Complications and difficulties of the Judet arthroplasty.

As far as we are aware arthroplasty of the Judet type was not performed in this country until 1950 and the first case was recorded in that year (King’s College Hospital Gazette 1950). Most surgeons are agreed that this operation is a welcome advance in the surgery of the hip and that it may herald progress in the treatment of other stiff and painful joints. The experience of the Judet brothers is considerable and they have expounded the advantages of this form of arthroplasty (1950) and in a recent review (1952) of 400 patients the morbidity and complications were described. MacAusland (1951) was first to record the operation in America, but in his series of thirty-one cases there is no mention of any complications. It is considered too early to assess the long-term value of the operation. The main object of this paper is to report measures adopted to prevent complications and discuss some of the difficulties of the operation and of the post-operative treatment. In a series of 100 operations, the following complications have occurred. Haematoma, 2*; dislocation, 5 ; new bone formation, 2 ; fracture of the stem, 2 ; deep vein thrombosis, 3. There was no case of deep wound infection. The series is unselected and represents the work of three surgeons and the operations were done in six different hospitals. The only patient no longer alive was a man of seventy-eight, who weighed 16 stone and who suffered from diabetes mellitus. He fractured the neck of his femur and died six months after replacement of the fractured head by a prosthesis. Prophylactic measures-Great stress is laid on the prevention of operative shock. Gentleness, control of haemorrhage and skilful anaesthesia are important. Blood transfusion is given as a routine immediately before and during the operation. It is not usual for any patient to need more than one pint of blood, since anaemia is corrected before operation and blood loss is not great. Chest complications are rare, and have usually taken the form of an exacerbation of chronic bronchitis. Advances in anaesthesia (which has always been a combination of the intravenous and inhalation types) have been instrumental in avoiding these complications. Breathing exercises before and after operation, and the routine use of systemic penicillin are measures of importance. Deep vein thrombosis has occurred in three cases-a low incidence in view of the average age of the patients (fifty-four years), the site and magnitude of the operation and the postoperative immobilisation. It is feared that thrombosis may occur with equal frequency in the operated and normal limb and it is a sound measure to prevent pressure on the calf of the normal limb by placing sorbo cushions beneath it during the operation. Limb movements are encouraged immediately after operation. \Vhen thrombosis has occurred treatment with anticoagulants is begun promptly. In only one case has physiotherapy been held up for more than a few days. In this case, that of a man of sixty-five with osteoarthritis of both hips, operation was followed by deep vein thrombosis in the calf on the side of the operation and a small pulmonary embolus. A large haematoma formed in the anterior part of the thigh, possibly from the use of heparin. Treatment for the hip was delayed for several weeks and, at the time of his discharge, movements were limited.