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Intraoperative blood pressure changes during cemented versus uncemented bipolar hemiarthroplasty for displaced femoral neck fracture: a multi-center cohort study

The effect of bone cement for bipolar hemiarthroplasty in elderly patients

  • Trauma Surgery
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Abstract

Introduction

The purpose of this study was to compare the cemented bipolar hemiarthroplasty with uncemented about the change of intraoperative blood pressure and the incidence of major complications in elderly patients with femoral neck fracture.

Materials and methods

This multiple center prospective cohort study included only patients with acute displaced femoral neck fracture (Garden stage III or IV). All patients were treated with cemented or uncemented bipolar hemiarthroplasty using modified Hardinge or Watson-Jones approach in the lateral decubitus position. Baseline data, medical history, type of anesthesia, FiO2 value, the number of vasopressor using during operation, femoral component, intraoperative blood pressure, SaO2, and major complications were evaluated.

Results

Of 164 patients (45 males and 119 females), 86 underwent cemented and 78 underwent uncemented bipolar hemiarthroplasty. Baseline medical histories were similar in both groups. In both the cemented and uncemented groups, intraoperative systolic blood pressure significantly decreased during cementing or rasping (106.3 and 103.6 mmHg) and after femoral component insertion (103.3 and 99.1 mmHg) compared to before rasping (120.7 and 116.4 mmHg) (p < 0.0001, respectively). Donaldson’s grade seemed more favorable in uncemented group than in cemented group during cementing or rasping, during stem insertion; however, no patients experienced the lethal complication in both groups.

Conclusions

Intraoperative blood pressure did not change during cemented and uncemented bipolar hemiarthrplasty for displaced femoral neck fracture. If the standard modern cement technique was performed during operation, bone cement is a safe and acceptable for elderly patients who have a lot of medical histories.

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Acknowledgements

We are grateful to Dr. Satoshi Iida, Dr. Tomonori Shigemura, Dr. Shunji Kishida, Dr. Isao Abe, Dr. Munenori Takeshita, and Dr. Yoshitada Harada, head of our department, for their valuable suggestions and support during this study. Dr. Junichi Nakamura, Dr. Sumihisa Orita, and Prof. Seiji Ohtori conceived of the study, participated in its design and coordination. We do not receive any funding or financial support that may be perceived to have based the study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan

    Shuichi Miyamoto, Junichi Nakamura, Sumihisa Orita & Seiji Ohtori

  2. Matudo City Hospital, 4005 Kamihongou, Matudo City, Chiba, 271-8511, Japan

    Satoshi Iida

  3. Sanmu Medical Center, 167 Narutou, Sanmu City, Chiba, 289-1326, Japan

    Tomonori Shigemura

  4. Seirei Sakura Citizen Hospital, 2-36-2 Eharadai, Sakura City, Chiba, 285-8765, Japan

    Shunji Kishida

  5. National Hospital Organization Chiba Medical Center, 4-1-2 Tubakinomori, Chuo-ku, Chiba City, Chiba, 260-8606, Japan

    Isao Abe

  6. Kimitu Central Hospital, 1010 Sakurai, Kisarazu City, Chiba, 292-8535, Japan

    Munenori Takeshita

  7. Saiseikai Narashino Hospital, 1-1-1 Izumichou, Narashino City, Chiba, 275-8580, Japan

    Yoshitada Harada

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  1. Shuichi Miyamoto
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  2. Junichi Nakamura
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Correspondence to Shuichi Miyamoto.

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All procedures performed in studies involving human participants were in accordance with the ethical standards approval of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Miyamoto, S., Nakamura, J., Iida, S. et al. Intraoperative blood pressure changes during cemented versus uncemented bipolar hemiarthroplasty for displaced femoral neck fracture: a multi-center cohort study. Arch Orthop Trauma Surg 137, 523–529 (2017). https://doi.org/10.1007/s00402-017-2651-9

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