, Volume 471, Issue 10, pp 3303-3307
Date: 20 Jun 2013

Complications of Cemented Long-stem Hip Arthroplasty in Metastatic Bone Disease Revisited

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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.

One author certifies that he (RLR) has received or may receive payments or benefits, during the study period, an amount of USD less than $10,000 from Biomet Orthopaedics, Inc, (Warsaw, IN, USA). One author certifies that he (SKA) has received or may receive payments or benefits, during the study period, an amount of USD less than $10,000 from Smith and Nephew, Inc (Memphis,TN, USA); an amount of USD less than $10,000 from ArthroCare Corp (Austin,TX, USA); and an amount of USD less than $10,000 from Pivot Medical (Sunnyvale,CA, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at the University of Utah, Salt Lake City, UT, USA.
A comment to this article is available at http://dx.doi.org/10.1007/s11999-013-3177-2.