Abstract
It is controversial whether a cemented long-stem femoral arthroplasty is a safe surgical option for patients with meta-static bone disease of the hip. Cemented long stems increase the risk of embolic cascades and may cause subsequent cardiopulmonary complications, particularly in patients with metastatic disease. We retrospectively reviewed results of 29 long-stem cemented femoral arthroplasties in 27 patients in which surgical techniques that minimized intramedullary debris and canal pressurization were used. The surgical techniques minimized intraoperative cement-related emboli with aggressive medullary lavage, intraoperative canal suctioning during cementation, use of early low-viscosity polymethylmethacrylate, and slow, controlled insertion of the long-stem prosthesis. Cement-associated hypotension occurred in four (14%) patients, sympathomimetics were administered in nine (31%) patients, and a worsening mental status occurred postoperatively in one (3%) patient. There were no cement-associated desaturation events, cardiac arrests, or intraoperative deaths. No patients required prolonged intubation, and there were no postoperative cardiopulmonary events. Cemented long-stem femoral arthroplasty is a safe procedure for patients with high-risk metastatic disease. Increased awareness of cement-related cardiopulmonary pathophysiology, and modifying conventional surgical techniques can minimize cement-associated complications.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 287-295 |
| Number of pages | 9 |
| Journal | Clinical Orthopaedics and Related Research |
| Issue number | 443 |
| DOIs | |
| State | Published - Feb 1 2006 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Orthopedics and Sports Medicine
Cite this
Complications of cemented long-stem hip arthroplasties in metastatic bone disease. / Randall, R; Aoki, Stephen K.; Olson, Patrick R.; Bott, Steven I.
In: Clinical Orthopaedics and Related Research, No. 443, 01.02.2006, p. 287-295.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Complications of cemented long-stem hip arthroplasties in metastatic bone disease
AU - Randall, R
AU - Aoki, Stephen K.
AU - Olson, Patrick R.
AU - Bott, Steven I.
PY - 2006/2/1
Y1 - 2006/2/1
N2 - It is controversial whether a cemented long-stem femoral arthroplasty is a safe surgical option for patients with meta-static bone disease of the hip. Cemented long stems increase the risk of embolic cascades and may cause subsequent cardiopulmonary complications, particularly in patients with metastatic disease. We retrospectively reviewed results of 29 long-stem cemented femoral arthroplasties in 27 patients in which surgical techniques that minimized intramedullary debris and canal pressurization were used. The surgical techniques minimized intraoperative cement-related emboli with aggressive medullary lavage, intraoperative canal suctioning during cementation, use of early low-viscosity polymethylmethacrylate, and slow, controlled insertion of the long-stem prosthesis. Cement-associated hypotension occurred in four (14%) patients, sympathomimetics were administered in nine (31%) patients, and a worsening mental status occurred postoperatively in one (3%) patient. There were no cement-associated desaturation events, cardiac arrests, or intraoperative deaths. No patients required prolonged intubation, and there were no postoperative cardiopulmonary events. Cemented long-stem femoral arthroplasty is a safe procedure for patients with high-risk metastatic disease. Increased awareness of cement-related cardiopulmonary pathophysiology, and modifying conventional surgical techniques can minimize cement-associated complications.
AB - It is controversial whether a cemented long-stem femoral arthroplasty is a safe surgical option for patients with meta-static bone disease of the hip. Cemented long stems increase the risk of embolic cascades and may cause subsequent cardiopulmonary complications, particularly in patients with metastatic disease. We retrospectively reviewed results of 29 long-stem cemented femoral arthroplasties in 27 patients in which surgical techniques that minimized intramedullary debris and canal pressurization were used. The surgical techniques minimized intraoperative cement-related emboli with aggressive medullary lavage, intraoperative canal suctioning during cementation, use of early low-viscosity polymethylmethacrylate, and slow, controlled insertion of the long-stem prosthesis. Cement-associated hypotension occurred in four (14%) patients, sympathomimetics were administered in nine (31%) patients, and a worsening mental status occurred postoperatively in one (3%) patient. There were no cement-associated desaturation events, cardiac arrests, or intraoperative deaths. No patients required prolonged intubation, and there were no postoperative cardiopulmonary events. Cemented long-stem femoral arthroplasty is a safe procedure for patients with high-risk metastatic disease. Increased awareness of cement-related cardiopulmonary pathophysiology, and modifying conventional surgical techniques can minimize cement-associated complications.
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UR - http://www.scopus.com/inward/citedby.url?scp=33645323290&partnerID=8YFLogxK
U2 - 10.1097/01.blo.0000191270.50033.3a
DO - 10.1097/01.blo.0000191270.50033.3a
M3 - Review article
C2 - 16462453
AN - SCOPUS:33645323290
SP - 287
EP - 295
JO - Clinical Orthopaedics and Related Research
JF - Clinical Orthopaedics and Related Research
SN - 0009-921X
IS - 443
ER -