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Pulmonary haemodynamics and right ventricular function in cemented vs uncemented total hip arthroplasty-A randomized trial

Journal article
Authors Mathias Hård af Segerstad
Fredrik Olsen
Arun Patel
Erik Houltz
Bengt Nellgård
Sven-Erik Ricksten
Published in Acta Anaesthesiologica Scandinavica
Volume 63
Issue 3
Pages 298-305
ISSN 0001-5172
Publication year 2019
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Pages 298-305
Language en
Links dx.doi.org/10.1111/aas.13262
Keywords cemented arthroplasty, ejection fraction, pulmonary haemodynamics, right ventricle, transesophageal echocardiography, femoral-neck, bone-cement, implantation syndrome, ejection fraction, acrylic cement, cardiac-output, fat-embolism, hemiarthroplasty, thermodilution, Anesthesiology, r gn, 1973, journal of pharmaceutical sciences, v62, p778, urup j, 1994, acta orthopaedica scandinavica, v65, p20
Subject categories Orthopedics, Cardiac and Cardiovascular Systems

Abstract

Background Bone cement implantation syndrome (BCIS) is a feared complication in orthopaedic surgery with a huge impact on post-operative morbidity. In this randomized trial, we evaluated the effects of bone cement on pulmonary and systemic haemodynamics in patients receiving either cemented or uncemented hip arthroplasty for isolated femoral neck fracture. Methods Twenty-two patients were randomized to receive either cemented (n = 10) or uncemented (n = 12) total hip arthroplasty. Surgery was performed under total intravenous anaesthesia in the lateral position. All patients were catheterized with radial- and pulmonary artery catheters, for continuous measurements of mean arterial pressure (MAP), pulmonary arterial pressure (PAP), cardiac output, right ventricular (RV) end-diastolic volume (RVEDV) and RV ejection fraction (RVEF). Haemodynamic measurements and blood gas analyses were performed after induction of anaesthesia, during surgery before and immediately after bone cementation and prosthesis insertion, 10 and 20 minutes after insertion and during skin closure. Results Pulmonary vascular resistance index (PVRI) increased during and after prosthesis insertion by 45% and 20% in the cemented and uncemented group, respectively (P < 0.005). Systolic and mean PAP increased by 18% and 17% in the cemented group, which was not seen in the uncemented group (P < 0.001). There was a trend for a more pronounced fall in RVEF in the cemented group, while there were no differences in cardiac output or stroke volume between groups. Conclusion The use of bone cement in total hip arthroplasty increases pulmonary vascular resistance and the afterload of the RV with potentially negative effects on RV performance.

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