[Prevention of haematoma after cemented total hip arthroplasty].

OBJECTIVE: To explore the cause of haematoma after the cemented total hip arthroplasty (THA) and find out the way to decrease the incidence of haematoma perioperatively.

METHODS: From March 2000 to October 2006, 103 patients were treated with the cemented THA. Among the patients, 44 were males and 59 were females with their ages ranging from 36 to 89 years, averaged 55.3 years. The femoral neck fracture (Garden 4) was found in 49 patients, avascular necrosis of the femoral head (Ficat 4) in 26, and osteoarthritis of the hip joint (Tonnis 3) in 28. Their illness course ranged from 1 day to 8 years. The average Harris score preoperatively was 36 (range, 19-48). The patients were divided into Group A (n = 43) and Group B (n = 60). The patients in Group A underwent the conventional surgical operations from March 2000 to December 2003; the patients in Group B underwent the same surgical procedures combined with additional procedures (e. g., ligation of the external rotators before incision, use of plastic bandage after the drainage tube was pulled out, prolonged stay period in bed postoperatively) from January 2004 to October 2006.

RESULTS: In Group A, postoperative haematoma occurred in 9 patients and the averaged 317.8 +/- .75.3 ml (range, 110-410 ml) of the accumulated blood was drained with a syringe. An average amount for the first drainage of the accumulated blood was 86.7 +/- 30.7 ml (range, 50-125 ml), and an average drainage time was 4.2 (range, 2-7). In Group B, postoperative haematoma occurred in 2 patients, with an amount of 110 ml and 160 ml of the accumulated blood and an amount of 40 ml and 60 ml of the drained blood at the first drainage. There was statistical difference in the amount of heamotoma between two groups (P < 0.05). The follow-up of 91 patients (39 in Group A, 52 in Group B) for 1.2-5.5 years (average, 3.7 years) revealed that the Harris scores were 78 in Group A and 85 in Group B on average. The Harris score for pain was 44 (Grade A) in 16 patients, 40 (Grade B) in 24 patients, and 30 (Grade C) in 3 patients in Group A; Grade A in 48 patients, Grade B in 12 patients, and Grade C in none of the patients in Group B. There was no statistical difference in Harris score between the two groups (P > 0.05).

CONCLUSION: Additional surgical procedures for the cemented THA, such as ligation of the external rotators before incision, use of plastic bandage after the drainage tube is pulled out, and prolonged stay in bed postoperatively, can greatly help to reduce the incidence of postoperative haematoma and the amount of the accumulated blood.