Tyrimo objektas: tiriamųjų funkcinė būklė. Tyrimo tikslas: įvertinti skirtingų kineziterapijos programų poveikį pacientų, kuriems endoprotezuotas klubo sąnarys, funkcinei būklei. Hipotezė: kineziterapija salėje bei kineziterapija vandenyje turės didesnį poveikį pacientų, kuriems endoprotezuotas klubo sąnarys, funkcinei būklei, nei tik kineziterapija salėje. Uždaviniai: 1. Įvertinti pacientų, kuriems taikyta kineziterapija salėje, funkcinės būklės kaitą. 2. Įvertinti pacientų, kuriems taikyta kineziterapija salėje ir kineziterapija vandenyje, funkcinės būklės kaitą. 3. Palyginti skirtingų kineziterapijos metodų efektyvumą. Tyrimo metodika: Tyrimas atliktas VŠĮ ,,Tulpė“ ir AB Birštono sanatorija ,,Versmė“. Trisdešimt tiriamųjų – asmenų, kuriems buvo atliktas klubo sąnario endoprotezavimas, – suskirstyti atsitiktine tvarka į dvi grupes po 15 ligonių. Vienai grupei buvo taikoma kineziterapija salėje, o kitai grupei – kineziterapija salėje ir vandenyje. Taikant šias priemones buvo pildomas tyrimo protokolas reabilitacijos eigoje: 1. Skausmui vertinti naudota VAS skalė (analoginė skausmo skalė); 2. Klubo sąnario judesių amplitudei vertinti naudotas goniometras; 3. Šlaunies apimčiai išmatuoti naudota centimetrinė juostelė; 4 . Funkciniam mobilumui ir griuvimo rizikai nustatyti naudotas ,,Stoti ir eiti“ testas; 5. Klubo sąnario funkcijai nustatyti naudota Harris Hip skalė. Visi matavimai atlikti I-ą dieną atvykus ir po 18 reabilitacijos dienų. Įvertinus abiejų grupių tiriamųjų... [toliau žr. visą tekstą] / The object of the Thesis: functional state for persons with endoprosthetic hip joint. The aim of the Thesis: to assess the effect of different physiotherapy methods on the functional state for persons with endoprosthetic hip joint. Hypothesis: Physiotherapy combined with aquatic therapy had a greater impact on persons functional status than only physiotherapy in the gym. The tasks of the Thesis: 1. To assess the effect of physiotherapy on the functional state for persons with endoprosthetic hip joint. 2. To asses the effect of physiotherapy combined with aquatic therapy on the functional state for persons with endoprosthetic hip joint. 3. To compare the effectiveness of different physiotherapy methods. The methods of the Thesis: The study was performed in ,,Tulpė“ sanatorium and sanatorium ,,Versmė“ in Birštonas. Thirty research subjects - persons with endoprosthetic hip joint – were randomly divided into two groups with 15 patients in each. One group received physiotherapy, the other – physiotherapy compared with aquatic therapy. While applying these modalities, a research protocol was completed during the rehabilitation: 1. VAS scale to assess pain; 2. Goniometer was used to assess the range of hip joint motions; 3. Measuring tape was used to assess thigh volume; 4. ,,Stand up and go“ test was used to assess functional mobility and risks of falls; 5. Harris Hip scale was used to assess joint function. All measurements were performed 1 day after arrival and 18 day after... [to full text]

New surgical approaches for total hip arthroplasty (THA) are being developed to reduce muscle damage sustained during surgery, in the hope to allow better muscle functioning afterwards. The goal of this study was to compare the muscle sparing anterior (ANT) approach to a traditional lateral (LAT) approach with three-dimensional motion analysis. Kinematics and kinetics were obtained with an infrared camera system and force plates. It was hypothesized that (1) the ANT group would have closer to normal range of motion, moments and powers, compared to the LAT group, and that (2) the ANT group would have higher peak hip abduction moment than the LAT group. Forty patients undergoing unilateral THA for osteoarthritis between the ages of 50 and 75 (20 ANT, 20 LAT) were asked to perform three trials of walking, stair ascent and stair descent. Patients were assessed between six to twelve months postoperatively. Twenty age- and weight-matched control participants (CON) provided normative data. Results indicated that both THA groups had gait anomalies compared to the CON group. Both THA groups had reduced hip abduction moment during walking (CON vs. ANT: p<0.001; CON vs. LAT: p=0.011), and the ANT group had a significantly lower hip abduction moment compared to the LAT group (p=0.008). Similar results were observed during stair descent, where the ANT group had reduced peak hip abduction moment compared to the CON group (p<0.001) and the LAT group (p=0.014). This indicates that the anterior approach did not allow better gait and stair climbing ability after THA. It is therefore thought that other variables, such as preoperative gait adaptations, trauma from the surgery, or postoperative protection mechanisms to avoid loading the prosthetic hip, are factors that might be more important than surgical approach in determining the mechanics of THA patients after surgery.

Bakgrund: Primär total höftplastik utförs vanligtvis på patienter med höftledsartros när konservativ behandlings smärtlindrande effekter inte är tillräckliga. Efter ingreppet kan postoperativa rörelserestriktioner tillämpas för att minska luxationsrisken. Rörelserestriktionerna har emellertid ifrågasatts då studier visat att något samband mellan tillämpande av restriktioner och minskad risk för luxation inte föreligger. Syfte: Kartlägga tillämpande av postoperativa rörelserestriktioner vid svenska sjukhus som genomför primär total höftplastik med direktlateralt snitt samt undersöka skillnader mellan universitets-/regionsjukhus, länssjukhus, länsdelssjukhus och privatsjukhus avseende tillämpandet av restriktioner. Studien syftade även till att kartlägga icke-standardiserade restriktioner. Metod: Tvärsnittsstudie med en deskriptiv och komparativ studiedesign. Totalt svarade 42 sjukhus på en egenkonstruerad webbenkät som utgjorde underlaget för datainsamlingen. Resultat: Vilka postoperativa restriktioner som tillämpades för flexion över 90°, utåtrotation över 45°, inåtrotation över 45°, adduktion över neutralläge samt flexion över 90° kombinerat med samtidig rotation och adduktion varierade på de deltagande sjukhusen. Det förelåg inga signifikanta skillnader mellan sjukhusgrupperna gällande nämnda rörelser. Flera sjukhus tillämpade icke-standardiserade restriktioner baserade på patients individuella förutsättningar samt kunde variera beroende på protestyp. Även rekommendationer om att undvika extrema rörelser förekom. Konklusion: Det är en variation gällande vilka restriktioner som tillämpas efter primär total höftplastik. Med hänsyn till denna studies resultat samt aktuell evidens bör postoperativa restriktioner fortsatt diskuteras. / Background: Total hip arthroplasty (THA) is commonly performed on patients with hip osteoarthritis when conservative treatment no longer reliefs pain sufficiently. Movement restrictions are applied to prevent hip dislocations, although those have recently been questioned since studies have shown that a liberal regimen does not increase the risk of hip dislocation. Purpose: To chart movement restrictions following THA performed with a direct lateral approach at Swedish hospitals and analyzes differences in those between university hospital, county hospitals, district hospitals and private hospitals. This study also aimed to chart non- standardized movement restrictions. Method: A cross-sectional study with a descriptive and comparative design. Data was collected from a self-made web survey, which was answered by 42 hospitals. Results: The appliance of restrictions regarding flexion beyond 90°, external rotation beyond 45°, internal rotation beyond 45°, adduction beyond centerline and flexion of 90° or beyond combined with adduction and rotation varied among the participating hospitals. There were no significant differences between participating hospital groups regarding mentioned movements. Non-standardized restrictions were influenced by the individual factors of the patient as well as the prosthesis type. Patients were also recommended to not perform any extreme movements. Conclusion: There is a variation regarding appliance of postoperative restrictions during the first six weeks postoperatively. In the light of the results of this study, together with recent evidence postoperative, restrictions should be further discussed.

Introdução: Com o desenvolvimento das artroplastias não cimentadas, estudos vêm sendo realizados com o objetivo de se determinar se as hastes femorais não cimentadas poderiam ser utilizadas em qualquer paciente,ou estaria reservada apenas para aqueles que possuem boa qualidade óssea. Um estudo comparativo é realizado para avaliar a osteointegração de hastes femorais não cimentadas nas artroplastias totais de quadril em pacientes que apresentam má qualidade óssea, comparando com pacientes que apresentam boa qualidade óssea. Materiais e métodos: Este estudo inclui 196 pacientes submetidos à artroplastia total do quadril primária não cimentada por diagnóstico de osteoartrite primária e secundária com no mínimo de 12 meses de seguimento, divididos em dois grupos: um contendo pacientes com boa qualidade óssea (DorrA); e outro com pacientes com má qualidade óssea (Dorr B e C). Foi avaliada a osteointegração através da análise radiográfica seguindo os critérios estabelecidos por Engh, além de avaliar o resultado clínico e funcional através do questionário de WOMAC. Foram também avaliadas as complicações decorrentes do processo cirúrgico em ambos os grupos. Resultados:Há diferença na frequência do gênero no grupo Má Qualidade Óssea (MQO) (p=0,009) com predomínio de mulheres e diferença no diagnóstico inicial,havendo um número maior de casos de patologias reumatológicas e sequelas de displasia no grupo MQO (p=0,0002). Não observamos diferença quanto a idade, lado operado e tempo de seguimento entre os dois grupos. Não observamos diferença entre os grupos quando avaliado o escore clínico, a osteointegração ou a necessidade de revisão. Observamos um maior risco de fratura intraoperatória do fêmur proximal no grupo MQO (p=0.03) comparando-se com o grupo Boa Qualidade Óssea (BQO). Conclusão: Concluímos que as hastes femorais não cimentadas osteointegram igualmente, independentemente da qualidade óssea do paciente e que fraturas intraoperatórias ocorrem mais quando realizadas hastes femorais não cimentadas em pacientes com má da qualidade óssea / Introduction: With the development of the non cemented total hip replacement, many studies were carried out to determinate if uncemented femoral stem can be used in every patient, or if this kind of implants are reserved for those patients with good bone quality. A comparative study was carried out to evaluate the osseointegration of uncemented femoral stem in total hip replacements in patients that have poor bone quality, comparing with patients that have good bone quality. Methods: The study included 196 cases of primary uncemented total hip arthroplasties due to a diagnosis of primary or secondary osteoarthritis, with a minimum of 12 months of follow-up, divided in two groups: one with patients that have good bone quality (Type A Dorr), and another with patients that have poor bone quality (Types B and C Dorr). Osseointegration was evaluated by X ray analysis, following the Engh\'s criteria. Clinical and functional results were also evaluated by the application of the WOMAC questionnaire, and complication in both groups were reported. Results: Regarding our patient\' gender, we observed a significant difference between the two groups: there was more women in the group of Poor Bone Quality (PBQ) (p=0,009). We also observed a significant difference in the initial diagnosis of the patients: there was more osteoarthritis secondary to rheumatic pathologies and hip dysplasia in the PBQ group (p=0,0002). There was no difference when observed the mean age, operation\' side and mean time of follow-up between the two groups. We also did not observed differences between the groups when evaluated the clinical scores, the osseointegration of the femoral stem and the need of revision of the arthroplasty by any reason. But, in the PBQ, we observed a higher risk of intra operative fracture in the proximal femur compared with the group Good Bone Quality (GBQ) (p=0,03). Conclusion: We concluded that the uncemented femoral stem has an equal rate of osseointegration, despite the bone quality and that there is a higher risk of intra operative fracture when implanted an uncemented femoral stem in bone with poor quality

Orientador: Maria Jose D'Elboux / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T11:56:56Z (GMT). No. of bitstreams: 1 Rampazo-Lacativa_MarianaKatia_M.pdf: 2793177 bytes, checksum: 7f2d1a73d29dbd1e5e1e6ab93f84eecd (MD5) Previous issue date: 2008 / Resumo: Este estudo teve como objetivo avaliar a qualidade de vida relacionada à saúde (QVRS) de idosos com artroplastia total de quadril (ATQ) por meio de um instrumento genérico e outro específico e investigar a influência de variáveis sociodemográficas, clínicas e funcionais desses sujeitos. Fizeram parte deste estudo 88 idosos com 60 anos ou mais, de ambos os gêneros, submetidos à ATQ primária, unilateral, há no mínimo seis meses, em dois hospitais de referência do interior de São Paulo. Os dados foram obtidos por meio da aplicação de quatro instrumentos: 1. questionário para a caracterização sociodemográfica, clínica e relacionada a ATQ; 2. questionário de avaliação funcional do quadril - Harris Hip Score (HHS); 3. instrumento genérico de avaliação da QVRS The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e 4. instrumento específico Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Os dados foram submetidos à análise estatística descritiva, efeitos teto e chão, de confiabilidade por meio do alfa de Cronbach, de variância univariada (ANOVA) e multivariada (MANOVA) e de comparação por meio dos testes de Mann-Whitney e Kruskal-Wallis. A amostra estudada teve predomínio das mulheres e a média de idade foi de 68,8(±7,4) anos. Os escores dos instrumentos de avaliação da QVRS demonstraram que as questões de natureza física afetaram mais a qualidade de vida desses idosos. A confiabilidade foi satisfatória para ambos instrumentos, com Alpha de Cronbach > 0,70, exceto na dimensão rigidez do WOMAC. O efeito teto foi exibido em alguns domínios tanto do WOMAC quanto do SF-36. De acordo com a MANOVA, a variável função do quadril, avaliada pelo HHS, foi a variável que apresentou influência significativa na QVRS sob a perspectiva dos instrumentos genérico e específico. As variáveis: uso de acessórios para a locomoção, função do quadril e satisfação com a cirurgia foram as variáveis que apresentaram diferenças significativas relevantes nas dimensões do SF-36 e do WOMAC. Os resultados evidenciam que os instrumentos SF-36 e WOMAC são adequados para avaliar a QVRS nesse grupo de idosos, porém apresentam algumas limitações. Por fim, sugere-se que ações que otimizem o status funcional possam contribuir para melhorar a QVRS dos idosos com ATQ. / Abstract: This study it had as objective to evaluate the Health-Related Quality of Life (HRQL) of elderly with Total Hip Arthroplasty (THA) by means of a generic instrument and another specific one and to investigate the influence of variable sociodemografics, clinical and functional of these citizens. It had been part of this study 88 aged ones with 60 years or more, of both the sorts, submitted the THA primary, unilateral, at least has six months, in two hospitals of the interior of São Paulo. The data had been gotten by means of the application of four instruments: 1. questionnaire for the characterization socio-demographic, clinical and related the THA; 2. questionnaire of functional evaluation of the hip - Harris Hip Score (HHS); 3. generic instrument of evaluation of the HRQL The Medical Study 36-item Short-Form Health Survey (SF-36) and 4. the specific Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The data had been submitted to the analysis descriptive statistics, ceiling and floor effects, of trustworthiness by means of the alpha of Cronbach < 0,70, variance univariada (ANOVA) and multivaried (MANOVA) and of comparison by means of the tests of Mann-Whitney and Kruskal-Wallis. The studied sample had predominance of the women and the age average was of 68,8 (±7,4) years. The scores of the instruments of the evaluation of HRQL had demonstrated that the questions of physical nature had affected more the quality of life (QoL) of these elderly. The reliability was satisfactory for both instruments, with Alpha de Cronbach > 0,70, except in the dimension stiffness of the WOMAC. The effect ceiling was shown in some domains in such a way of the WOMAC as well of the SF-36. According to MANOVA the variable function of the hip, evaluated for the HHS, was the variable that presented significant influence in the HRQL under the perspective of the instruments generic and specific. The variables: use of accessories for the locomotion, function of the hip and satisfaction with the surgery had been the variables that had presented excellent significant differences in the dimensions of the SF-36 and the WOMAC. The results evidence that instruments SF-36 and WOMAC are adjusted to evaluate the HRQL of elderly patients with THA, but present some limitations. Therefore, one suggests that actions that optimize the functional status can contribute to improve the HRQL of the aged ones with THA. / Mestrado / Mestre em Gerontologia

Orientador: Maria Jose D'Elboux / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Enfermagem / Made available in DSpace on 2018-08-25T01:39:10Z (GMT). No. of bitstreams: 1 Rampazo-Lacativa_MarianaKatia_D.pdf: 3832763 bytes, checksum: 74508e760d038080210f9abd42778325 (MD5) Previous issue date: 2014 / Resumo: Com a crescente população idosa, a artroplastia total de quadril (ATQ) é um tratamento cada vez mais comum para pacientes idosos com osteoartrite do quadril. Os efeitos de várias estratégias de reabilitação no pós-operatório desta cirurgia devem ser melhor compreendidos quando voltadas para pacientes idosos. O presente estudo teve como objetivo avaliar o efeito do exercício no cicloergômetro associado aos exercícios convencionais no desempenho funcional e na qualidade de vida relacionada à saúde de idosos submetidos à artroplastia total de quadril. Este estudo é classificado como um ensaio clínico aleatorizado, com grupos paralelos. Os pacientes com 60 anos ou mais submetidos à ATQ, primária e unilateral, devido à osteoartrite do quadril, foram consecutivamente, aleatorizados em dois grupos. O Grupo 1 (n = 8) realizou reabilitação por meio de exercício no cicloergômetro associado aos exercícios convencionais e o Grupo 2 (n = 7) realizou somente o programa de exercícios convencionais no pós-operatório. As sessões foram iniciadas após a segunda semana de pós-operatório, duas vezes por semana, durante 8 semanas. As medidas de desfecho primário incluiram a função do quadril avaliada pelo Harris Hip Score (HHS) e a avaliação do desempenho físico pelo Short Physical Performance Battery (SPPB), que engloba testes de equilíbrio, da velocidade da marcha e de força nos membros inferiores. A qualidade de vida relacionada à saúde foi considerada o desfecho secundário, sendo utilizado o questionário genérico: The Medical Outcomes Study 36 -Item Short-Form Health Survey (SF- 36) e o específico: Western Ontario e McMaster Universities Osteoartrite Index (WOMAC). As avaliações foram realizadas antes e após as intervenções, além do acompanhamento por seis meses após a cirurgia (24 semanas de pós-operatório). Os resultados são apresentados no formato de dois artigos. O Artigo 1 refere-se ao protocolo de estudo do ensaio aleatorizado e o Artigo 2 contempla a aplicação das intervenções propostas no protocolo. Nesse último, os resultados mostraram que os dois grupos melhoraram após as intervenções. No entanto, os idosos do Grupo 1, obtiveram significativamente melhores resultados comparados com seus pares do Grupo 2 para as medidas do HHS: função, escore total do SPPB, bem como, nos teste de equilíbrio, velocidade da marcha do mesmo, além da dimensão atividade física do WOMAC (P < 0,05). Não foram encontradas diferenças significativas entre os grupos no teste de força muscular dos membros inferiores do SPPB, nas dimensões dor e rigidez do WOMAC e nas dimensões do SF-36. Este estudo mostrou que a reabilitação por exercício no cicloergômetro associado aos exercícios convencionais pode ser uma estratégia mais eficaz para a recuperação do desempenho funcional e físico de idosos, após a artroplastia total de quadril. (Registro: NCT01622465) / Abstract: Following the growing of elderly population, the total hip arthroplasty is an increasingly common treatment for elderly patients with hip osteoarthritis. The effects of various rehabilitation strategies in the postoperative phase of this surgery should be better understood when targeting elderly patients. This study aimed to evaluating the effect of the exercise on cycle ergometer associated with conventional exercises on the functional performance and health-related quality of life in older people undergoing total hip arthroplasty. This study is classified as a randomized clinical trial with parallel groups. Patients aged 60 years or older undergoing primary unilateral THA, due to osteoarthritis of the hip, were consecutively assigned into two groups, randomically. The Group 1 (n = 8) performed exercise on cycle ergometer associated with conventional exercises and the group 2 (n = 7) performed the conventional exercises program, carried out during the postoperative phase. The reahabilitation sessions began after the second week of the postoperative phase and they were performed twice a week, for eight weeks. The primary outcome measures included hip function assessed by Harris Hip Score (HHS) and the evaluation of physical performance by the Short Physical Performance Battery (SPPB), which includes balance, gait speed and strength of the lower limbs tests. The health-related quality of life was considered a secondary outcome and it was assessed both by the generic questionnaire - Medical Outcomes Study 36 - Item Short - Form Health Survey (SF -36), and the specific one - Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The evaluations were performed before and after rehabilitation interventions, in addition to six-month follow-up after surgery (24 weeks postoperative). The results are presented in format of two articles. Article 1 refers to the study protocol of the randomized trial, and Article 2 contemplates the implementation of the proposed interventions in the protocol. The results showed that after interventions both groups improved. However, the elderly in Group 1 presented significantly better results compared to their peers in Group 2 regarding the following variables: HHS function, total score of the SPPB and on tests of balance and speed gait, and on the WOMAC physical activity dimension (P < 0.05). No significant differences between groups were found in the lower limb muscle strength test of the SPPB, in the pain and stiffness dimensions of the WOMAC and in the SF-36. This study showed that the rehabilitation exercise on cycle ergometer associated with conventional exercises can be a more effective strategy for the recovery of functional and physical performance in elderly patients after total hip arthroplasty. (Registration: NCT01622465) / Doutorado / Enfermagem e Trabalho / Doutora em Ciências da Saúde

Class of 2013 Abstract / Specific Aims:  To determine the efficacy of apixaban when compared to LMWH (enoxaparin) when used as thromboprophylaxis for patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA), and medically ill patients  To determine the safety of apixaban when compared to LMWH (enoxaparin) when used as thromboprophylaxis for patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA), and medically ill patients Methods: A systematic search of the literature for randomized controlled trials of apixaban thromboprophylaxis therapy versus enoxaparin was conducted using three databases: PubMed, EMBASE, and the Cochrane library. Data from five studies with 12,938 total patients were analyzed using Bayesian random effects meta-analysis. To evaluate efficacy, a composite of venous thromboembolism and death during follow-up was measured. To evaluate safety, major and total bleeding events were considered. Main Results: The odds ratio (OR) for the composite outcome of thromboembolism/death was 0.66 (95% CI: 0.33 to 1.29) for apixaban compared to enoxaparin, while there was a similar risk of major bleeding (OR=1.03, 95%CI: 0.36 to 3.73) and total bleeding (OR=0.92, 95%CI: 0.64 to 1.20). Conclusion: These results suggest a lack of clear superiority of apixaban relative to enoxaparin. Apixaban is an oral alternative with similar efficacy and safety to existing anticoagulant therapies.

New surgical approaches for total hip arthroplasty (THA) are being developed to reduce muscle damage sustained during surgery, in the hope to allow better muscle functioning afterwards. The goal of this study was to compare the muscle sparing anterior (ANT) approach to a traditional lateral (LAT) approach with three-dimensional motion analysis. Kinematics and kinetics were obtained with an infrared camera system and force plates. It was hypothesized that (1) the ANT group would have closer to normal range of motion, moments and powers, compared to the LAT group, and that (2) the ANT group would have higher peak hip abduction moment than the LAT group. Forty patients undergoing unilateral THA for osteoarthritis between the ages of 50 and 75 (20 ANT, 20 LAT) were asked to perform three trials of walking, stair ascent and stair descent. Patients were assessed between six to twelve months postoperatively. Twenty age- and weight-matched control participants (CON) provided normative data. Results indicated that both THA groups had gait anomalies compared to the CON group. Both THA groups had reduced hip abduction moment during walking (CON vs. ANT: p<0.001; CON vs. LAT: p=0.011), and the ANT group had a significantly lower hip abduction moment compared to the LAT group (p=0.008). Similar results were observed during stair descent, where the ANT group had reduced peak hip abduction moment compared to the CON group (p<0.001) and the LAT group (p=0.014). This indicates that the anterior approach did not allow better gait and stair climbing ability after THA. It is therefore thought that other variables, such as preoperative gait adaptations, trauma from the surgery, or postoperative protection mechanisms to avoid loading the prosthetic hip, are factors that might be more important than surgical approach in determining the mechanics of THA patients after surgery.

The development of total hip arthroplasty has reached a state when quality prostheses are made, whose longevity is influenced significantly by material properties, design, component fixation and rate of wear of the articulating surfaces. It is the wear rate which is the most important factor influencing successful results for the use of total hip prostheses. The aim of this thesis is to perform a research on the various combinations of hip prostheses and its loading conditions. Also an experimental measurements of Bovine serum lubricating film thickness between the artificial femoral head and a glass disc are performed for different contact kinematic conditions.

Study Objective Although data from the Regulation of Coagulation in Orthopedic Surgery to Prevent Deep Venous Thrombosis and Pulmonary Embolism (RECORD) 1-4 trials have shown a similar postoperative bleeding risk between rivaroxban and enoxaparin in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), anecdotal observations from local institutions have suggested that postoperative bleeding rates seemed higher in patients who received rivaroxaban than those reported in the RECORD trials. Thus, the objective of this pilot study was to assess postoperative bleeding events observed in clinical practice in patients receiving rivaroxaban after undergoing THA and TKA and to compare their results with those published in the RECORD trials. Design Retrospective cohort study with a comparator group of patients from the RECORD 1-4 trials. Setting Two institutions within a regional health care system. Patients Four hundred forty adults who received at least one dose of rivaroxaban 10 mg daily after undergoing THA or TKA in the two institutions between August 2011 and October 2013 (cohort group), and 6183 patients who received rivaroxaban in the RECORD 1-4 trials (comparator group). Measurements and Main Results Postoperative bleeding was assessed in the cohort patients versus the patients in the RECORD trials. The primary outcome, occurrence of any postoperative bleeding, was a composite of major and clinically relevant nonmajor bleeding as defined in the RECORD trials. Any postoperative bleeding occurred in 6.8% of the cohort patients versus 3.2% of the RECORD trial patients (p<0.0001); 1.4% of the cohort patients versus 0.38% of the RECORD trial patients suffered a major bleed (p=0.013). Within defined major bleeding, bleeding leading to reoperation and clinically overt extrasurgical site bleeding resulting in either a hemoglobin level decrease of at least 2 g/dl or transfusion of 2 units or greater of packed red blood cells were reported in 0.68% versus 0.19% (p=0.073) and 0.68% versus 0.13% (p=0.032), respectively, of the cohort patients versus the RECORD trial patients. Conclusion Overall, any postoperative bleeding in the cohort patients occurred significantly more frequently than that observed in the RECORD trial patients. The major bleeding rate was also significantly higher in the cohort patients, influenced by higher rates of bleeding leading to reoperation and clinically overt extrasurgical site bleeding resulting in either a hemoglobin decrease of at least 2 g/dl or transfusion of two units or greater of packed red blood cells. These findings from our pilot study are thought provoking and, thus, invite further investigation.