Clinical Orthopaedics and Related Research®

, Volume 471, Issue 10, pp 3303–3307 | Cite as

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. Lor Randall
Clinical Research

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.

References

  1. 1.
    Alvi HM, Damron TA. Prophylactic stabilization for bone metastases, myeloma, or lymphoma: do we need to protect the entire none? Clin Orthop Relat Res. 2013;471:706–714.PubMedCrossRefGoogle Scholar
  2. 2.
    Bickels J, Dadia S, Lidar Z. Surgical management of metastatic bone disease. J Bone Joint Surg Am. 2009;91;1503–1516.PubMedCrossRefGoogle Scholar
  3. 3.
    Biermann JS, Holt GE, Lewis VO, Schwartz HS, Yaszemski MJ. Metastatic bone disease: diagnosis, evaluation and treatment. J Bone Joint Surg Am. 2009;91:1518–1530.PubMedGoogle Scholar
  4. 4.
    Chia SK, Speers CH, D’yachikova Y, Kang A, Malfair-Taylor S, Barnett J, Coldman A, Gelmon KA, O’reilly SE, Olivotta IA. The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer. Cancer. 2007;110:973–979.PubMedCrossRefGoogle Scholar
  5. 5.
    Coleman R, Gnant M, Morgan G, Clezardin P. Effects of bone-targeted agents on cancer progression and mortality. J Natl Cancer Inst. 2012;104:1059–1067.PubMedCrossRefGoogle Scholar
  6. 6.
    Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009;102:12–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Fallon KM, Fuller JG, Morley-Forster P. Fat embolization and fatal cardiac arrest during hip arthroplasty with methylmethacrylate. Can J Anaesth. 2001;48:626–629.PubMedCrossRefGoogle Scholar
  8. 8.
    Herrenbruck T, Erickson EW, Damron TA, Heiner J. Adverse clinical events during cemented long-stem femoral arthroplasty. Clin Orthop Relat Res. 2002;395:154–163.PubMedCrossRefGoogle Scholar
  9. 9.
    Mirels H. Metastatic disease in longs bones: a proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;249:256–264.PubMedGoogle Scholar
  10. 10.
    Paulson OB, Strandsgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev. 1990;2:161–192.PubMedGoogle Scholar
  11. 11.
    Randall RL, Aoki SK, Olson PR, Bott SI. Complications of cemented long-stem hip arthroplasties in metastatic bone disease. Clin Orthop Relat Res. 2006;443:287–295.PubMedCrossRefGoogle Scholar
  12. 12.
    Ryan CJ, Elkin EP, Cowan J, Carroll PR. Initial treatment patterns and outcome of contemporary prostate cancer patients with bone metastases at initial presentation: data from CaPSURE. Cancer. 2007;110:81–86.PubMedCrossRefGoogle Scholar
  13. 13.
    Schulman KL, Kohles J. Economic burden of metastatic bone disease in the U.S. Cancer. 2007;109:2334–2342.PubMedCrossRefGoogle Scholar
  14. 14.
    Selek H, Basarir K, Yildiz Y, Saglik Y. Cement endoprosthetic replacement for metastatic bone disease in the proximal femur. J Arthroplasty. 2008;23:112–117.PubMedCrossRefGoogle Scholar
  15. 15.
    Thein R, Herman A, Chechik A, Liberman B. Uncemented arthroplasty for metastatic disease of the hip: preliminary clinical experience. J Arthroplasty. 2012;27:1658–1662.PubMedCrossRefGoogle Scholar
  16. 16.
    Weber KL, Randall RL, Grossman S, Parvizi J. Management of lower-extremity bone metastasis. J Bone Joint Surg Am. 2006;88(suppl 4):11–19.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Shawn L. Price
    • 1
  • M. Aabid Farukhi
    • 2
  • Kevin B. Jones
    • 1
  • Stephen K. Aoki
    • 3
  • R. Lor Randall
    • 1
  1. 1.Department of Orthopaedics Sarcoma Services, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUSA
  2. 2.University of Utah School of MedicineSalt Lake CityUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of UtahSalt Lake CityUSA

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