Complications of cemented long-stem hip arthroplasty in metastatic bone disease revisited

Shawn L. Price, M. Aabid Farukhi, Kevin B. Jones, Stephen K. Aoki, R Randall

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

Background: The literature suggests that a cemented long-stem femoral arthroplasty is associated with increased intraoperative and perioperative risks. Embolic events may precipitate cardiopulmonary complications and even death; by contrast, others have reported that the use of a cemented long-stem femoral arthroplasty in patients with metastatic bone disease is a safe procedure. Questions/purposes: Specifically, in this study, we sought to identify (1) intraoperative complications potentially attributable to the use of cemented long-stem femoral components, and (2) early postoperative complications potentially attributable to the use of cemented long-stem femoral components in patients having an arthroplasty for metastatic bone disease. Methods: In this study, we performed a retrospective chart review of 42 patients (44 arthroplasties), in which the same surgical technique was used. The primary outcome measure was perioperative complications, including intraoperative cement-associated desaturation, cement-associated hypotension, sympathomimetic administration, postoperative hypotension/desaturation, and death. Results: In this series, 19% of the patients had cement-associated hypotension and sympathomimetics were administered to 48%. Two patients required prolonged intubation. One death occurred during hospitalization but there were no cardiopulmonary events. Conclusions: This study showed that some patients experienced postoperative desaturation, prolonged intubation, and increased use of sympathomimetics, however, these events were short-lived and did not result in patient mortality. Although there are significant risks to cemented long-stem femoral arthroplasty, it can be performed with a low risk of fatal cardiopulmonary complications and remains a surgical option when treating patients with metastatic bone disease. Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)3303-3307
Number of pages5
JournalClinical Orthopaedics and Related Research
Volume471
Issue number10
DOIs
StatePublished - Oct 1 2013
Externally publishedYes

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Bone Diseases
Arthroplasty
Hip
Thigh
Sympathomimetics
Hypotension
Intraoperative Complications
Intubation
Hospitalization
Outcome Assessment (Health Care)
Mortality

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Complications of cemented long-stem hip arthroplasty in metastatic bone disease revisited. / Price, Shawn L.; Farukhi, M. Aabid; Jones, Kevin B.; Aoki, Stephen K.; Randall, R.

In: Clinical Orthopaedics and Related Research, Vol. 471, No. 10, 01.10.2013, p. 3303-3307.

Research output: Contribution to journalReview article

Price, Shawn L. ; Farukhi, M. Aabid ; Jones, Kevin B. ; Aoki, Stephen K. ; Randall, R. / Complications of cemented long-stem hip arthroplasty in metastatic bone disease revisited. In: Clinical Orthopaedics and Related Research. 2013 ; Vol. 471, No. 10. pp. 3303-3307.
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abstract = "Background: The literature suggests that a cemented long-stem femoral arthroplasty is associated with increased intraoperative and perioperative risks. Embolic events may precipitate cardiopulmonary complications and even death; by contrast, others have reported that the use of a cemented long-stem femoral arthroplasty in patients with metastatic bone disease is a safe procedure. Questions/purposes: Specifically, in this study, we sought to identify (1) intraoperative complications potentially attributable to the use of cemented long-stem femoral components, and (2) early postoperative complications potentially attributable to the use of cemented long-stem femoral components in patients having an arthroplasty for metastatic bone disease. Methods: In this study, we performed a retrospective chart review of 42 patients (44 arthroplasties), in which the same surgical technique was used. The primary outcome measure was perioperative complications, including intraoperative cement-associated desaturation, cement-associated hypotension, sympathomimetic administration, postoperative hypotension/desaturation, and death. Results: In this series, 19{\%} of the patients had cement-associated hypotension and sympathomimetics were administered to 48{\%}. Two patients required prolonged intubation. One death occurred during hospitalization but there were no cardiopulmonary events. Conclusions: This study showed that some patients experienced postoperative desaturation, prolonged intubation, and increased use of sympathomimetics, however, these events were short-lived and did not result in patient mortality. Although there are significant risks to cemented long-stem femoral arthroplasty, it can be performed with a low risk of fatal cardiopulmonary complications and remains a surgical option when treating patients with metastatic bone disease. Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.",
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N2 - Background: The literature suggests that a cemented long-stem femoral arthroplasty is associated with increased intraoperative and perioperative risks. Embolic events may precipitate cardiopulmonary complications and even death; by contrast, others have reported that the use of a cemented long-stem femoral arthroplasty in patients with metastatic bone disease is a safe procedure. Questions/purposes: Specifically, in this study, we sought to identify (1) intraoperative complications potentially attributable to the use of cemented long-stem femoral components, and (2) early postoperative complications potentially attributable to the use of cemented long-stem femoral components in patients having an arthroplasty for metastatic bone disease. Methods: In this study, we performed a retrospective chart review of 42 patients (44 arthroplasties), in which the same surgical technique was used. The primary outcome measure was perioperative complications, including intraoperative cement-associated desaturation, cement-associated hypotension, sympathomimetic administration, postoperative hypotension/desaturation, and death. Results: In this series, 19% of the patients had cement-associated hypotension and sympathomimetics were administered to 48%. Two patients required prolonged intubation. One death occurred during hospitalization but there were no cardiopulmonary events. Conclusions: This study showed that some patients experienced postoperative desaturation, prolonged intubation, and increased use of sympathomimetics, however, these events were short-lived and did not result in patient mortality. Although there are significant risks to cemented long-stem femoral arthroplasty, it can be performed with a low risk of fatal cardiopulmonary complications and remains a surgical option when treating patients with metastatic bone disease. Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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