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Hamburg, Germany

Mommsen P.,Hannover Medical School | Doering M.,ENDO Clinic Hamburg | Rohrs E.,ENDO Clinic Hamburg | Egidy C.,ENDO Clinic Hamburg | And 3 more authors.
Technology and Health Care | Year: 2014

BACKGROUND: Low-molecular-weight heparins (LMWH), e.g. enoxaparin, represent the standard thromboprophylactic agents in Europe after total hip replacement. The oral direct thrombin inhibitor dabigatran etexilate provides comparable effectiveness and safety. The present study aimed to evaluate the influence of dabigatran etexilate on perioperative blood loss and wound secretion in total hip arthroplasty compared to enoxaparin. METHODS: Patients receiving primary total hip replacement between January and June 2009 were included. The association between thromboembolism prophylaxis with dabigatran etexilate or enoxaparin and the perioperative blood loss was investigated. The effective blood loss (EBL) was calculated taking blood transfusions and the difference between preoperative haemoglobin and haemoglobin on the day of discharge into account. Additional comparison of wound secretion depending on thromboprophylactic agents was performed in a separate, prospectively collected patients' population. Statistical analysis was performed with χ ^{2}-Test, Student's t-test or Mann-Whitney U-test. Statistical significance was considered at p < 0.05. RESULTS: 198 patients (111 women, 87 men) with primary total hip arthroplasty were enrolled. Patients' mean age was 63.0 ± 11.9 years. Thromboembolism prophylaxis was performed in 111 patients (56.1%) with dabigatran etexilate, 87 patients (43.9%) received enoxaparin. No significant differences concerning EBL and wound secretion were found between both study groups. In the dabigatran etexilate group the EBL was 1.66 ± 0.56 l compared to 1.77 ± 0.65 l in patients with enoxaparin. CONCLUSIONS: Dabigatran etexilate can safely be used for thromboembolism prophylaxis after primary total hip replacement without an increased risk for perioperative blood loss and prolonged wound secretion. © 2014 - IOS Press and the authors.

Haasper C.,ENDO Clinic Hamburg | Kendoff D.O.,ENDO Clinic Hamburg | Gebauer M.,ENDO Clinic Hamburg | Zahar A.,ENDO Clinic Hamburg | And 3 more authors.
HSS Journal | Year: 2013

Adequate trauma of a well-fixed total hip prosthesis might cause relevant osseous injuries. Concomitant occult fractures of the implant itself are very rare. We report on two patients admitted to our institution and who were previously treated with similar types of short-stem total hip arthroplasty (THA). Both were unable to walk after an adequate trauma, although the initial admitting hospital misdiagnosed the exact diagnosis. Detailed reexamination later revealed a prosthetic neck fracture of the cement-free stem. Both patients were treated with a stem revision. In THA patient, special attention should be drawn to the implants after relevant trauma. A single examination shortly after trauma seems to be insufficient to diagnose implant-related injuries. A secondary follow-up several weeks after trauma, including at least X-rays, has to be recommended. © 2012 Hospital for Special Surgery.

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