Does venous thromboembolism prophylaxis affect the risk of venous thromboembolism and adverse events following primary hip and knee replacement? A retrospective cohort study

Preoperative Use of Aspirin in Total Knee Arthroplasty: Safe or Not?

OBJECTIVE

To compare the blood loss, transfusion rates and complications between the aspirin and non-aspirin group in unilateral and bilateral total knee arthroplasties (TKAs) with a nested case-control design.

METHODS

The present study retrospectively selected TKA cases from the Joint Arthroplasty Database at the Peking Union Medical College Hospital from January 2014 to December 2019 following strict inclusion and exclusion criteria, and divided them into the aspirin and non-aspirin group based on the use of aspirin preoperatively. Bleeding was measured by blood loss, transfusion rate, drainage volume, hemoglobin (HGB) and hematocrit (HCT), while complications (cardiovascular events, venous thromboembolism events, cerebrovascular events and wound events) were compared between the groups. Student's unpaired t-test and Mann-Whitney U-test were used to compare the differences of continuous variables between the two groups while chi-square test and Fisher's exact test were applied in categorical variables.

RESULTS

A total of 560 patients with unilateral TKA and 285 patients with bilateral TKA were extracted. Among these, 280 patients used aspirin preoperatively. No other differences were found in demographic and surgical characteristics between the two groups except for the proportion of coronary artery diseases (P < 0.001). For primary outcomes, there was no significant higher blood loss and transfusion rate in the aspirin group, while the drainage of aspirin group was higher than the control group in bilateral TKAs (P = 0.043). The HGB and HCT of the aspirin group was significant lower in both unilateral and bilateral TKAs at POD5 (P < 0.05). For complications, there was a lower vascular related complication rate in aspirin group after unilateral TKAs (P = 0.040), but the wound event rate in aspirin group was higher than the control group (P = 0.049).

CONCLUSIONS

Preoperative use of aspirin could prevent vascular related events during the perioperative period of TKA. However, it might also increase the risk of bleeding and wound complications.

Effects of Incontro, Alleanza, Responsabilita, Autonomia Intervention Model Combined with Orem Self-Care Model and the Use of Smart Wearable Devices on Perceived Stress and Self-Efficacy in Patients after Total Hip Arthroplasty

Objective

To explore the effects of Incontro, Alleanza, Responsabilita, Autonomia (IARA) combined with Orem self-care model and the use of smart wearable devices on perceived stress and self-efficacy in patients after total hip arthroplasty (THA).

Methods

A total of 60 patients after THA in our hospital were enrolled. Patients were randomly divided into control group (IARA intervention model combined with Orem self-care model) and study group (intelligent wearable device combined conference-IARA and Orem self-care model). Harris hip function score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, functional independence measure (FIM) score, social support level, perceived stress, and self-efficacy were compared between the two groups.

Results

Harris hip function score, WOMAC score, FIM score, and the level of social support of the study group were higher compared with the control group after operation (P < 0.05). Additionally, the perceptual pressure in the study group was lower compared with the control group after intervention (P < 0.05). The self-efficacy of the two groups was compared, and the self-efficacy of the study group was higher than that of the control group at 4, 6, 8, and 12 weeks after the intervention, and the difference was statistically significant (P < 0.05).

Conclusion

Patients after THA utilize an intelligent wearable device combined with IARA model and Orem self-care model, which can effectively reduce awareness pressure, improve self-efficacy, and facilitate the improvement of the hip fracture.

Effect of Rehabilitation Nursing under the Guidance of the Health Action Process Approach Model on Perioperative Nursing Effect of Artificial Hip Arthroplasty: Effect on Promoting Quality of Life and Postoperative Rehabilitation

Objective

To explore the influence of rehabilitation nursing under the guidance of Health Action Process Approach (HAPA) model on the perioperative nursing effect of artificial hip replacement and to analyze the effect of this nursing model on the quality of life and postoperative rehabilitation of patients undergoing artificial hip replacement.

Methods

A total of 200 patients with hip arthroplasty treated in our hospital from January 2019 to July 2021 were enrolled. The patients were randomly assigned into the control group and study group. The former received routine nursing, and the latter received rehabilitation nursing under the guidance of the HAPA model. Nursing satisfaction, pain score, Harris hip function score, timed stand-up-walk test, MBI score, and quality of life score were compared.

Results

First of all, we compared the nursing satisfaction. In the study group, 86 cases were very satisfied, 8 cases were satisfied, and 6 cases were general; the satisfaction rate was 100%. In the control group, 48 cases were very satisfied, 22 cases were satisfied, 12 cases were general, and 18 cases were dissatisfied; the satisfaction rate was 82.0%. The nursing satisfaction in the study group was higher compared to that in the control group (P < 0.05). Secondly, we compared the pain scores. Before nursing, there exhibited no significant difference (P > 0.05). After nursing, the pain score of the two groups increased. Moreover, the pain score of the study group at discharge and 1 month, 3 months, and 6 months after operation was lower compared to that of the control group (P < 0.05). Before nursing, there exhibited no significant difference in the Harris hip joint function score (P > 0.05). After nursing, the Harris hip function score increased. Furthermore, the Harris hip function score of the study group at discharge and 1 month, 3 months, and 6 months after operation was higher compared to that of the control group (P < 0.05). In terms of the timed stand-up-walking test, there exhibited no significant difference before nursing (P > 0.05). After nursing, the time of the timed stand-up-walk test in both groups decreased. And the timed stand-up-walk test at discharge and 1 month, 3 months, and 6 months after operation in the study group was lower compared to that in the control group (P < 0.05). Compared with the MBI scores, there exhibited no significant difference before nursing (P > 0.05). After nursing, the MBI scores increased. Of note, the MBI scores of the study group at discharge and 1 month, 3 months, and 6 months after operation were higher compared to those of the control group (P < 0.05). Finally, we compared the scores of life quality. Before nursing, there exhibited no significant difference (P > 0.05). After nursing, the scores of life quality decreased. The scores of physiological function, psychological function, social function, and health self-cognition in the study group were lower compared to those in the control group (P < 0.05).

Conclusion

The perioperative rehabilitation nursing program of artificial hip replacement for the elderly based on the HAPA model is feasible, which can effectively enhance the functional recovery of hip joint, promote the ability of self-care of daily life, relieve pain and anxiety, and help to achieve dynamic balance and gait stability in the early stage. The rehabilitation program is better than routine nursing. As a new social cognitive model, the HAPA model is applied to the rehabilitation nursing environment of hip replacement from the aspect of social cognitive behavior, which can help to enhance the rehabilitation behavior of elderly patients, playing an important role in the rehabilitation effect of perioperative nursing.