Hemodynamic and Arterial Blood Gas Parameters during Cemented Hip Hemiarthroplasty in Elderly Patients

Document Type: RESEARCH PAPER

Authors

1 Department of Orthopedics, Assistant professor, Guilan University of medical science, Rasht, Iran

2 2. Department of Anesthesiology, Associated professor, Guilan University of medical science, Rasht, Iran

3 associated professor anesthesiology research center guilan university of medical sciences

4 Department of Anesthesiology, Assistant professor, Guilan University of medical science, Rasht, Iran

Abstract

Background:
 Patients undergoing cemented hip hemiarthroplasty may develop bone cement implantation syndrome (BCIS) which is a leading cause of intraoperative complications. The purpose of this study was to evaluate cardiovascular changes during cemented hip hemiarthroplasty in elderly patients.  
Methods:
 Cemented hip hemiarthroplasty was performed on 72 patients with femoral neck fracture. All patients were catheterized with a radial artery catheter to assess mean arterial pressure (MAP) and arterial blood gas (ABG) in these time points: just before cementation, just after cementation (0th), 5 min (5th) and 10 min (10th ) after cementation, and at the end of surgery (END). Also, systolic and diastolic blood pressure (SBP & DBP), heart rate and any arrhythmia or cardiac arrest was evaluated.
 Results:
 Seventy-two patients (33 females, 39 males; mean age: 66.8±7 years) were evaluated. All parameters changed during cementation with a significant drop in MAP, SBP, and DBP immediately after cementation and pH and base excess decreased significantly (P<0.001) with no changes in O2 saturation. Mean heart rate rose until the 5th and then decreased dramatically with no bradycardia presentation. During cementation, 12 patients showed arrhythmia, but no cardiac-arrest was observed.  
Conclusions:
 Under strict observation of a anesthesiology care team, hemiarthroplasty can be a safe method for femoral neck fracture in elderly osteoporotic patients without severe cardiopulmonary compromise. 

Keywords


Bhandari M, Devereaux PJ, Tornetta P, Swiontkowski MF, Berry DJ, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005; 87(9): 2122–30.

  • Ahn J, Man LX, Park S, Sodl JF, Esterhai JL. Systematic review of cemented and uncemented hemiarthroplasty outcomes for femoral neck fractures. Clin Orthop Relat Res. 2008; 466(10):2513-8.

  • Viberg B, Overgaard S, Lauritsen J, Ovensen O. Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture. Acta Orthop. 2013; 84(3):254-9.

  • Razuin R, Effat O, Shahidan MN, Shama DV, Miswan MF. Bone cement implantation syndrome. Malays J Pathol. 2013; 35(1):87-90.

  • Ono S, Kadoma Y, Morita S, Takakuda K. Development of new bone cement utilizing low toxicity monomers. J Med Dent Sci. 2008; 55:189-96.

  • Yamada T, Momwaki K, Shmroyama K, Ohtai T, Sakai A, Miki T, et al. High incidence of cardiorespiratory deterioration in patients receiving cemented hip hemiarthroplasty for femoral neck fracture. Masui. 2007; 56(7):810-6.

  • Clayer M, Bruckner J. Occult hypoxia after femoral neck fracture and elective hip surgery. Clin Orthop Relat Res. 2000; 370:265-71.

  • Pitto RP, Blunk J, Kossler M. Trans-esophageal echocardiography and clinical features of fat embolism during cemented total hip arthroplasty. A randomized study in patients with a femoral neck fracture. Arch Orthop Trauma Surg. 2000; 120:53-8.

  • Edmonds CR, Barbut D, Hager D, Sharrock NE. Intraoperative cerebral arterial embolization during total hip arthroplasty. Anesthesiology. 2000; 93:315-8.

  • Yli-Kyyny T, Ojanpera J, Venesmaa P, Kettunen J, miettnen H, Salo J, et al. Perioperative complications after cemented or uncemented hemiarthroplasty in hip fracture patients. Scand J Surg. 2013; 102(2):124-8.

  • Figved W, Opland V, Frihagen F, Jervidalo T, Madsen JE, Nordsletten L. Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures. Clin Orthop Relat Res. 2009; 467(9): 2426–35.

  • Dunne NJ, Orr JF. Curing characteristics of acrylic bone cement. J Mater Sci Mater Med. 2002; 13:17–22.

  • Magnan B, Bondi M, Maluta T, Samaila E, Schirru L, Dall’Oca C. Acrylic bone cement: current concept review. Musculoskelet Surg. 2013; 97(2):93-100.

  • Mudgalkar N, Ramesh KV. Bone cement implantation syndrome: A rare catastrophe. Anesthesia Essays and Researches. 2011; 5(2):240-2.

  • Morejon L, Mendizabal E, Delgado JA, Davidenko N, López-Dellamary F, Manriquez R, et al. Synthesis and characterization of Poly-methyl-metha-acrylate-styrene co-polymeric beads for bone cements. Latin American Applied Research. 2005; 35(3):175-82.

  • Burlingame B. Bone cement implantation syndrome. AORN J. 2009; 89(2): 399-400.

  • Byrick RJ. Cement implantation syndrome: a time limited embolic phenomenon. Can J Anaesth. 1997; 44(2):107-11.

  • Rothberg DL, Kubiak EN, Peters CL, Ranadall RL, Aoki SK. Reducing the risk of bone cement implantation syndrome during femoral arthroplasty. Orthopedics. 2013; 36(4): 463-7

  • Christie J, Burnett R, Potts HR, Pell AC. Echocardiography of Trans-atrial embolism during cemented and uncemented hemiarthroplasty of the hip. J Bone Joint Surg Br. 1994; 76(3):409–12.

  • Sierra RJ, Timperley JA, Gie GA. Contemporary cementing technique and mortality during and after Exeter total hip arthroplasty. J Arthroplasty. 2009; 24(3):325-32.

  • Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009; 102(1):12-22.

  • Clark DI, Ahmed AB, Baxendale BR, Moran CG. Cardiac output during hemiarthroplasty of the hip. A prospective, controlled trial of cemented and uncemented prostheses. J Bone Joint Surg Br. 2001; 83(3):414-8.

  • Kotyra M, Houltz E, Ricksten SE. Pulmonary hemodynamics and right ventricular function during cemented hemiarthroplasty for femoral neck fracture. Acta Anaesthesiologica Scandinavica. 2010; 54(10):1210-6.

  • Taylor F, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am. 2012; 94(7):577-83.

  • Li T, Zhuang Q, Weng X, Zhou L, Bian Y. Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis. PloS One. 2013; 8(7):68903.