PURPOSE OF THE STUDY: Aprotinin is a non-specific inhibitor of serine proteases with hemostyptic and hemostatic properties. The effect covers suppression of fibrinolysis and support of the role of thrombocytes in coagulation. In a prospective randomized study we verified whether the application of aprotinin (Antilysin Spofa, Czech Republic) in the dosage effective in cardiosurgical patients reduces blood loss and the need for blood transfusion for orthopaedic patients. MATERIAL: 42 patients indicated to the primary THA were randomly selected into the study and control groups. Excluded were allergic patients and those who used aprotinin before. METHODS: Administration of 2.10(6) KIU of aprotinin was started preoperatively and is continued in the course of the first hour of surgery. In the operated on patients we recorded prior to operation and in the first post-operative morning the level of hemoglobin in blood and hematocrit, the number of infusions and blood transfusion units administered in the course of the surgery and in the post-operative period until the first post-operative morning. We recorded blood loss in the period between the surgery and the first post-operative morning. Data acquired in the patients of the studied and control groups were compared by means of ANOVA test for repeated measuring and with the use of Mann-Whitney and chi 2-test, the level of significance p < or = 0.05. During the hospitalization we the patients were checked for symptoms of deep venous trombosis and tromboembolic or other adverse events. RESULTS: Hemoglobinemia and hematocrit in both groups significantly decreased after the operation (p < 0.0005), the differences between the studied and control groups were not significant. The number of administered blood units did not differ in the examined and control groups. The frequency of blood transfusions was postoperatively higher in the control group (59.1% as compared to 30%), however, the difference was not statistically significant (p = 0.059). Blood loss in the post-operative period was higher in the control group (p = 0.048). Patients from the control group got in total blood transfusion more frequently (p = 0.032). Differences in the total frequency of blood transfusion and in the amount of post-operative blood loss were statistically significant. In the course of hospitalisation no signs of deep phlebothrombosis or thromboembolic condition were encountered in either group of patients. Complications were not recorded. DISCUSSION: Our results correspond with most of the published data. Blood loss of the operated on patients who were administered prior to and at the beginning of the operation in total 2.10(6) KIU of aprotinin (Antilysin Spofa) in infusion was on average by 33% less in the post-operative period and in the whole peropetive period they required less frequently blood transfusion (40% vs 73%). CONCLUSION: Infusion of aprotinin (Antilysin Spofa) in the dosage of the order of 106 KIU significantly reduces post-operative blood loss and frequency of transfusion in the peroperative period in patients undergoing THA.

• MeSH
• aprotinin terapeutické užití   MeSH
• hemostatika terapeutické užití   MeSH
• inhibitory serinových proteinas terapeutické užití   MeSH
• krvácení při operaci prevence a kontrola   MeSH
• lidé MeSH
• náhrada kyčelního kloubu * MeSH
• pooperační krvácení prevence a kontrola   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• klinické zkoušky MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• aprotinin MeSH
• hemostatika MeSH
• inhibitory serinových proteinas MeSH

PURPOSE OF THE STUDY: To present the first 3-5 year experience in primary implantation of the Ultima cementless hemispherical threaded cup. MATERIAL: In the period between October 1995 and June 1997 we implanted in total 30 Ultima cementless cups in 28 patients (10 men, 18 women). The average age of the operated on was 60 years (41-74 years). Twenty-four patients, i.e. 26 hips were available for the follow up. From the viewpoint of diagnosis the group of patients included 15 cases of primary osteoarthritis, 9 cases of acute intracapsular femoral neck fracture, 3 cases of postdysplastic osteoarthritis, 2 cases (1 female patient with bilateral affection) of rheumatoid osteoarthritis (RA) accompanied with the protrusion of acetabulum and 1 case of idiopathic necrosis of the head. METHODS: The average follow up was 39 months (31-51 months). Subjectively, we followed the patients' satisfaction with the result of the surgery, i.e. subsidence of pain, range of motions and the willingness to undergo the surgery once more on the basis of its result. Radiologically, we assessed the shape of acetabulum prior to operation, the position of the implanted cup in ap projection on the postoperative radiograph, on the last control radiograph we evaluated osteointegration of the cup and also potential particular ossification. RESULTS: Nineteen patients out of 24 were subjectively satisfied with the result of the operation. The primary shape of acetabulum was in 24 cases spherical, 4 times dysplastic slightly lower CE (Wiberg) angle and twice there occurred protrusion of the head (the female patient with RA). The position of the cup in ap projection was evaluated in 25 cases as correct (45 degrees declination), in 2 cases as valgus (more than 55 degrees declination), in 3 cases as varus (less than 35 degrees declination) and in 1 case the cup was inserted too deep. Osteointegration was evaluated in 25 cases. In 22 cases we considered the osteointegration as good, i.e. without signs of a radioluscent line around the circumference of the cup. This line we encountered in 2 patients around the whole circumference of the cup but without any signs of a change in the position of the cup and without subjective complaints (pain in the hip). Both patients operated on for the primary osteoarthritis had a spherical shape of acetabulum and the declination of the cup was assessed as satisfactory. In 1 case we had to re-operate on due to the migration of the cup in the pelvis, namely in the female patient with RA and bilateral affection. The migration occurred on the left side 2.5 year after the primary surgery. Particular ossification was encountered 3 times, one case required extirpation. Complications were recorded in 8 patients. In one case the lateral cortex was peroperatively perforated by the stem of the femoral component. In another patient with a dysplastic acetabulum the cup was inserted to deep in the medial wall of the acetabulum. In the third patient the greater trochanter got broken, remained displaced and only the ligaments healed. Early postoperative complications were recorded twice. In one case it was a serous secretion from the wound which subsided after a few days without the necessity of revision. Revision was required in the second case when the R-drainage broke in the course of its removal. Late complications occurred in 3 patients. In one case there developed a mitigated infection requiring revision surgery, in case of the female patient with RA the cup protruded in the pelvis which necessitated a revision surgery. DISCUSSION: So far there are no literary data on this type of cup. The only existing information relates to the preceding type of a similar design, i.e. Mecring cup, which failed. CONCLUSION: Despite relatively good but short-term results of this small series the unusual design of the Ultima hemispherical threaded cup requires a great prudence in its application and additional long-term follow-up. Therefore the cup cannot be recommended for a regular use for the time being.

• MeSH
• cementování * MeSH
• dospělí MeSH
• kyčelní protézy * MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu * MeSH
• selhání protézy MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• práce podpořená grantem MeSH