts: Low Molecular Weight Heparin for the Prevention of Thromboembolism in Lower Extre
MEDLINE Abstracts: Low Molecular Weight Heparin for the Prevention of Thromboembolism in Lower Extremity Arthroplasty
What's new in prophylactic regimens for the prevention of thromboembolism and pulmonary embolism after hip and knee arthroplasty? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics and Sports Medicine.
Anonymous
Journal of the Kansas Dental Association 82(4):14, 16-7, 1997 Oct
An expert panel of dentists, orthopaedic surgeons, and infectious disease specialists, convened by the American Dental Association and the American Academy of Orthopaedic Surgeons, or AAOS, performed a thorough review of all available data to determine the need for antibiotic prophylaxis to prevent hematogenous prosthetic joint infections in dental patients who have undergone total joint arthroplasties. The result is this report, which has been adopted by both organizations as an advisory statement. The panel's conclusion. Antibiotic prophylaxis is not indicated for dental patients with pins, plates and screws, nor is it routinely indicated for most dental patients with total joint replacements. However, it is advisable to consider premedication in a small number of patients who may be at potential increased risk of hematogenous total joint infection.
An YH, Friedman RJ
Journal of Hospital Infection 33(2):93-108, 1996 Jun
Because of the adoption of effective prophylactic measures such as improved operating room techniques and systemic antibiotics, the prosthetic infection rate for artificial joint procedures has been reduced to 1% to 2%. However, because of the devastating results and large number of prosthetic procedures, prosthetic infection remains a major challenge. Common pathogens and mechanisms of infection, methods of preventing bacterial adherence to biomaterial surfaces, and clinical preventive strategies for prosthetic infections are discussed.
Westrich GH, Sculco TP
Journal of Bone & Joint Surgery - American Volume 78(6):826-34, 1996 Jun
A prospective, randomized study was conducted to assess the efficacy of pulsatile pneumatic plantar compression for prophylaxis against deep venous thrombosis after total knee arthroplasty performed with use of regional anesthesia. One hundred and twenty-two patients (164 knees) who were scheduled to have a unilateral or a one-stage bilateral total knee arthroplasty were separately randomized to be managed with either aspirin alone or the pulsatile pneumatic plantar-compression device and aspirin. The prevalence of deep venous thrombosis was 27 per cent (twenty-two of eighty-one knees) in the group treated with pneumatic plantar compression compared with 59 per cent (forty-nine of eighty-three knees) in the patients managed with aspirin alone (the control group) (P < 0.001). A significant difference was also noted in the group that had had a unilateral arthroplasty (a prevalence of 27 per cent [eleven of forty-one knees] in the group treated with pneumatic plantar compression, compared with 67 per cent [twenty-six of thirty-nine knees] in that treated with aspirin alone; P < 0.006) and in the group that had had a one-stage bilateral procedure (a prevalence of 28 per cent [eleven of forty knees] in the group treated with pneumatic plantar compression, compared with 52 per cent [twenty-three of forty-four knees] in that treated with aspirin alone; P < 0.03). No proximal thrombi were noted in any patient who used the pulsatile pneumatic plantar-compression device, while the prevalence of proximal thrombosis in the popliteal or femoral veins was 14 per cent (twelve of eighty-three knees) in the group treated with aspirin alone (P < 0.0003). In the group treated with a unilateral procedure and aspirin alone the prevalence of proximal thrombosis was 13 per cent (five of thirty-nine knees; P < 0.02), while in the group treated with a bilateral procedure and aspirin alone it was 16 per cent (seven of forty-four knees; P < 0.01). Only in the patients who had had a unilateral procedure was use of the compression device associated with significantly less edema postoperatively than was use of aspirin alone. The change between the preoperative and postoperative circumferences of the thigh and leg was significantly less (9 ± 4.1 millimeters [mean and standard deviation] less for the thigh [P < 0.01] and 6 ± 3.9 millimeters less for the leg [P < 0.049]) with the compression device than with aspirin alone. In addition, there was significantly less mean drainage (98 ± 61.1 milliliters) in the group treated with a unilateral procedure and pneumatic compression, compared with that treated with a unilateral procedure and aspirin alone (P < 0.041). An internal timer of the compression device was used to assess the compliance of the patient with use of the device, and a relationship between deep venous thrombosis and the total duration of treatment with the device was found. The patients in whom deep venous thrombosis did not develop used the device for a mean of 96 ± 23.4 hours (range, sixty to 164 hours) postoperatively, or 19.2 ± 5.1 hours a day, while those in whom thrombosis developed used it for a mean of 67 ± 21.1 hours (range, twenty-six to 101 hours), or 13.4 ± 4.3 hours a day (P < 0.001). No untoward effects were noted in any patient who used the device. This study confirms the safety and efficacy of pulsatile pneumatic plantar compression and aspirin compared with aspirin alone and supports the use of mechanical compression for prophylaxis against deep venous thrombosis and for reduction of edema in patients who have had a total knee arthroplasty. In addition, we found a direct relationship between compliance with the use of this device and its efficacy in reducing deep venous thrombosis.
Yagiela JA
Journal of the California Dental Association 23(10):29-40, 1995 Oct
The administration of antibiotics in dentistry to prevent systemic disease should be based on a rational consideration of both the anticipated benefits of such practice and the potential risks. In the case of patients susceptible to infective endocarditis, the routine use of prophylactic antibiotics is justified for high-risk patients and for procedures likely to cause significant bacteremia; in the case of patients with prosthetic joints, it is not.
Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA
Arthritis & Rheumatism 38(12):1819-25, 1995 Dec
Objective: To quantify potential risk factors for septic arthritis, in order to identify a basis for prevention.
Methods: The occurrence of potential risk factors for septic arthritis in patients with joint diseases attending a rheumatic disease clinic was prospectively monitored at 3-month intervals over a period of 3 years. Potential risk factors investigated were type of joint disease, comorbidity, medication, joint prosthesis, infections, and invasive procedures. The frequencies of risk factors in patients with and those without septic arthritis were compared using multiple logistic regression analysis.
Results: There were 37 patients with and 4,870 without septic arthritis. Risk factors for developing septic arthritis were age > or = 80 years (odds ratio [OR] = 3.5, 95% confidence interval [95% CI] 1.4-8.6), diabetes mellitus (OR = 3.3, 95% CI 1.1-10.1), rheumatoid arthritis (OR = 4.0, 95% CI 1.9-8.3), hip and/or knee prosthesis (OR = 15, 95% CI 4.1-54.3), joint surgery (OR = 5.1, 95% CI 2.2-11.9), and skin infection (OR = 27.2, 95% CI 7.6-97.1).
Conclusion: These findings indicate that preventive measures against septic arthritis in patients with joint diseases should mainly be directed at those with joint prostheses and/or skin infection.
What's new in prophylactic regimens for the prevention of thromboembolism and pulmonary embolism after hip and knee arthroplasty? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics and Sports Medicine.
Anonymous
Journal of the Kansas Dental Association 82(4):14, 16-7, 1997 Oct
An expert panel of dentists, orthopaedic surgeons, and infectious disease specialists, convened by the American Dental Association and the American Academy of Orthopaedic Surgeons, or AAOS, performed a thorough review of all available data to determine the need for antibiotic prophylaxis to prevent hematogenous prosthetic joint infections in dental patients who have undergone total joint arthroplasties. The result is this report, which has been adopted by both organizations as an advisory statement. The panel's conclusion. Antibiotic prophylaxis is not indicated for dental patients with pins, plates and screws, nor is it routinely indicated for most dental patients with total joint replacements. However, it is advisable to consider premedication in a small number of patients who may be at potential increased risk of hematogenous total joint infection.
An YH, Friedman RJ
Journal of Hospital Infection 33(2):93-108, 1996 Jun
Because of the adoption of effective prophylactic measures such as improved operating room techniques and systemic antibiotics, the prosthetic infection rate for artificial joint procedures has been reduced to 1% to 2%. However, because of the devastating results and large number of prosthetic procedures, prosthetic infection remains a major challenge. Common pathogens and mechanisms of infection, methods of preventing bacterial adherence to biomaterial surfaces, and clinical preventive strategies for prosthetic infections are discussed.
Westrich GH, Sculco TP
Journal of Bone & Joint Surgery - American Volume 78(6):826-34, 1996 Jun
A prospective, randomized study was conducted to assess the efficacy of pulsatile pneumatic plantar compression for prophylaxis against deep venous thrombosis after total knee arthroplasty performed with use of regional anesthesia. One hundred and twenty-two patients (164 knees) who were scheduled to have a unilateral or a one-stage bilateral total knee arthroplasty were separately randomized to be managed with either aspirin alone or the pulsatile pneumatic plantar-compression device and aspirin. The prevalence of deep venous thrombosis was 27 per cent (twenty-two of eighty-one knees) in the group treated with pneumatic plantar compression compared with 59 per cent (forty-nine of eighty-three knees) in the patients managed with aspirin alone (the control group) (P < 0.001). A significant difference was also noted in the group that had had a unilateral arthroplasty (a prevalence of 27 per cent [eleven of forty-one knees] in the group treated with pneumatic plantar compression, compared with 67 per cent [twenty-six of thirty-nine knees] in that treated with aspirin alone; P < 0.006) and in the group that had had a one-stage bilateral procedure (a prevalence of 28 per cent [eleven of forty knees] in the group treated with pneumatic plantar compression, compared with 52 per cent [twenty-three of forty-four knees] in that treated with aspirin alone; P < 0.03). No proximal thrombi were noted in any patient who used the pulsatile pneumatic plantar-compression device, while the prevalence of proximal thrombosis in the popliteal or femoral veins was 14 per cent (twelve of eighty-three knees) in the group treated with aspirin alone (P < 0.0003). In the group treated with a unilateral procedure and aspirin alone the prevalence of proximal thrombosis was 13 per cent (five of thirty-nine knees; P < 0.02), while in the group treated with a bilateral procedure and aspirin alone it was 16 per cent (seven of forty-four knees; P < 0.01). Only in the patients who had had a unilateral procedure was use of the compression device associated with significantly less edema postoperatively than was use of aspirin alone. The change between the preoperative and postoperative circumferences of the thigh and leg was significantly less (9 ± 4.1 millimeters [mean and standard deviation] less for the thigh [P < 0.01] and 6 ± 3.9 millimeters less for the leg [P < 0.049]) with the compression device than with aspirin alone. In addition, there was significantly less mean drainage (98 ± 61.1 milliliters) in the group treated with a unilateral procedure and pneumatic compression, compared with that treated with a unilateral procedure and aspirin alone (P < 0.041). An internal timer of the compression device was used to assess the compliance of the patient with use of the device, and a relationship between deep venous thrombosis and the total duration of treatment with the device was found. The patients in whom deep venous thrombosis did not develop used the device for a mean of 96 ± 23.4 hours (range, sixty to 164 hours) postoperatively, or 19.2 ± 5.1 hours a day, while those in whom thrombosis developed used it for a mean of 67 ± 21.1 hours (range, twenty-six to 101 hours), or 13.4 ± 4.3 hours a day (P < 0.001). No untoward effects were noted in any patient who used the device. This study confirms the safety and efficacy of pulsatile pneumatic plantar compression and aspirin compared with aspirin alone and supports the use of mechanical compression for prophylaxis against deep venous thrombosis and for reduction of edema in patients who have had a total knee arthroplasty. In addition, we found a direct relationship between compliance with the use of this device and its efficacy in reducing deep venous thrombosis.
Yagiela JA
Journal of the California Dental Association 23(10):29-40, 1995 Oct
The administration of antibiotics in dentistry to prevent systemic disease should be based on a rational consideration of both the anticipated benefits of such practice and the potential risks. In the case of patients susceptible to infective endocarditis, the routine use of prophylactic antibiotics is justified for high-risk patients and for procedures likely to cause significant bacteremia; in the case of patients with prosthetic joints, it is not.
Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA
Arthritis & Rheumatism 38(12):1819-25, 1995 Dec
Objective: To quantify potential risk factors for septic arthritis, in order to identify a basis for prevention.
Methods: The occurrence of potential risk factors for septic arthritis in patients with joint diseases attending a rheumatic disease clinic was prospectively monitored at 3-month intervals over a period of 3 years. Potential risk factors investigated were type of joint disease, comorbidity, medication, joint prosthesis, infections, and invasive procedures. The frequencies of risk factors in patients with and those without septic arthritis were compared using multiple logistic regression analysis.
Results: There were 37 patients with and 4,870 without septic arthritis. Risk factors for developing septic arthritis were age > or = 80 years (odds ratio [OR] = 3.5, 95% confidence interval [95% CI] 1.4-8.6), diabetes mellitus (OR = 3.3, 95% CI 1.1-10.1), rheumatoid arthritis (OR = 4.0, 95% CI 1.9-8.3), hip and/or knee prosthesis (OR = 15, 95% CI 4.1-54.3), joint surgery (OR = 5.1, 95% CI 2.2-11.9), and skin infection (OR = 27.2, 95% CI 7.6-97.1).
Conclusion: These findings indicate that preventive measures against septic arthritis in patients with joint diseases should mainly be directed at those with joint prostheses and/or skin infection.
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