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1.  Gastric Protection and Gastrointestinal Bleeding with Aspirin Thromboprophylaxis in Hip and Knee Joint Replacements 
INTRODUCTION
Upper gastrointestinal (GI) bleeding in patients who undergo hip and knee arthroplasty tends to be associated with non-steroidal anti-inflammatory drug use, steroid intake, pre-existing peptic ulcers and smoking. The use of aspirin for thromboprophylaxis is an added risk for the occurrence of GI bleed. The aim of this study was to determine the incidence of upper GI bleeding and whether the use of peri-operative oral ranitidine reduces the incidence of upper GI bleeding when aspirin thromboprophylaxis is used for hip and knee arthroplasty.
PATIENTS AND METHODS
Data from 1491 and 886 patients who underwent hip and knee replacements at the James Cook University Hospital (group 1) and at Friarage Hospital, Northallerton (group 2), respectively, were analysed in retrospect. All patients received 150 mg of aspirin per day for a period of 6 weeks from the day of surgery. Additionally, patients operated at the Friarage Hospital received 300 mg of oral ranitidine per day, for three postoperative days.
RESULTS
We observed that patients in group 1 had a higher incidence of overt upper GI haemorrhage, which was statistically significant (P <0.014) compared to patients in group 2.
CONCLUSIONS
Based on this experience, we recommend the use of peri-operative gastric protection with ranitidine when aspirin is used for thromboprophylaxis in hip and knee arthroplasty.
doi:10.1308/003588408X285946
PMCID: PMC2647198  PMID: 18492400
Aspirin; Gastrointestinal bleeding; Histamine blockers
2.  Patient Decision Aids in Joint Replacement Surgery: A Literature Review and An Opinion Survey of Consultant Orthopaedic Surgeons 
INTRODUCTION
Patient decision aids could facilitate shared decision-making in joint replacement surgery. However, patient decision aids are not routinely used in this setting.
METHODS
With a view to developing a patient decision aid for UK hip/knee joint replacement practice, we undertook a systematic search of the literature for evidence on the use of shared decision-making and patient decision aids in orthopaedics, and a national survey of consultant orthopaedic surgeons on the potential acceptability and feasibility of patient decision aids.
RESULTS
We found little published evidence regarding shared decision-making or patient decision aids in orthopaedics. In the survey, 362 of 639 (57%) randomly selected consultant orthopaedic surgeons responded. Respondents appear representative of consultant orthopaedic surgeons in the UK. Of 272 valid responses, 79% (95% CI, 73–85%) thought patient decision aids a good or excellent idea. There was consensus on the potential helpfulness of patient decision aids and core content. A booklet to take home was the preferred medium/practice model.
CONCLUSIONS
Despite the increased emphasis on patient involvement in decision-making, there is little evidence in the medical literature relating to shared decision-making or the use of patient decision aids in orthopaedic surgery. Further research in this area of clinical practice is required. Our survey shows that consultant orthopaedic surgeons in the UK are generally positive about the use of patient decision aids for joint replacement surgery. Survey results could inform future development of patient decision aids for joint replacement practice in the UK.
doi:10.1308/003588408X285748
PMCID: PMC2430464  PMID: 18430333
Decision support techniques; Arthroplasty; Attitude of health personnel; Questionnaire

Results 1-2 (2)