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Cemented stems in healthy elderly patients result in higher hypoxia despite a paradoxical lower femoral increase of intramedullary pressure

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Abstract

Purpose

Hypoxia is a well-known complication in cemented arthroplasty; however, it is not known whether the level of hypoxia is related to the intramedullary pressure or to the age of the patient; therefore, we studied the intramedullary pressure and level of hypoxia in patients undergoing cemented arthroplasty.

Methods

A prospective study was performed during cemented arthroplasties in 25 patients with an average age of 66.2 ± 12.1 years old. The intramedullary pressure (IMP) was measured by placing a pressure transducer within the bone while simultaneously measuring the pulse oximetry arterial oxygen saturation (SpO2), pulse, and blood pressure. These variables were obtained immediately after spinal anaesthesia, five minutes after cementation, and 15 minutes after prosthesis insertion.

Results

One hundred percent of patients had hypoxia at some level, but 83% of elderly patients (older than 66.5 years) had hypoxia (SpO2 <94%) as compared to only 23% of younger patients (p = 0.006). In the group of young patients, IMP was roughly increased 32 times as compared with baseline level, with as consequences a decrease of 4% of SpO2 (from 98.3 to 94.15%); in the elderly group, the IMP was only increased 20 times, but a decrease of 6% of SpO2 (from 97.25 to 91%) was observed.

Conclusions

This series demonstrated higher hypoxia in elderly healthy patients despite a paradoxical lower femoral increase of intramedullary pressure as compared with younger patients. This hypoxia is probably not only related to the cement but also to the patient’s age with decline of maximum oxygen uptake capacity and increase bone porosity.

Clinical trials

ClinicalTrials.gov Identifier: NCT03930537 https://clinicaltrials.gov/ct2/show/NCT03930537

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ClinicalTrials.gov ID: NCT03930537

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Authors and Affiliations

  1. University of Ljubljana, Ljubljana, Slovenia

    Skender Ukaj, Matjaž Veslko & Matej Cimerman

  2. Orthopaedic and Traumatology Department, University Clinical Center of Prishtina, Prishtina, Kosovo

    Skender Ukaj, Vlora Podvorica & Arben Ahmeti

  3. Faculty of Medicine “Fehmi Agani”, University of Gjakova, Gjakova, Kosovo

    Skender Ukaj

  4. Faculty of Medicine, University of Prishtina, Prishtina, Kosovo

    Shaip Krasniqi

  5. National Institute of Public Health, Prishtina, Kosovo

    Fatime Ukaj

  6. Université Paris Est, Paris, France

    Philippe Hernigou

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  1. Skender Ukaj
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  8. Matej Cimerman
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Contributions

SU: Surgery

MS, SK, VP, and AA: Data collection

PH: Study design, redaction, iconography

FU: Statistics

MC: Redaction

Corresponding author

Correspondence to Philippe Hernigou.

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All procedures were in accordance with the ethical standards 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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Informed consent was obtained from all individual participants included in the study

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Informed consent was obtained from all individual participants included in the study

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Participants have given consent for data publication.

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The authors declare no competing interests.

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Ukaj, S., Veslko, M., Krasniqi, S. et al. Cemented stems in healthy elderly patients result in higher hypoxia despite a paradoxical lower femoral increase of intramedullary pressure. International Orthopaedics (SICOT) 45, 915–922 (2021). https://doi.org/10.1007/s00264-021-04955-0

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  • DOI: https://doi.org/10.1007/s00264-021-04955-0

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