Relevance. The frequency of surgical diseases of large joints of the lower extremities currently has a clear tendency to increase. This pathology occurs in 7-12% of the world's population, and in people over 60 years old, its probability approaches 100%. The hip joint is most often affected - in more than half of the cases[1]. Despite the fact that joint replacement of large joints belongs to operations of the highest category of complexity and significant surgical risk, up to 1.5 million operations for total joint replacement of large joints are performed annually in the world[2]. Against this background, the growth of postoperative complications is inevitable. These can be intraoperative complications, general somatic complications, specific local complications, as well as late complications developing in the long term after surgery[3,4].
Goal: Analysis of general somatic complications (disorders of the blood coagulation system, gastrointestinal bleeding, acute ulcers of the stomach and intestines, intestinal obstruction, etc.) occurring in the early postoperative period after total hip and knee replacement.
Materials and methods. A retrospective analysis of the medical histories of 322 patients operated on in trauma department No. 3 of the 6th City Clinical Hospital of Minsk in 2015 was conducted. They underwent total hip and knee replacement for degenerative-dystrophic changes in the joints, as well as changes caused by rheumatoid conditions, post-traumatic changes, etc. 264 (81.9%) patients were operated on as planned, 58 (18.1%) on an emergency basis. Of these, 212 (65.8%) were operated on at the age of 60 years and older. Patients did not undergo any special preoperative preparation. Anamnestic data and outpatient examination materials were taken into account.
Total replacement of large joints was performed under general or spinal anesthesia. After surgery, all patients received anticoagulants from the group of low molecular weight heparins prophylactically.
Results and discussion. In the early postoperative period, 26 (8.07%) patients had complications. Among them:
- disorders of the blood coagulation system (phlebothrombosis of deep vessels of the legs) - 8 (2.5%);
- gastrointestinal bleeding - 7 (2.2%);
- acute intestinal ulcer with perforation – 1 (0.3%);
- impaired intestinal passage of dynamic nature (gastro-duodenostasis, dynamic intestinal paresis, coprostasis) - 6 (1.9%);
- others (cholecystitis, acute urinary retention) - 4 (1.24%).
Acute gastrointestinal bleeding after surgery was confirmed clinically and endoscopically in 7 patients. In 3 of them, signs of bleeding in the form of hemorrhagic gastritis were found, and in 4 patients, multiple flat subepithelial bleeding mucosal defects with a diameter of 1–3 mm with slight perifocal inflammatory reaction were detected.
All patients with complications identified in the postoperative period were given adequate treatment in the intensive care unit. For gastrointestinal bleeding, in 6 out of 7 patients, bleeding was stopped endoscopically, 1 was operated on. Another patient was operated on for acute intestinal ulcer with perforation. Patients with other complications were treated conservatively.
Conclusions.
- Postoperative complications in patients undergoing TJA represent an important problem requiring a systematic approach at all stages of treatment.
- There is a need to develop an algorithm for preoperative management of patients with surgical pathology of large joints.
- To improve the results of surgical treatment of patients with TJA of large joints, it is necessary to develop tactics for the use of anticoagulant therapy to prevent thromboembolic complications and coagulopathies.
Literature
- Prokhorenko V. M. Primary and revision hip replacement. Novosibirsk: NIITO; 2007. 348 p.
- Giles R., Scuderi A. (ed.) Minimally invasive interventions in orthopedics. M.: BINOM; 2014; vol. 1. 408 p.
- Errors, hazards and complications in hip replacement and their prevention: guidelines. St. Petersburg: PPMI; 1995. 24 p.
- Bulych P.V., Kosyakov A.N., Babich N.V. Ulcerative lesions of the stomach and duodenum in the practice of joint replacement. Klinichna khirurgiya. 2008; 1(778); 49-52.
