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Intraoperative unfractionated heparin before femoral component cementation should be avoided in femoral neck fracture treated with hybrid total hip arthroplasty

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

To compare the incidence of perioperative thromboembolic events in femoral neck fracture (FNF) patients treated with hybrid total hip arthroplasty (THA) with intraoperative unfractionated heparin (UFH) versus a control group without intraoperative UFH before femoral component cementation.

Methods

We compared 139 cases without UFH (group A) versus 134 who received 10 UI/kg UFH (group B). Indication of UFH before cementation depended on the preferences of the anaesthesiologists in each case. We assessed intraoperative bone cement implantation syndrome (BCIS) and 30-day thromboembolic events, and 90-day and 1-year mortality. BCIS was classified as per Donaldson et al.’s classification according to the degree of hypotension, arterial desaturation or loss of consciousness.

Results

BCIS was observed in 51 (18%) cases, including 37 (13%) grade 1 and 14 (5%) grade 2. Forty-seven BCISs (35%) were observed in group B and 4 (3%) in group A (p < 0.001). Multivariate regression showed that intraoperative UFH (OR = 18, CI 95% 6–52) and consumption of oral anticoagulants (OR = 3.3, CI 95% 1–10) increased the risk of BCIS. Five patients further developed a 30-day pulmonary embolism in group B, while 2 presented this complication in group A (p = 0.231). No association between BCIS and 30-day thromboembolic events was found (p = 0.62). 90-day (1% each, p = 0.98) and 1-year (2% vs. 3%, p = 0.38) mortality were similar.

Conclusions

BCIS was a frequent finding in FNF patients treated with hybrid THA. We found a paradoxically significant increase in BCIS with the use of UFH. Heparin did not seem to prevent BCIS, other thromboembolic events and mortality in this group of patients.

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Funding

The authors declare that no funds, grants or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Sir John Charnley’ Hip Surgery Unit, Institute of Orthopaedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, 4190 Peron St, C1199ABH, Buenos Aires, Argentina

    Agustín García-Mansilla, Fernando Holc, Nicolas Martin Molho, Pablo Ariel Slullitel & Martin Alejandro Buttaro

  2. Department of Anaesthesiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina

    Agustina Castro Lalín & Anibal Vescovo

Authors
  1. Agustín García-Mansilla
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  2. Agustina Castro Lalín
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  3. Fernando Holc
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  4. Nicolas Martin Molho
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  5. Anibal Vescovo
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  6. Pablo Ariel Slullitel
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  7. Martin Alejandro Buttaro
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Contributions

A GM and A CL were involved in idea, design, data acquisition, analysis and interpretation of data, writing and revising. FH helped in analysis and interpretation of data, writing, revising. NM contributed to data acquisition, analysis and interpretation of data. AV was involved in design, analysis and interpretation of data, revising. PAS and MAB helped in design, analysis and interpretation of data, writing and revising. All authors read and approved the final manuscript.

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Correspondence to Fernando Holc.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. Each author certifies that they have no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Italian hospital of Buenos Aires. This study was REB approved IRB00010193, protocol #5839.

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García-Mansilla, A., Castro Lalín, A., Holc, F. et al. Intraoperative unfractionated heparin before femoral component cementation should be avoided in femoral neck fracture treated with hybrid total hip arthroplasty. Eur J Orthop Surg Traumatol 33, 2547–2554 (2023). https://doi.org/10.1007/s00590-023-03472-7

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