The influence of bone cement and American Society of Anesthesiologists (ASA) class on cardiovascular status during bipolar hemiarthroplasty for displaced femoral-neck fracture: A multicenter, prospective, case-control study - 01/06/18

Doi : 10.1016/j.otsr.2018.03.014

Shuichi Miyamoto ^a,^⁎ , Junichi Nakamura ^b, Satoshi Iida ^c, Tomonori Shigemura ^d, Shunji Kishida ^e, Isao Abe ^f, Munenori Takeshita ^a, Makoto Otsuka ^a, Yoshitada Harada ^g, Sumihisa Orita ^b, Seiji Ohtori ^b
^a Kimitsu Central Hospital, 1010 Sakurai, 292-8535 Kisarazu city, Chiba, Japan
^b Graduate School of Medicine, Chiba University, 1-8-1, Inohana Chuo-ku, 260-8677 Chiba city, Chiba, Japan
^c Matudo City Hospital, 4005 Kamihongou, 271-8511 Matudo city, Chiba, Japan
^d Sanmu Medical Center, 167 Narutou, 289-1326 Sanmu city, Chiba, Japan
^e Seirei Sakura Citizen Hospital, 2-36-2 Eharadai, 285-8765 Sakura city, Chiba, Japan
^f National Hospital Organization Chiba Medical Center, 4-1-2 Tubakinomori, 260-8606 Chuo-ku, Chiba city, Chiba, Japan
^g Saiseikai Narashino Hospital, 1-1-1 Izumichou, 275-8580 Narashino City, Chiba, Japan

^⁎Corresponding author. Department of Orthopaedic Surgery, Kimitsu Central Hospital, 1010 Sakurai, 292-8535 Kisarazu City, Chiba, Japan.Department of Orthopaedic Surgery, Kimitsu Central Hospital1010 SakuraiKisarazu City, Chiba292-8535Japan

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Abstract

Background

Little is known about how bone cement and American Society of Anesthesiologists (ASA) classification influence the cardiovascular system in elderly patients with femoral-neck fractures treated with cemented hemiarthroplasty. Therefore, we performed a case-control study to investigate these questions and compared the following:≥ASA III with≤ASA II patients who underwent cemented hemiarthroplasty; and cemented with cementless hemiarthroplasty in≥ASA III patients.

Hypothesis

ASA classification influences the cardiovascular system during cemented hemiarthroplasty and bone cement influences intraoperative blood pressure [IBP] in patients rated≥ASA III.

Materials and methods

This multicenter, prospective study included patients with acute displaced femoral-neck fractures. Baseline data, medical history, anesthesia, FiO₂, vasopressor use, femoral component, IBP, SpO₂, and complications were evaluated. Of 200 patients, 100 were cemented (mean age, 77±10 years), and 100 were cementless (mean age, 78±9 years). Cemented hemiarthroplasty employed a third-generation technique (plugging, irrigating, drying and filling the canal with cement under pressurization).

Results

Systolic blood pressure (SBP) decreased significantly during cementing, versus pre-rasping in≤ASA II patients (from 117.9±24.5 [range, 65–199] to 106.9±20.3 [range, 59–172]; p=0.007), in≥ASA III patients (from 129.5±21.0 [range, 90–169] to 110.4±17.9 [range, 79–157]; p=0.006), and post-stem-insertion, versus pre-rasping in≤ASA II patients (from 117.9±24.5 [range, 65–199] to 103.9±20.7 [range, 53–178]; p=0.0004), and in≥ASA III patients (from 129.5±21.0 [range, 90–169] to 111.2±24.6 [range, 70–156]; p=0.009). In≥ASA III patients, SBP decreased significantly during cementing or rasping, versus pre-rasping in cemented patients (from 129.5±21.0 [range, 90–169] to 110.4±17.9 [range, 79–157]; p=0.006), in cementless patients (from 115.0±17.7 [range, 85–150] to 100.7±15.7 [range, 75–142]; p=0.004), and post-stem-insertion, versus pre-rasping in cemented patients (from 129.5±21.0 [range, 90–169] to 111.2±SD [range]; p=0.009), and in cementless patients (from 115.0±17.7 [range, 85–150] to 89.4±17.5 [range, 58–140]; p<0.0001). There were no lethal complications.

Conclusions

This study indicate a similar hemodynamic change intraoperatively between≤ASA II patients and≥ASA III patients in the cemented group, and between patients with cemented and cementless hemiarthroplasty in the≥ASA III patients. With modern hemiarthroplasty techniques, bone cement might be as safe as cementless techniques in elderly,≥ASA III patients.