DOACs edge LMWH for VTE prophylaxis after hip replacement, and stem choice should depend on sex and age

The edition in brief

A meta-analysis of 22 randomised trials in 28,112 patients found direct oral anticoagulants lowered VTE after elective total hip arthroplasty compared with low molecular weight heparin (OR 0.62), driven by fewer deep vein thromboses. Bleeding was slightly higher overall (OR 1.19) but not when restricted to UK-licensed agents and doses (OR 1.06), and reoperation and mortality did not differ. A Norwegian analysis of 204,041 primary hip arthroplasties found that cemented composite beam stems carried the lowest risk of reoperation for periprosthetic femoral fracture, especially in men over 75 and women over 70, with polished taper-slip stems linked to much higher risk in men of all ages. A network meta-analysis of 35 trials found combined aerobic and resistance exercise gave the largest short-term pain benefit in knee osteoarthritis, on low-certainty evidence. A meta-analysis of 12 trials found platelet-rich plasma had limited and inconsistent effects on joint structure. The pearl covers renal function and drug checks before choosing a DOAC.