Cardiopulmonary and haemodynamic changes during total hip arthroplasty

López-Durán, L.; García-López, Antonio; Duran, Luis Lopez; Hurtado, J.M Delgado; Ruiz, Cesar Augusto Franco; Rodrigo, José Luis

doi:10.1007/s002640050161

Cited by 10 publications

(8 citation statements)

References 49 publications

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“…López-Durán et al [11] showed similar values for SaO 2 ; however, their results revealed that partial pressure of oxygen (PaO 2 ) decreased by 17 mmHg from baseline during cementation. Nolan et al [13] also reported a decrease in mean PaO 2 of 16 %.…”

Section: Discussionmentioning

confidence: 90%

“…In a canine-model study, the insertion of cement and prosthesis was followed by severe hypotension, elevated pulmonary artery pressure, decreased systemic vascular resistance, and a 21 % reduction in cardiac output [12]. However, another human study measured arterial blood pressure during total hip arthroplasty and documented slight hypertension in both cemented and uncemented groups at the time of both medullary reaming and insertion of cement and stem, compared with the baseline value [11]. Nolan et al [13] reported a 20 % increase in mean arterial pressure after insertion of the femoral components in cemented total hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…Little is known about changes in blood pressure induced by the cement during bipolar hemiarthroplasty; previous studies have reported both hypotension and hypertension during cementing arthroplasty [10][11][12][13]. Furthermore, there have been few reports on radiographic follow-up assessment of cemented bipolar hemiarthroplasty.…”

Section: Introductionmentioning

confidence: 99%

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Blood-pressure changes and outcomes associated with cemented bipolar hemiarthroplasty for displaced femoral-neck fractures

Miyamoto

Nakamura

Iida

et al. 2015

Eur Orthop Traumatol

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Background The purpose of this retrospective cohort study was to investigate the cementing effects on intraoperative blood pressure and the clinical and radiographic outcomes in elderly patients with femoral-neck fracture undergoing bipolar hemiarthroplasty using a polished, tapered stem. Methods This retrospective cohort study included 38 patients with acute displaced femoral-neck fractures (mean age, 76.2 years; mean follow-up, 21.4 months (68 % follow-up rate)). Results Intraoperative systolic blood pressure decreased significantly, both during cementing (109.1 mmHg) and after stem insertion (101.6 mmHg), compared with the level before rasping (122.2 mmHg; p=0.0036 and p=0.0001, respectively). Diastolic blood pressure decreased significantly after stem insertion (57.9 mmHg versus 67.3 mmHg before rasping; p= 0.003). Hypoxia did not occur. Nineteen patients were Donaldson's grade 1, 16 were grade 2, and none were grade 3. Twenty-three patients (74 %) maintained their preoperative activity level; 15 (26 %) worsened after surgery. Stem subsidence significantly increased over time: 0.32 mm at 6 months, 0.53 mm at 1 year, 0.91 mm at 2 years, 1.08 mm at 3 years, and 1.13 mm at 4 years. Conclusions Cemented bipolar hemiarthroplasty for displaced femoral-neck fracture in elderly patients leads to hypotension, unchanged arterial oxygen saturation, favorable clinical outcomes, and acceptable stem subsidence.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Blood-pressure changes and outcomes associated with cemented bipolar hemiarthroplasty for displaced femoral-neck fractures

Miyamoto

Nakamura

Iida

et al. 2015

Eur Orthop Traumatol

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“…Most trials however, have found little clinical significance of events surrounding the so called “bone cement implantation syndrome” and have described changes in pulmonary pressures and right heart function as small and relatively short lived 12–14. While most studies have employed transesophageal monitoring for hemodynamic assessment, López-Durán et al using Swan Ganz catheters showed that during elective unilateral total hip replacement under general anesthesia pulmonary arterial pressures and pulmonary vascular resistance remained virtually unchanged,14 supporting our findings that no major significant changes were seen in these parameters intraoperatively in response to the first hip implant.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Pulmonary Circulatory Changes During Bilateral Total Hip Arthroplasty Under Regional Anesthesia

Memtsoudis

Salvati

Go³

et al. 2010

Regional Anesthesia and Pain Medicine

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Background and Objectives-The transient and rarely clinically relevant effect of bone and cement embolization during unilateral joint arthroplasty is a known phenomenon. However, available studies do not address events surrounding bilateral total hip arthroplasties, during which embolic load is presumably doubled. To elucidate events surrounding this increasingly utilized procedure and assess the effect on the pulmonary hemodynamics in the intra-and postoperative period, we studied 24 subjects undergoing cemented bilateral total hip arthroplasty during the same anesthetic session.

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“…2,36 In addition, marrow contents are known to be thrombogenic causing activation of the coagulation and fibrinolytic pathways, as well as that which would be expected from the surgical stimulus alone. 2,3,37 Although the coagulative and cardiopulmonary effects of replacement arthroplasty of the hip and knee have previously been examined, 38,39 this is the first clinical study to attempt specifically to quantify these effects in patients undergoing reamed nailing. We have shown that reamed nailing is associated with the activation of coagulation pathways.…”

Section: Discussionmentioning

confidence: 99%

The coagulative and cardiorespiratory responses to reamed intramedullary nailing of isolated fractures

Robinson

Ludlam

Ray

et al. 2001

The Journal of Bone and Joint Surgery. British volume

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We measured the changes during operation in seven markers of coagulation in a prospective series of 84 patients with fractures of the tibia or femur who were undergoing reamed intramedullary nailing. All patients were also continually monitored using transoesophageal echocardiography to assess marrow embolism. In a subset of 40 patients, intraoperative cardiopulmonary function was monitored, using pulmonary and systemic arterial catheterisation.The procedure produced a significant increase in prothrombin time, activated partial thromboplastin time, the level of prothrombin fragments F 1+2 and D-dimers, and a decrease in the fibrinogen level, suggesting activation of both the coagulation and fibrinolytic pathways. There was evidence of both platelet hyper-reactivity and depletion, as estimated by an increase in ␤-thromboglobulin levels and a decrease in the platelet count. In the patients who had invasive monitoring there was an incremental increase in mean pulmonary arterial pressure, with the changes being greatest during insertion of the guide-wire and reaming.The change in markers of coagulation, pulmonary artery pressure and arterial oxygen partial pressures correlated with the intraoperative embolic response. Greater changes in these parameters were observed during stabilisation of pathological fractures and in those patients in whom surgery had been delayed for more than 48 hours.Seven patients with pathological fractures developed more severe hypoxic episodes during reaming, which were associated with significantly greater arterial hypoxaemia, a fall in the right ventricular ejection fraction and an increase in the mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure and the pulmonary vascular resistance index. These changes suggested that the patients had transient intraoperative right heart strain.Eight patients developed significant postoperative respiratory compromise. They all had severe intraoperative embolic responses and, in the three who had invasive monitoring, there was a significantly greater increase in pulmonary artery pressure and alveolar-arterial oxygen gradient, and a fall in the ratio of arterial partial pressure of oxygen to the inspired oxygen concentration. Operative delay, intraoperative paradoxical embolisation and the scores for the severity of the coagulative and embolic responses were predictive of the development of postoperative respiratory complications on univariate logistic regression analysis. On multivariate analysis, however, only the embolic and coagulative scores were significant independent predictors of respiratory complications.

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Cardiopulmonary and haemodynamic changes during total hip arthroplasty

Cited by 10 publications

References 49 publications

Blood-pressure changes and outcomes associated with cemented bipolar hemiarthroplasty for displaced femoral-neck fractures

Blood-pressure changes and outcomes associated with cemented bipolar hemiarthroplasty for displaced femoral-neck fractures

Perioperative Pulmonary Circulatory Changes During Bilateral Total Hip Arthroplasty Under Regional Anesthesia

The coagulative and cardiorespiratory responses to reamed intramedullary nailing of isolated fractures

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