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Baig MN, Curtin W, Callaghan MA, Murphy CG. Catastrophic cement reaction following cementation for megaprosthesis for proximal femoral fracture. BMJ Case Rep 2017; 2017:bcr-2017-220158. [PMID: 28942397 DOI: 10.1136/bcr-2017-220158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bone cement implantation syndrome (BCIS) is a well-described and potentially fatal complication of orthopaedic surgery involving pressurised bone cement. Although also described for certain spinal procedures, it is most commonly associated with cemented hip and knee arthroplasty and with cemented hemiarthroplasty following neck of femur fracture in particular.Donaldson et alproposed the definition of BCIS as a syndrome "characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery". Other features include increased vascular resistance, cardiac arrhythmias and cardiac arrest post cement use.We describe a case of a patient who suffered a catastrophic reaction to cement during surgery for a comminuted proximal femoral fracture.
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Affiliation(s)
- Muhammad Nouman Baig
- Department of Trauma and Orthopaedics, Galway University Hospital, Galway, Ireland
| | - William Curtin
- Department of Trauma and Orthopaedics, Galway University Hospital, Galway, Ireland
| | | | - Colin G Murphy
- Department of Trauma and Orthopaedics, Galway University Hospital, Galway, Ireland
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202
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Dick AG, Davenport D, Bansal M, Burch TS, Edwards MR. Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era? Geriatr Orthop Surg Rehabil 2017; 8:161-165. [PMID: 28835873 PMCID: PMC5557200 DOI: 10.1177/2151458517722104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/31/2017] [Accepted: 06/14/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.
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Affiliation(s)
- Alastair G Dick
- King's College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, United Kingdom
| | - Dominic Davenport
- King's College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, United Kingdom
| | - Mohit Bansal
- King's College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, United Kingdom
| | - Therese S Burch
- King's College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, United Kingdom
| | - Max R Edwards
- King's College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, United Kingdom
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203
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Moppett IK, White S, Griffiths R, Buggy D. Tight intra-operative blood pressure control versus standard care for patients undergoing hip fracture repair - Hip Fracture Intervention Study for Prevention of Hypotension (HIP-HOP) trial: study protocol for a randomised controlled trial. Trials 2017; 18:350. [PMID: 28743315 PMCID: PMC5526232 DOI: 10.1186/s13063-017-2066-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/24/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypotension during anaesthesia for hip fracture surgery is common. Recent data suggest that there is an association between the lowest intra-operative blood pressure and mortality, even when adjusted for co-morbidities. This is consistent with data derived from the wider surgical population, where magnitude and duration of hypotension are associated with mortality and peri-operative complications. However, there are no trial to data to support more aggressive blood pressure control. METHODS/DESIGN We are conducting a three-centre, randomised, double-blinded pilot study in three hospitals in the United Kingdom. The sample size will be 75 patients (25 from each centre). Randomisation will be done using computer-generated concealed tables. Both participants and investigators will be blinded to group allocation. Participants will be aged >70 years, cognitively intact (Abbreviated Mental Test Score 7 or greater), able to give informed consent and admitted directly through the emergency department with a fractured neck of the femur requiring operative repair. Patients randomised to tight blood pressure control or avoidance of intra-operative hypotension will receive active treatment as required to maintain both of the following: systolic arterial blood pressure >80% of baseline pre-operative value and mean arterial pressure >75 mmHg throughout. All participants will receive standard hospital care, including spinal or general anaesthesia, at the discretion of the clinical team. The primary outcome is a composite of the presence or absence of defined cardiovascular, renal and delirium morbidity within 7 days of surgery (myocardial injury, stroke, acute kidney injury, delirium). Secondary endpoints will include the defined individual morbidities, mortality, early mobility and discharge to usual residence. DISCUSSION This is a small-scale pilot study investigating the feasibility of a trial of tight intra-operative blood pressure control in a frail elderly patient group with known high morbidity and mortality. Positive findings will provide the basis for a larger-scale study. TRIAL REGISTRATION ISRCTN Registry identifier: ISRCTN89812075 . Registered on 30 August 2016.
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Affiliation(s)
- Iain Keith Moppett
- Anaesthesia and Critical Care Section, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Stuart White
- Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Richard Griffiths
- Department of Anaesthesia, Peterborough & Stamford Hospitals NHS Trust, Peterborough, UK
| | - Donal Buggy
- School of Medicine, Mater Hospital, Eccles Street, Dublin 7, Ireland
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204
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Morwood MP, Johnston PS, Garrigues GE. Proximal ingrowth coating decreases risk of loosening following uncemented shoulder arthroplasty using mini-stem humeral components and lesser tuberosity osteotomy. J Shoulder Elbow Surg 2017; 26:1246-1252. [PMID: 28159474 DOI: 10.1016/j.jse.2016.11.041] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 11/25/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mini-stem humeral component (MSHC) use during total shoulder arthroplasty (TSA) provides bone preservation and ease of revision. MSHCs rely solely on proximal metaphyseal fixation; some early reports have demonstrated an unacceptably high rate of early loosening. To our knowledge, no study analyzing the effect of proximal porous coating on MSHCs has been performed. METHODS We performed a retrospective review of consecutive patients who underwent anatomic TSA using coated or uncoated MSHCs with minimum 2-year follow-up. Postoperative radiographs were assessed for risk of or frank stem loosening, subsidence, and presence of radiolucencies. Range of motion, outcome scores (visual analog scale pain, American Shoulder and Elbow Surgeons, and Single Assessment Numeric Evaluation), and any complications were noted. RESULTS We analyzed 68 shoulders with a mean follow-up of 27.3 months (range, 24-50 months). Of these, 34 had proximal coating and 34 were uncoated. In the coated group, no stems loosened, 1 (2.9%) subsided, and 7 (20.6%) developed radiolucencies. In the uncoated group, 1 stem (2.9%) became aseptically loose (requiring revision after 26 months), 7 (20.6%) were judged at risk of loosening (2 because of subsidence), and 15 (44.1%) developed radiolucencies. There was also an increased risk of proximal medial humeral radiolucencies among uncoated MSHCs. There were no significant differences in final range of motion or outcome scores. CONCLUSION MSHC use is appropriate for TSA, achieving desired pain relief and functional improvement. Overall, component loosening appears uncommon at early follow-up; however, uncoated stems appear to be at greater risk of loosening and developing radiolucencies. Selecting an MSHC with proximal porous coating may decrease the risk of implant-related complications.
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Affiliation(s)
- Michael P Morwood
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Peter S Johnston
- Southern Maryland Orthopaedic and Sports Medicine Center, Leonardtown, MD, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
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205
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Risk of cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine. Spine J 2017; 17:837-844. [PMID: 28108403 DOI: 10.1016/j.spinee.2017.01.009] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 12/07/2016] [Accepted: 01/12/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cement-augmented pedicle screw instrumentation (CAPSI) of the thoracolumbar spine is indicated in osteoporosis or osteopenia to improve pullout strength and biomechanical stability of pedicle screws (PS). Only a few studies report on the incidence of pulmonary cement embolism or other complications associated with CAPSI. PURPOSE The aim of this retrospective study was to assess the rate of CAPSI-associated complications. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Patients who underwent CAPSI due to spinal tumors or degenerative spine disease. OUTCOME MEASURES Cement leakage, pulmonary cement embolism (PCE), mortality rate. METHODS Our clinical database was reviewed for patients who underwent CAPSI between January 2012 and June 2015. A total of 165 patients (mean age 71±11.2; range: 46 to 93 years; m=62, f=103) were included. Indications were osteoporotic fractures (n=40), spinal metastases (n=57), degenerative (n=49) or infectious spine disease (n=5), and traumatic vertebral fractures (n=14) with an associated osteoporosis. Every patient received between 2 and 21 (mean 8±3.3) cement-augmented pedicle screws in the thoracolumbar and lumbosacral spine. Both intraoperative cement leakage in prevertebral veins, the inferior vena cava, and/or pulmonary arteries, and leakage detected on postoperative imaging were evaluated. We assessed the incidence of clinically symptomatic and asymptomatic events. RESULTS In 29 of 31 patients with intraoperative suspicion of cement leakage into prevertebral veins or the inferior vena cava on lateral fluoroscopy, which were without hemodynamic relevance, cement extrusion was confirmed on postoperative X-ray or computed tomography (CT) scan. In three of eight patients with suspicion of PCE, PCE was verified on thoracic CT. Four patients experienced life-threatening intraoperative hemodynamic reactions, either due to cement embolism (n=2; 1.2%) or anaphylactic shock (n=2; 1.2%) with need for intraoperative cardiopulmonary resuscitation in three cases. Two patients died due to fulminant PCE. Three patients with dyspnea 1 day after surgery were also confirmed with PCE on chest CT. In five patients, an asymptomatic PCE was found incidentally on postoperative imaging. In addition, 68 patients with cement leakage into prevertebral veins or the ascending cava vein were found incidentally on postoperative spine X-ray or CT. Two of 10 patients with intraspinal epidural cement leakage required revision surgery. One hundred ten of 165 patients (66.7%) had clinically asymptomatic cement leakage. Thirteen patients had PCE (7.9%), of whom five (3.0%) were symptomatic. Two patients experienced intraoperative cement-induced anaphylaxis (1.2%). The overall symptomatic complication rate was 5.5% (n=9). The 30-day mortality rate was 1.8% (n=3). CONCLUSIONS CAPSI bears a high risk of asymptomatic cement leakage. The risk for associated severe complications was also relatively high and probably underestimated considering the retrospective nature of the present study. A strict indication for cement augmentation, especially in patients with cardiac predisposition, should be the consequence. We doubt that technical aspects of cement application and/or different types of cement are capable of reducing the risk of these complications substantially.
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206
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Mao Y, Wen S, Chen G, Zhang W, Ai Y, Yuan J. Management of intra-operative acute pulmonary embolism during general anesthesia: a case report. BMC Anesthesiol 2017; 17:67. [PMID: 28549416 PMCID: PMC5446758 DOI: 10.1186/s12871-017-0360-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/17/2017] [Indexed: 12/30/2022] Open
Abstract
Background Acute pulmonary embolism (APE) can be life-threatening. Early detection is even more difficult for patients under general anesthesia as common symptoms are not available and the pathophysiological course of intra-operative APE is influenced by procedures of surgery and anesthesia, which makes patients under general anesthesia a distinctive group. Case presentation We report a case of APE during orthopedic surgery under general anesthesia. A 64-year-old female with atrial fibrillation and surgical history of varicosity underwent total right hip replacement surgery under general anesthesia. No arterial or deep vein thrombosis (DVT) was found prior to the surgery, but APE still occurred intraoperatively. The sudden decrease in PETCO2 and increase in PaCO2 combined other clues raised the suspect of APE, which is further evidenced by transesophageal echocardiogram (TEE). Multidisciplinary consultation was started immediately. After discussion with the consultation team and communication with patient’s family members, anticoagulation therapy was started and IVC filter was placed to prevent PE recurrence. The patient went through the operation and discharged uneventfully 30 days later. Conclusions Pulmonary embolism is a rare and potentially high-risk perioperative situation, with a difficult diagnosis when occurs under anesthesia. The separation phenomenon of decrease in PETCO2 and increase in PaCO2 might be a useful and suggestive sign, enabling prompt management and therefore improving the prognosis. Electronic supplementary material The online version of this article (doi:10.1186/s12871-017-0360-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuanyuan Mao
- Department of Anesthesiology, First Affiliated Hospital of Zhengzhou University, No.1 East-JianShe Road, Zhengzhou, 450052, China
| | - Shuai Wen
- Department of Modern Education Technology Center, Henan Medical College, No.8 Shuanghu Road, Longhu, Zhengzhou, 451191, China
| | - Gezi Chen
- Department of Anesthesiology, First Affiliated Hospital of Zhengzhou University, No.1 East-JianShe Road, Zhengzhou, 450052, China
| | - Wei Zhang
- Department of Anesthesiology, First Affiliated Hospital of Zhengzhou University, No.1 East-JianShe Road, Zhengzhou, 450052, China
| | - Yanqiu Ai
- Department of Anesthesiology, First Affiliated Hospital of Zhengzhou University, No.1 East-JianShe Road, Zhengzhou, 450052, China
| | - Jingjing Yuan
- Department of Anesthesiology, First Affiliated Hospital of Zhengzhou University, No.1 East-JianShe Road, Zhengzhou, 450052, China.
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207
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Abstract
UNLABELLED To evaluate the evidence for the resuscitation of patients with hip fracture in the preoperative or perioperative phase of their treatment and its impact on mortality. DESIGN We searched MEDLINE, EMBASE, CENTRAL and PROSPERO databases using a systematic search strategy for randomised trials and observational studies investigating the fluid resuscitation of any patient with hip fracture. No language limits were applied to the search, which was complemented by manually screening the reference lists of appropriate studies. OUTCOME MEASURES Mortality at 1 week, 30 days and 1 year following surgery. RESULTS Two hundred and ninety-eight citations were identified, and 12 full manuscripts were reviewed; no studies satisfied the inclusion criteria. The background literature showed that the mortality for these patients at 30 days is approximately 8.5% and that bone cement implantation syndrome is insufficient to explain this. The literature was explored to define the need for an interventional investigation into the preoperative resuscitation of patients with hip fracture. CONCLUSIONS Patients with hip fracture show similar physiological disturbance to major trauma patients. Nineteen per cent of patients presenting with hip fracture are hypoperfused and 50% show preoperative anaemia suggesting that under resuscitation is a common problem that has not been investigated. A properly conducted interventional trial could improve the outcome of these vulnerable patients.
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Affiliation(s)
- Brett Rocos
- Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, UK
| | | | - Michael B Kelly
- Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, UK
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208
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Veldman HD, Heyligers IC, Grimm B, Boymans TAEJ. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: a systematic review and meta-analysis of current generation hip stems. Bone Joint J 2017; 99-B:421-431. [PMID: 28385929 DOI: 10.1302/0301-620x.99b4.bjj-2016-0758.r1] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/05/2016] [Indexed: 12/23/2022]
Abstract
AIMS Our aim was to prepare a systematic review and meta-analysis to compare the outcomes of cemented and cementless hemiarthroplasty of the hip, in elderly patients with a fracture of the femoral neck, to investigate the mortality, complications, length of stay in hospital, blood loss, operating time and functional results. MATERIALS AND METHODS A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on randomised controlled trials (RCTs), studying current generation designs of stem only. The synthesis of results was done of pooled data, with a fixed effects or random effects model, based on heterogeneity. RESULTS A total of five RCTs including 950 patients (950 hips) were included. Cementless stems were found to be associated with more complications compared with cemented stems (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.12 to 2.31, p = 0.01), especially implant-related complications (OR 3.15, 95% CI 1.55 to 6.41, p = 0.002). The operating time was shorter for cementless stems (weighted mean difference -9.96 mins, 95%CI -12.93 to -6.98, p < 0.001). The data on functional outcomes could not be pooled. There was no statistically significant difference for any other outcome between the two methods of fixation. CONCLUSION In hemiarthroplasty of the hip using current generation stems, cemented stems result in fewer implant-related complications and similar mortality compared with cementless stems. Cite this article: Bone Joint J 2017;99-B:421-31.
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Affiliation(s)
- H D Veldman
- Zuyderland Medical Center, H. Dunantstraat 5, NL-6419 PC Heerlen, The Netherlands
| | - I C Heyligers
- Zuyderland Medical Center, H. Dunantstraat 5, NL-6419 PC Heerlen, The Netherlands
| | - B Grimm
- Zuyderland Medical Center, H. Dunantstraat 5, NL-6419 PC Heerlen, The Netherlands
| | - T A E J Boymans
- Zuyderland Medical Center, H. Dunantstraat 5, NL-6419 PC Heerlen, The Netherlands
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209
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Ramanathan S, Vora T, Gulia A, Mahajan A, Desai S. Pulmonary cement embolism in a child following total elbow replacement for primitive neuroectodermal tumour (PNET) of the humerus. Skeletal Radiol 2017; 46:715-718. [PMID: 28233027 DOI: 10.1007/s00256-017-2602-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/31/2017] [Accepted: 02/08/2017] [Indexed: 02/05/2023]
Abstract
Pulmonary bone cement embolism (PCE) is an uncommon event occurring after implantation of polymethylmethacrylate (PMMA) in orthopaedic surgeries involving adult patients, more so in the elderly. Its incidence in the paediatric population is extremely rare. We herein describe a case of PCE in a 15-year-old girl, 9 days after she underwent total elbow replacement with PMMA placement for a primitive neuroectodermal tumour (PNET) of the distal humerus. This report describes the occurrence of a common post-operative complication of bone cement embolism in an uncommon scenario of total elbow replacement for a bone tumour in a child, which masqueraded initially as acute pneumonitis.
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Affiliation(s)
- Subramaniam Ramanathan
- Department of Medical Oncology (Paediatric), Tata Memorial Hospital, Dr. E. Borges Road Parel, Mumbai, 400012, India.
| | - Tushar Vora
- Department of Medical Oncology (Paediatric), Tata Memorial Hospital, Dr. E. Borges Road Parel, Mumbai, 400012, India
| | - Ashish Gulia
- Department of Surgical Oncology (Orthopaedic), Tata Memorial Hospital, Mumbai, India
| | - Abhishek Mahajan
- Department of Radio-Diagnosis, Tata Memorial Hospital, Mumbai, India
| | - Subhash Desai
- Department of Radio-Diagnosis, Tata Memorial Hospital, Mumbai, India
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210
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Moerman S, Mathijssen NMC, Niesten DD, Riedijk R, Rijnberg WJ, Koëter S, Kremers van de Hei K, Tuinebreijer WE, Molenaar TL, Nelissen RGHH, Vochteloo AJH. More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures: a randomized controlled trial of 201 patients, with one year follow-up. BMC Musculoskelet Disord 2017; 18:169. [PMID: 28431543 PMCID: PMC5399836 DOI: 10.1186/s12891-017-1526-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 04/07/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND It is unclear whether cemented or uncemented hemiarthroplasty is the best treatment option in elderly patients with displaced femoral neck fractures. Previous randomized trials comparing cemented and uncemented hemiarthroplasty have conflicting results. We conducted a randomized controlled trial to compare cemented and uncemented hemiarthroplasty. METHODS This multicenter parallel-randomized controlled trial included patients of 70 years and older with a displaced femoral neck fracture (Garden type III or IV). Inclusion was between August 2008 and June 2012. Patients were randomized between a cemented hemiarthroplasty, type Müller Straight Stem or an uncemented hemiarthroplasty, type DB-10. Primary outcomes were complications, operation time, functional outcome (measured by Timed-Up-and-Go (TUG) and Groningen Activity Restriction Scale (GARS)) and mid-thigh pain. Health Related Quality of Life (HRQoL, expressed with the SF-12) was measured as an secondary outcome. Follow up was 1 year. RESULTS In total 201 patients were included in the study (91 uncemented, 110 cemented hemiarthroplasties) The uncemented group showed more major local complications (intra- and postoperative fractures and dislocations) odds ratio (95% confidence interval) 3.36 (1.40 to 8.11). There was no difference in mean operation time (57.3 vs 55.4 min). There were no differences in functional outcomes (TUG 12.8 (9.4) vs. 13.9 (9.0), GARS 43.2 (19.7) vs. 39.2 (16.5)) and mid-thigh pain (18.6 vs 21.6%). Physical component SF-12 HRQoLwas lower in the uncemented group (30.3 vs. 35.3 p < 0.05 after six weeks, 33.8 vs 38.5 p < 0.05 after 12 weeks). CONCLUSION A cemented hemiarthroplasty in elderly patients with a displaced femoral neck fracture results in less complications compared to an uncemented hemiarthroplasty. TRIAL REGISTRATION Netherlands Trial Registry; NTR 1508 , accepted date 27 okt 2008.
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Affiliation(s)
- Sophie Moerman
- Department of Orthopaedics, Reinier de Graaf Group, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands.
| | - Nina M C Mathijssen
- Department of Orthopaedics, Reinier de Graaf Group, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - Dieu D Niesten
- Department of Orthopaedics, Reinier de Graaf Group, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | | | | | - Sander Koëter
- Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Wim E Tuinebreijer
- Department of Surgery/Traumatology, Erasmus MC, Rotterdam, The Netherlands
| | - Tim L Molenaar
- Department of Orthopaedics, Reinier de Graaf Group, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
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211
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Chammout G, Muren O, Laurencikas E, Bodén H, Kelly-Pettersson P, Sjöö H, Stark A, Sköldenberg O. More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly. Acta Orthop 2017; 88:145-151. [PMID: 27967333 PMCID: PMC5385108 DOI: 10.1080/17453674.2016.1262687] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Total hip replacement (THR) is the preferred method for the active and lucid elderly patient with a displaced femoral neck fracture (FNF). Controversy still exists regarding the use of cemented or uncemented stems in these patients. We compared the effectiveness and safety between a modern cemented, and a modern uncemented hydroxyapatite-coated femoral stem in patients 65-79 years of age who were treated with THR for displaced FNF. Patients and methods - In a single-center, single-blinded randomized controlled trial, we included 69 patients, mean age 75 (65-79) and with a displaced FNF (Garden III-IV). 35 patients were randomized to a cemented THR and 34 to a reverse-hybrid THR with an uncemented stem. Primary endpoints were: prevalence of all hip-related complications and health-related quality of life, evaluated with EuroQol-5D (EQ-5D) index up to 2 years after surgery. Secondary outcomes included: overall mortality, general medical complications, and hip function. The patients were followed up at 3, 12, and 24 months. Results - According to the calculation of sample size, 140 patients would be required for the primary endpoints, but the study was stopped when only half of the sample size was included (n = 69). An interim analysis at that time showed that the total number of early hip-related complications was substantially higher in the uncemented group, 9 (among them, 3 dislocations and 4 periprosthetic fractures) as compared to 1 in the cemented group. The mortality and functional outcome scores were similar in the 2 groups. Interpretation - We do not recommend uncemented femoral stems for the treatment of elderly patients with displaced FNFs.
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212
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Nawaz SZ, Keightley AJ, Desai A, Granville-Chapman J, Elliott D, Newman K, Khaleel A. Displaced intracapsular neck of femur fractures: Outcome of 810 hydroxyapetite coated (HAC) uncemented hemiarthroplasties. Injury 2017; 48:909-913. [PMID: 28259379 DOI: 10.1016/j.injury.2016.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/16/2016] [Indexed: 02/02/2023]
Abstract
A Cochrane review influenced new NICE guidelines, which recommended surgeons: Offer cemented implants to patients undergoing surgery with arthroplasty. However our trust routinely uses HAC uncemented stem (Taperloc®, Biomet) hemiarthroplasties. A review of a consecutive series of uncemented HAC stem hemiarthroplasties including measures such as intro-operative complications, mortality and revision surgery. Prospectively collected data between January 2008 and June 2014 was used, with medical record and radiographic reviews performed. 810 consecutive Taperloc uncemented hemiarthroplasty with monopolar heads were performed in 763 patients, with a minimum 12 month follow-up (12-90) follow-up. Mean age 83yrs; 71% female. Meantime to operation was 28.5h. 30day mortality: 4.4% (33/763). One year mortality was 11.2% (89/763). 2.5% (20/810) were admitted on a separate admission with the periprosthetic fracture. 0.6% (5/810) were revised to total hip replacement for subsidence and associated pain. Only 1% (8/810) had intraoperative calcar fractures, all of which were treated with intraoperative cabling with no evidence of clinically relevant subsidence or medium term complications requiring revision surgery within a year. To the author's knowledge this is largest outcome series for modern design uncemented hemiarthroplasty. Our study shows comparable data to cemented hemiarthroplasty but no deaths in the first 2days post-op. Our series also demonstrates a well below average mortality figures which are clearly multifactorial but believe uncemented prosthesis play a role. We believe that uncemented proven stem design hemiarthroplasty remains a safe and good surgical option for displaced intracapsular fractures.
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Affiliation(s)
- S Z Nawaz
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia.
| | - A J Keightley
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - A Desai
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - J Granville-Chapman
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - D Elliott
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - K Newman
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - A Khaleel
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
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Miyamoto S, Nakamura J, Iida S, Shigemura T, Kishida S, Abe I, Takeshita M, Harada Y, Orita S, Ohtori S. 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. Arch Orthop Trauma Surg 2017; 137:523-529. [PMID: 28213848 DOI: 10.1007/s00402-017-2651-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Indexed: 01/17/2023]
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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Affiliation(s)
- Shuichi Miyamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan.
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Satoshi Iida
- Matudo City Hospital, 4005 Kamihongou, Matudo City, Chiba, 271-8511, Japan
| | | | - Shunji Kishida
- Seirei Sakura Citizen Hospital, 2-36-2 Eharadai, Sakura City, Chiba, 285-8765, Japan
| | - Isao Abe
- National Hospital Organization Chiba Medical Center, 4-1-2 Tubakinomori, Chuo-ku, Chiba City, Chiba, 260-8606, Japan
| | - Munenori Takeshita
- Kimitu Central Hospital, 1010 Sakurai, Kisarazu City, Chiba, 292-8535, Japan
| | - Yoshitada Harada
- Saiseikai Narashino Hospital, 1-1-1 Izumichou, Narashino City, Chiba, 275-8580, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
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214
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Birt MC, Anderson DW, Toby EB, Wang J. Osteomyelitis: Recent advances in pathophysiology and therapeutic strategies. J Orthop 2017; 14:45-52. [PMID: 27822001 PMCID: PMC5090239 DOI: 10.1016/j.jor.2016.10.004] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/13/2016] [Indexed: 01/29/2023] Open
Abstract
This review article summarizes the recent advances in pathogenic mechanisms and novel therapeutic strategies for osteomyelitis, covering both periprosthetic joint infections and fracture-associated bone infections. A better understanding of the pathophysiology including the mechanisms for biofilm formation has led to new therapeutic strategies for this devastating disease. Research on novel local delivery materials with appropriate mechanical properties, lower exothermicity, controlled release of antibiotics, and absorbable scaffolding for bone regeneration is progressing rapidly. Emerging strategies for prevention, early diagnosis of low-grade infections, and innovative treatments of osteomyelitis such as biofilm disruptors and immunotherapy are highlighted in this review.
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Affiliation(s)
| | | | | | - Jinxi Wang
- Department of Orthopedic Surgery, University of Kansas Medical Center,
Kansas City, KS 66160, USA
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215
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Palomäki A, Lempainen L, Matilainen M, Eskelinen A, Remes V, Virolainen P, Mäkelä KT. Survival of uncemented cups from a single manufacturer implanted from 1985 to 2013: Finnish Arthroplasty Register data. Arch Orthop Trauma Surg 2017; 137:311-320. [PMID: 28091739 DOI: 10.1007/s00402-017-2624-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Total hip arthroplasty (THA) with uncemented implants has been a relatively common procedure in Finland during the recent decades. The most common brand of uncemented implants was chosen for further analysis to study the survivorship of this uncemented cup design in comparison to cemented references. PATIENTS, MATERIALS AND METHODS Since 1980, The Finnish Arthroplasty Register has collected information on THAs on a national level. This study was based on information of THAs recorded in the Finnish Arthroplasty Register from 1985 to 2013. If patient had undergone bilateral THA, only the first one was included. Altogether, 49,289 THAs were included. RESULTS The overall 10-year implant survivorship of uncemented implants was 84.3% (95% CI 83.5-85.0%) and of cemented implants 90.6% (90.2-90.0%). The 10-year survival of the contemporary uncemented implants was 90.8% (94.0-95.5%) and 88.5% (84.2-91.7%). The most recently introduced uncemented cup designs had good survivorship rates at 5 years; 10-year survival data are not yet available. CONCLUSIONS We found that modern uncemented cup designs may provide good long-term survivorship rates comparable with the gold standard of cemented cups. However, polyethylene wear, liner problems and periosthetic osteolysis may still occur, also with modern uncemented acetabular components.
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Affiliation(s)
- Antton Palomäki
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland.
| | - Lasse Lempainen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | | | | | | | - Petri Virolainen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Keijo T Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
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216
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Prashanth YS, Niranjan M. Comparative Study of Surgical Management of Fracture Neck of Femur with Cemented Versus Uncemented Bipolar Hemiarthroplasty. J Clin Diagn Res 2017; 11:RC17-RC21. [PMID: 28384949 PMCID: PMC5376863 DOI: 10.7860/jcdr/2017/22598.9454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/21/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There is evidence for use of cemented hemiarthroplasty resulting in greater anchoring and lesser peri prosthetic fracture. However, this procedure results in more haemodynamic instability and cardiopulmonary complications termed as 'cement reaction' or bone cement implantation syndrome. There has been a heightened interest among surgeons to compare cemented and uncemented hemiarthroplasty for fracture neck of femur. AIM To compare cemented and uncemented hemiarthroplasty in terms of blood loss during the procedure, post-operative complications, mortality, functional recovery and long term clinical outcome. MATERIALS AND METHODS In a prospective study spanning 8 years from January 2006 to January 2014 in a tertiary care hospital, 52 cases of fracture of neck were selected. Twenty four patients underwent cemented and 28 patients underwent uncemented hemiarthroplasty. Mean follow up duration was 59.3 months. Harris Hip Score evaluation was done at each follow up. Radiological evaluation was done at each follow up for calcar length and periprosthetic fractures. RESULTS Mean age of patients was 70 years. Harris Hip scores at 3, 6 and 12 months did not show statistically significant differences. Periprosthetic osteolysis or loosening was not seen in the present study. No complications noted in uncemented hemiarthroplasty. Four patients who had cemented hemiarthroplasty had infections. No mortality occurred during admission and within 12 months after surgery. CONCLUSION No significant difference was noted between the cemented and uncemented hemiarthroplasty procedures on long term follow up in terms of functionality. No re-operations and no mortality reported. Cemented hemiarthroplasty had more blood loss and minimal post-operative complications.
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Affiliation(s)
- YS Prashanth
- Assistant Professor, Department of Orthopaedics, Azeezia Institute of Medical Sciences, Kollam, Kerala, India
| | - M Niranjan
- Professor and Head, Department of Orthopaedics, Bangalore Baptist Hospital, Bangalore, Karnataka, India
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217
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Chatterjee K, Mittadodla PS, Colaco C, Jagana R. A Rare Cause of Pulmonary Edema in the Postoperative Period. Indian J Crit Care Med 2017; 21:108-109. [PMID: 28250610 PMCID: PMC5330051 DOI: 10.4103/ijccm.ijccm_495_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
With the increasing longevity of the population, the annual rates of hip arthroplasties performed have been steadily increasing over the past decade. Given the presence of medical comorbidities in the older patients, the peri-operative care of these individuals requires multi-specialty care, now more than ever. Hip arthroplasty is generally well tolerated, with early mortality after the procedure being <1%. Bone cement implantation syndrome (BCIS) is an entity that is occasionally encountered during or after the surgery. It is characterized by hypoxemia, hypotension, cardiac arrhythmias, and cardiac arrest leading to death, in severe cases. We report a case of a middle-aged female who developed refractory hypotension and pulmonary edema while undergoing hemiarthroplasty for a pathological femoral neck fracture and experienced cardiac arrest in the immediate postoperative period. Critical care physicians must familiarize themselves with promptly diagnosing and managing BCIS.
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Affiliation(s)
- Kshitij Chatterjee
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Penchala S Mittadodla
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clinton Colaco
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rajani Jagana
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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218
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Abstract
The results of modern cemented and uncemented total hip arthroplasties are outstanding and both systems have their advantages and disadvantages. This paper aims to examine the designs of different types of prostheses, some history behind their development and the reported results. Particular emphasis is placed on cemented stem design and the details of cementing technique.
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Affiliation(s)
- Joanna Maggs
- Princess Elizabeth Orthopaedic Centre, Exeter, EX2 5DW, UK
| | - Matthew Wilson
- Princess Elizabeth Orthopaedic Centre, Exeter, EX2 5DW, UK,Address for correspondence: Dr. Matthew Wilson, Princess Elizabeth Orthopaedic Centre, Exeter, EX2 5DW, UK. E-mail:
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219
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Rezaie W, Wei W, Cleffken BI, van der Vlies CH, Cleffken BI, Roukema GR. Internal Fixation Versus Hemiarthroplasty for Displaced Intra-Capsular Femoral Neck Fractures in ASA 3-5 Geriatric Patients. Open Orthop J 2016; 10:765-771. [PMID: 28217201 PMCID: PMC5299552 DOI: 10.2174/1874325001610010765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The treatment of choice for elderly with a displaced intra-capsular femoral neck fractures is prosthetic replacement. This is however a major surgical procedure for geriatric patients with multiple co-morbidities which can threaten hemodynamic stability and lead to death. In this study we compared the outcome of internal fixation (IF) versus hemiarthroplasty (HA) for the management of intra-capsular femoral neck fractures in the elderly with severe co-morbidities. METHODS We conducted a retrospective cohort study of all the patients who were admitted to our Level-II trauma centre with a femoral neck fracture between January 2009 and June 2011. Inclusion criteria were: 70 years or older, ASA 3 or higher, a displaced femoral neck fracture and treatment with either internal fixation or a cemented hemiprosthesis. The primary outcome was 6-month mortality rate. Secondary outcomes were 30-day mortality, post-operative complications, re-operation rate and length of hospital stay. RESULTS 80 patients met our inclusion criteria. The mean age of the IF group was 81.6 years and in the HA group it was 84.5 years (P=0.07). The medical records were retrieved 34-64 months after surgery. Two intra-operative deaths due to cement implantation syndrome were found in the HA group and none in the IF group. Twelve patients (21.8%) in the HA group died within 30 days after surgery and 2 (8.0%) in the IF group (P=0.21). The mean operating time was 83 min. for the HA group and 51 min. for the IF group (P=0.000). There were more implant-related complications in the IF than in the HA group (36% vs 9.1% respectively, P=0.008). The 6-month mortality rates didn't differ between the IF and the HA groups (respectively 28.0% vs 34.5%, P=0.62). CONCLUSION The post-operative mortality rates did not differ between the IF and the HA groups in elderly patients with a displaced femoral neck fracture and ASA 3 to 5. However, the HA associated with less implant-related complications than the IF in this group and it is therefore the treatment of choice.
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Affiliation(s)
- W Rezaie
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - W Wei
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - B I Cleffken
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - C H van der Vlies
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - B I Cleffken
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - G R Roukema
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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220
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Ten Hagen A, Doldersum P, van Raaij T. Anaphylactic shock during cement implantation of a total hip arthroplasty in a patient with underlying mastocytosis: case report of a rare intraoperative complication. Patient Saf Surg 2016; 10:25. [PMID: 27822310 PMCID: PMC5097346 DOI: 10.1186/s13037-016-0113-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cemented total hip arthroplasty (THA) is a safe and common procedure. In rare cases life threatening bone cement implantation syndrome (BCIS) may occur, which is commonly caused by pulmonary embolism (PE). CASE PRESENTATION We describe the rare case of a 70-year old patient who underwent an elective total hip replacement. Before surgery he was diagnosed with underlying systemic indolent mastocytosis, a rare pathological disorder that may result in anaphylaxis after massive systemic mast cell activation. Triggers may be IgE-mediated, direct mast cell activation, or unclear. Some patients may be at risk for severe non IgE-mediated reactions, such as those experienced with nonsteroidal anti-inflammatory drugs, or with perioperative muscle relaxants. During cementing of the acetabular component, our patient developed acute hypotension (blood pressure dropped from 90/50 to 60/40 mmHg, and saturation dropped from 95 to 80 %). The differential diagnosis of acute PE was excluded (no signs of breathing abnormalities during physical examination, normal arterial blood sample, and no electrocardiography or cardiac ultrasound abnormalities). The patient was diagnosed with acute anaphylactic shock, which was successfully managed by 100 % oxygen administration, rapid fluid induction, and vasoconstrictive drug therapy. He recovered hemodynamically within 15 min, did not lose consciousness, and did not develop angioedema or an urticarial rash. Forty-five minutes after onset of the symptoms, the surgical procedure was completed after inserting a press fitted uncemented femoral stem component. The patient was transported to the Intensive Care Unit (ICU) for optimal monitoring. Our patient had an uneventful recovery. Within six hours after surgery he started to ambulate following our standard fast-track rehabilitation regime. Post-operative day one he was discharged to the specialized Orthopedic Department, and after five hospital days discharged to his home. Twelve months after THA surgery our patient was satisfied with an optimal functional status of his hip joint replacement. CONCLUSION The differential diagnosis of anaphylactic shock must be taken into consideration in patients with acute hypotension during cementing of total hip arthroplasty components. Patients with underlying mastocytosis are at particular risk of this potential life-threatening intra-operative complication. This rare entity should be taken into consideration during the pre-operative risk stratification and shared decision-making process for elective cemented joint replacement.
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Affiliation(s)
- Anita Ten Hagen
- Department of Anesthesiology, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, The Netherlands
| | - Pieter Doldersum
- Department of Anesthesiology, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, The Netherlands
| | - Tom van Raaij
- Department of Orthopaedic Surgery, Martini Hospital Groningen, van Swietenplein 1, 9728 NT Groningen, The Netherlands
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221
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Moskal JT, Capps SG, Scanelli JA. Still no single gold standard for using cementless femoral stems routinely in total hip arthroplasty. Arthroplast Today 2016; 2:211-218. [PMID: 28326430 PMCID: PMC5247516 DOI: 10.1016/j.artd.2016.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/01/2016] [Accepted: 02/08/2016] [Indexed: 11/28/2022] Open
Abstract
Background There is now a clear trend with increased usage of cementless femoral stems for all ages and most patients. As the number of total hip arthroplasties (THAs) performed annually continues to increase with expanding indications for THA and demands for improved quality of life, so will the prevalence of THA in the elderly and aging populations. This is worrisome as the risk of complications with cementless femoral stems increases in elderly patients and those with poor bone quality. The purpose of this study is to analyze the available data from comparative studies to determine whether cementless femoral stems are overused and whether cemented stems warrant increased consideration. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searches were performed to find original studies comparing cementless and cemented femoral stems; large population registry studies and reports were also included. Results This systematic review documents that older patients with cementless fixation increase the risk of revision, there is no clear fixation advantage in midaged patients, and younger patients fare better with cementless fixation. Complications after THA create burdens on the health care system and on patients. Conclusions Using evidence-based data should be better guidance in selecting the most reliable implants for THA. Although cementless femoral fixation for THA has evolved to the “new standard,” it has not been proven to be the “gold standard” for all patients.
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Affiliation(s)
- Joseph T Moskal
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Institute for Orthopaedics and Neurosciences at Carilion Clinic, Roanoke, VA, USA
| | | | - John A Scanelli
- The George Washington Medical Center, Washington Circle Orthopedic Associates, Washington, DC, USA
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222
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Chen Q, Huang C, Zhang YJ. The effect of intravertebral anesthesia on bone cement implantation syndrome in aged patients: A single-center 5-year retrospective study. Medicine (Baltimore) 2016; 95:e4775. [PMID: 27603378 PMCID: PMC5023901 DOI: 10.1097/md.0000000000004775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The aim of the study was to assess the effect of commonly used intravertebral anesthesia on bone cement implantation syndrome (BCIS) in aged patients undergoing hemiarthroplasty.The medical records of 1210 aged patients receiving hemiarthroplasty under intravertebral anesthesia were retrospectively reviewed. Anesthesia charts for all patients were reviewed for central venous pressure, mean arterial pressure, arterial oxygen saturation, and heart rate before, during, and after cementation. Each patient was classified into no BCIS (grade 0) or BCIS grade 1, 2, or 3 according to the degree of hypotension, arterial desaturation, or loss of consciousness around cementation. Changes in these grades after cementation were compared according to the ways of intravertebral anesthesia used.Among all included patients, 72.2% (874/1210) showed grade 1 or higher grade of BCIS after cementation. Compared with spinal-epidural anesthesia, single epidural anesthesia showed adjusted odds ratios (95% confidence interval) of 1.25 (1.13-1.43) for grade 1, 1.36 (0.83-2.06) for grade 2, and 3.55 (1.52-7.06) for marked postoperatively grade 3 of BCIS versus grade 0 (Type III P < 0.0001).Single epidural anesthesia was associated with increased odds for elevation of these grades after cementation compared with spinal-epidural anesthesia.
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Affiliation(s)
| | | | - Ya-Jun Zhang
- Department of Anesthesiology, East branch, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, Chengdu 610110, China
- Correspondence: Ya-Jun Zhang, Department of Anesthesiology, Sichuan Provincial People's Hospital (east branch), Sichuan Academy of Medical Science, north Da Mian Hong HeAve, Long Quan district, Chengdu, China (e-mail: )
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223
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Park KJ, Menendez ME, Mears SC, Barnes CL. Patients With Multiple Myeloma Have More Complications After Surgical Treatment of Hip Fracture. Geriatr Orthop Surg Rehabil 2016; 7:158-62. [PMID: 27551575 PMCID: PMC4976742 DOI: 10.1177/2151458516658330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objectives: Bone lesions from multiple myeloma may lead to pathological fracture of the proximal femur, requiring either fixation or arthroplasty. Little is known about the impact of multiple myeloma on hip fracture care. We investigated whether the patients with multiple myeloma undergoing surgical treatment of hip fractures would be at increased risk for adverse outcomes versus patients who sustain a hip fracture without multiple myeloma. Methods: Using discharge records from the Nationwide Inpatient Sample (2002-2011), we identified 2 440 513 patients older than 50 years of age with surgically treated hip fractures. Of which, 4011 (0.2%) were found to have multiple myeloma. We compared perioperative outcomes between the patients with multiple myeloma and the nonmultiple myeloma patients using multivariable logistic regression modeling. Results: Patients with multiple myeloma were more likely to have several postoperative complications, such as in-hospital pneumonia (odds ratio [OR]: 1.31, 95% confidence interval [CI]: 1.14-1.51), sepsis (OR: 1.72, 95% CI: 1.32-2.25), surgical site infection (OR: 1.66, 95% CI: 1.38-2.00), and acute renal failure (OR: 1.28, 95% CI: 1.14-1.43). We found that myeloma was not associated with increased inpatient mortality, myocardial infarction, respiratory failure, thromboembolic events, or pulmonary embolism. Conclusion: Patients with multiple myeloma are at increased risk for immediate postoperative complications following surgical treatment of hip fractures including in-hospital pneumonia, surgical site infection, and acute renal failure but not hospital mortality, when compared to hip fracture patients without multiple myeloma. Perioperative management of hip fractures in patients with myeloma may be optimized by increased awareness of these risks in this subset of patients.
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Affiliation(s)
- Kwan Jun Park
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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224
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Güler G, Atıcı Ş, Kurt E, Karaca S, Yılmazlar A. Current Approaches in Hip and Knee Arthroplasty Anaesthesia. Turk J Anaesthesiol Reanim 2016; 43:188-95. [PMID: 27366493 DOI: 10.5152/tjar.2015.26096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 01/19/2023] Open
Abstract
Risk assesment, preoperative drug regulation, the anesthesia and analgesia techniques are very important and the effectivity on success of surgery is great. So, these topics in arthroplasty were reviewed under current knowledge.
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Affiliation(s)
- Gülen Güler
- Department of Anaesthesiology and Reanimation, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Şebnem Atıcı
- Department of Anaesthesiology and Reanimation, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ercan Kurt
- Department of Anaesthesiology and Reanimation, Gülhane Military Medical Academy, Ankara, Turkey
| | - Saffet Karaca
- Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Aysun Yılmazlar
- Department of Anaesthesiology and Reanimation, Private Medicabil Hospital, Bursa, Turkey
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225
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Ma LL, Yu XR. Severe Acute Respiratory Distress Syndrome after Bilateral Total Knee Replacement. Chin Med J (Engl) 2016; 128:2977-8. [PMID: 26521804 PMCID: PMC4756890 DOI: 10.4103/0366-6999.168083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Xue-Rong Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
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226
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Naik AA, Lietman SA. Complications With Long Cemented Stems in Proximal Femoral Replacement. Orthopedics 2016; 39:e423-9. [PMID: 27064780 DOI: 10.3928/01477447-20160404-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/04/2015] [Indexed: 02/03/2023]
Abstract
This study attempted to determine whether patients undergoing cemented long-stem proximal femoral replacement had: (1) an increased short-term mortality rate; (2) greater intraoperative hemodynamic instability; (3) a greater need for resuscitation; and (4) a decreased risk of periprosthetic fracture. The current study reviewed intraoperative and short-term events related to clinical outcomes in 24 consecutive patients who were treated at a single institution over a 5-year period. These patients underwent primary long-stem (≥250 mm, n=13) vs short-stem (<250 mm, n=11) cemented proximal femoral replacement. Other than stem length, the 2 groups were not significantly different in terms of patient age, sex, height, weight, body mass index, diagnosis, or preoperative American Society of Anesthesiologists functional score. Primary outcomes were intraoperative death, blood loss, blood transfusions, fluid resuscitation, hypotension, oxygen desaturation, mortality up to 1 year, and need for revision surgery. At 1 year, a significantly increased mortality rate (77% vs 27%, P=.03) was noted in patients receiving long-stem vs short-stem arthroplasty. Patients who received longer stems also required more intraoperative blood transfusions and fluid resuscitation (P=.04) for greater hypotension (P=.04) and oxygen desaturation (P=.04). Two intraoperative deaths occurred in the long-stem group, and none occurred in the short-stem group. The findings suggest that there is an increased risk of intraoperative hemodynamic instability with long-stem vs short-stem proximal femoral replacement, with a need for greater resuscitative efforts and an increased risk of mortality at 1 year. [Orthopedics. 2016; 39(3):e423-e429.].
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227
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Saleh KJ, El Othmani MM, Tzeng TH, Mihalko WM, Chambers MC, Grupp TM. Acrylic bone cement in total joint arthroplasty: A review. J Orthop Res 2016; 34:737-44. [PMID: 26852143 DOI: 10.1002/jor.23184] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/03/2016] [Indexed: 02/04/2023]
Abstract
Acrylic bone cement has a variety of applications in orthopedic surgery. Primary uses in total arthroplasties are limited to prostheses fixation and antibiotic delivery. With the large number of total joint arthroplasties expected to continue to rise, understanding the role bone cement plays in the success of total joint arthroplasty can have a significant impact on daily practice. The literature is inconclusive on whether cemented or cementless fixation technique is superior, and choice of fixation type is mainly determined by surgeon preference and experience. Surgeons should understand that if poor techniques exist, short-term outcomes of the replaced joint may be at risk. Statement of clinical significance: This article attempts to clarify some points of bone cement use through a review of the mechanical properties related to bone cement, a comparison to alternative materials, influence of additives, and the effects on surgical outcomes. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:737-744, 2016.
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Affiliation(s)
- Khaled J Saleh
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Mouhanad M El Othmani
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Tony H Tzeng
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, 956 Court Ave, Suite E226, Memphis, Tennessee, 38163
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Thomas M Grupp
- Clinic for Orthopaedic Surgery, Campus Grosshadern, Ludwig Maximilians University, Munich, Germany Aesculap AG, Research & Development, Tuttlingen, Germany
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228
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Singh V, Bhakta P, Zietak E, Hussain A. Bone cement implantation syndrome: a delayed postoperative presentation. J Clin Anesth 2016; 31:274-7. [PMID: 27185726 DOI: 10.1016/j.jclinane.2016.01.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 12/17/2022]
Abstract
Bone cement implantation syndrome (BCIS) is a well-known entity but is poorly understood and rarely reported. It is an important cause of perioperative morbidity and mortality in the patient undergoing cemented hip arthroplasty. BCIS is characterized by hypotension, hypoxia, cardiac arrhythmias, and increased pulmonary vascular resistance and can lead to eventual cardiac arrest if not managed properly. We hereby report a case of delayed presentation of BCIS following cemented right hip arthroplasty.
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Affiliation(s)
- Vikash Singh
- Department of Anaesthesia and Intensive care, Beaumont Hospital, Dublin, Ireland.
| | - Pradipta Bhakta
- Department of Anaesthesia and Intensive care, Our Lady of Lourdes Hospital, Drogheda, Ireland.
| | - Edyta Zietak
- Department of Physical Medicine, Wiszia, Zamosc, Poland.
| | - Ashfaq Hussain
- Department of Anaesthesia and Intensive care, Our Lady of Lourdes Hospital, Drogheda, Ireland.
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229
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Perioperative Hypersensitivity Reactions: Diagnosis, Treatment and Evaluation. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0078-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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230
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White SM, Moppett IK, Griffiths R, Johansen A, Wakeman R, Boulton C, Plant F, Williams A, Pappenheim K, Majeed A, Currie CT, Grocott MPW. Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2). Anaesthesia 2016; 71:506-14. [DOI: 10.1111/anae.13415] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 12/13/2022]
Affiliation(s)
- S. M. White
- Brighton and Sussex University Hospitals NHS Trust; Brighton East Sussex UK
| | - I. K. Moppett
- Anaesthesia and Critical Care Section; Division of Clinical Neuroscience; University of Nottingham; Queen's Medical Centre Campus; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - R. Griffiths
- Peterborough and Stamford Hospitals NHS Trust; Peterborough UK
| | - A. Johansen
- National Hip Fracture Database, Falls and Fragility Fracture Audit Programme; Clinical Effectiveness and Evaluation Unit; Royal College of Physicians; London UK
| | - R. Wakeman
- National Hip Fracture Database, Falls and Fragility Fracture Audit Programme; Clinical Effectiveness and Evaluation Unit; Royal College of Physicians; London UK
| | - C. Boulton
- National Hip Fracture Database, Falls and Fragility Fracture Audit Programme; Clinical Effectiveness and Evaluation Unit; Royal College of Physicians; London UK
| | - F. Plant
- The Royal National Orthopaedic Hospital; Stanmore Middlesex UK
| | - A. Williams
- Gloucestershire Royal Hospital; Gloucester Gloucestershire UK
| | - K. Pappenheim
- Association of Anaesthetists of Great Britain and Ireland; London UK
| | - A. Majeed
- King Fahad Medical City; Riyadh Saudi Arabia
| | | | - M. P. W. Grocott
- Anaesthesia and Critical Care Medicine; University of Southampton and Southampton NIHR Respiratory Biomedical Research Unit; Southampton UK
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231
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Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J 2016; 98-B:291-7. [DOI: 10.1302/0301-620x.98b3.36515] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This review summarises the evidence for the treatment of displaced fractures of the femoral neck in elderly patients. Results from randomised clinical trials and national register studies are presented when available. The advantages of arthroplasty compared with internal fixation are supported by several studies. A number of studies contribute to the discussions of total hip arthroplasty (THA) versus hemiarthroplasty and unipolar versus bipolar hemiarthroplasty, but no clear-cut evidence-based recommendation can be made. THA may be particularly advantageous for active, lucid patients with a relatively long life expectancy. For patients who are physiologically older, hemiarthoplasty is probably satisfactory, and for the oldest patients with more comorbidities, unipolar implants are considered to be sufficient. If the hospital can support emergency THA surgery in sufficient numbers and quality, there may be few patients who warrant bipolar hemiarthroplasty. The direct lateral approach reduces the risk of dislocation compared with the posterior approach. Cemented implants lower the risk of periprosthetic fracture and its subsequent morbidity and mortality. As the risk of peri-operative death related to bone cement can be reduced by adequate measures, cemented implants are recommended in fracture cases. Take home message: There remains a great variation in the surgical management of patients with a hip fracture, and an evidence-based approach should improve the outcomes for this vulnerable patient group. Cite this article: Bone Joint J 2016;98-B:291–7.
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Affiliation(s)
- C. Rogmark
- Lund University, Skåne University Hospital,
Malmö, Sweden and, Swedish Hip Arthroplasty
Register, Registercentrum VGR, Gothenburg, Sweden
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232
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Tsai SW, Chen CF, Wu PK, Huang CK, Chen WM, Chang MC. Does Implant Selection Impact Postoperative Complications Following Hip Arthroplasty for Failed Intertrochanteric Fractures? A Retrospective Comparative Study. Artif Organs 2016; 40:798-804. [DOI: 10.1111/aor.12676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Shang-Wen Tsai
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Cheng-Fong Chen
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Po-Kuei Wu
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Ching-Kuei Huang
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Wei-Ming Chen
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Ming-Chau Chang
- Taipei Veterans General Hospital-Orthopaedics and Traumatology; Taipei Taiwan
- Department of Orthopedics; School of Medicine; National Yang-Ming University; Taipei Taiwan
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233
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Boymans TAEJ, Heyligers IC, Grimm B. The Morphology of the Proximal Femoral Canal Continues to Change in the Very Elderly: Implications for Total Hip Arthroplasty. J Arthroplasty 2015; 30:2328-32. [PMID: 26187385 DOI: 10.1016/j.arth.2015.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/19/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023] Open
Abstract
A shape mismatch between cementless stems and the femoral canal of very elderly patients could partly explain the inferior performance of cementless compared to cemented stems in this age group. Influences of age and gender on canal morphology were investigated by measuring coronal/sagittal dimensions on CT-scans of subjects ≥80 years old (n = 117) and subjects < 80 years old (n = 51). Absolute canal dimensions like width were larger in octogenarians than in younger subjects. These differences were larger in the sagittal plane than in the coronal plane (P < 0.001). Canal flaring changed asymmetrically with increased medial and less lateral flaring in octogenarians. Age-related changes were mainly observed in females and should be taken into consideration for implant design, selection and implantation in octogenarians.
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Affiliation(s)
- Tim A E J Boymans
- AHORSE Research Foundation, Atrium Medical Center Heerlen, Dept. of Orthopaedic Surgery, Heerlen, the Netherlands
| | - Ide C Heyligers
- AHORSE Research Foundation, Atrium Medical Center Heerlen, Dept. of Orthopaedic Surgery, Heerlen, the Netherlands
| | - Bernd Grimm
- AHORSE Research Foundation, Atrium Medical Center Heerlen, Dept. of Orthopaedic Surgery, Heerlen, the Netherlands
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234
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Mazzola P, Picone D, Anzuini A, Corsi M, Bellelli G, Annoni G. Takotsubo cardiomyopathy in an 81-year-old woman after injection of bone cement during hemiarthroplasty: An orthogeriatric case report. Int J Surg Case Rep 2015; 18:37-41. [PMID: 26688511 PMCID: PMC4701876 DOI: 10.1016/j.ijscr.2015.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Takotsubo cardiomyopathy is a syndrome characterized by transient cardiac ischemia-like symptoms, such as chest pain, increase of myocardial necrosis markers, electrocardiographic changes, and temporary left ventricular apical ballooning without significant coronary artery disease, often triggered by a particularly stressful situation. The association between Takotsubo and hip fracture surgery has been rarely reported in the literature. PRESENTATION OF CASE An 81-year-old woman was hospitalized with a diagnosis of right femoral neck fracture. During the surgical procedure, she displayed acute coronary symptoms a few minutes after the injection of bone cement, in the absence of coronary lesions. Due to the time relationship, bone cement implantation syndrome - not uncommon to observe - was considered in the differential diagnosis. However, the instrumental findings and the transient nature of the abnormalities guided us toward a diagnosis of Takotsubo. The treatment with Levosimendan, Amiodarone, and Metoprolol allowed gradual and satisfactory recovery of the cardiac function within a few days. The follow-up performed two and six months after surgery revealed complete cardiac recovery, and ability to walk at home comparable to the pre-fracture situation. DISCUSSION Takotsubo cardiomyopathy is more common in women during the postmenopausal phase, especially if undergoing stressful physical or emotional stimuli. In this case, the sequence of hip fracture, pain, hospitalization, and surgery could easily be intended as a strong stressful event with high physical/psychological burden. CONCLUSION Despite the good prognosis associated with early recognition, Takotsubo represents a life-threatening adverse event. Considering its possible pathogenesis, a "gentle care" approach and the optimization of pain control must be pursued in elderly subjects with hip fracture, aiming at reducing the stress of the hospitalization and related procedures.
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Affiliation(s)
- Paolo Mazzola
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy; NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, 20126 Milano-MI, Italy.
| | - Domenico Picone
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy
| | - Alessandra Anzuini
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy
| | - Maurizio Corsi
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy
| | - Giuseppe Bellelli
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy; NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, 20126 Milano-MI, Italy
| | - Giorgio Annoni
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy; NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, 20126 Milano-MI, Italy
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235
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Takahata T, Okihara T, Yoshida Y, Yoshihara K, Shiozaki Y, Yoshida A, Yamane K, Watanabe N, Yoshimura M, Nakamura M, Irie M, Van Meerbeek B, Tanaka M, Ozaki T, Matsukawa A. Bone engineering by phosphorylated-pullulan and
β
-TCP composite. Biomed Mater 2015; 10:065009. [DOI: 10.1088/1748-6041/10/6/065009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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236
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Ni C, Xu T, Li N, Tian Y, Han Y, Xue Q, Li M, Guo X. Cerebral oxygen saturation after multiple perioperative influential factors predicts the occurrence of postoperative cognitive dysfunction. BMC Anesthesiol 2015; 15:156. [PMID: 26503361 PMCID: PMC4624171 DOI: 10.1186/s12871-015-0117-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/01/2015] [Indexed: 01/18/2023] Open
Abstract
Background Postoperative cognitive dysfunction (POCD) is a frequent complication in elderly patients undergoing major non-cardiac surgery, but its etiology is still unclear. Cerebral oxygen saturation (ScO2) represents the balance of cerebral oxygen supply and demand. The aim of present study was to evaluate the relationship between perioperative ScO2 and POCD, and to verify the hypothesis that the value of ScO2 after multiple perioperative influential factors could predict POCD in elderly patients undergoing total knee arthroplasty (TKA). Methods Seventy eight Patients aged more than 65 years undergoing elective TKA with intrathecal anesthesia were enrolled. Cognitive functions were assessed one day before and 6 days after surgery, and POCD were defined according to ISPOCD. Demographics were recorded. Perioperative ScO2, blood pressure (BP), blood gas analysis and other clinical data were monitored and recorded, then the decrease of ScO2, BP and PaO2 after influential factors were calculated. Results POCD occurred in 15 patients (19.2 %). BP decreased after anesthesia induction and tourniquet deflation, and PaO2 decreased after cement implantation, then percentage decrease of BP was higher in POCD group. ScO2 of POCD group is significantly lower than non-POCD group (P < 0.05), and the absolute value and percentage decrease of ScO2 became significant between two groups after multiple influential factors. ScO2 after all influential factors (anesthesia induction, cement implantation and tourniquet deflation) had the best predictive performance for POCD (AUC = 0.742), and the optimal threshold was 66.5 %. Conclusions Perioperative ScO2 of patients with POCD is lower than patients without POCD. ScO2 after multiple perioperative influential factors could be an effective predictor for POCD, which reveal an important role of ScO2 decrease in the development of POCD and provide possible treatment target.
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Affiliation(s)
- Cheng Ni
- Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, China
| | - Ting Xu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China
| | - Yang Tian
- Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, China
| | - Yongzheng Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, China
| | - Qingsheng Xue
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Min Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, China.
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237
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Andersen MF, Jakobsen T, Bensen AS, Krarup N. Lower reoperation rate for cemented femoral stem than for uncemented femoral stem in primary total hip arthroplasty following a displaced femoral neck fracture. SICOT J 2015; 1:26. [PMID: 27163081 PMCID: PMC4849254 DOI: 10.1051/sicotj/2015028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction: Acute displaced femoral neck fractures are often treated with cemented hemiarthroplasty (HA). There is increasing evidence that total hip arthroplasty (THA) may be a better alternative, but the degree to which the fixation of the femoral stem used affects the outcome is not fully known. The aim of this study is to compare rates of operative complications and implant survival following THA treatment of displaced femoral neck fractures with either a cemented or an uncemented femoral stem. Methods: The study consists of two groups of patients (N = 334), who were treated for a displaced femoral neck fracture with THA at the Regional Hospital of Viborg during 2007–2012. The first group (50.9%) had uncemented (Corail®) stem while the second group (49.1%) had cemented (Exeter®) stem implanted. Nearly all patients had uncemented dual mobility cup (Saturne®) as acetabular component and were followed up to three months postoperatively. Data regarding rates of implant survival and operative complications were obtained by retrospective review of medical records. Results: We found a statistically significant difference regarding rates of postoperative reoperation with 1.2% (95% CI 0.005–0.03) for cemented and 5.9% (95% CI 0.02–0.09) for uncemented stem (p = 0.02). The main causes for reoperation were peri-prosthetic fractures and deep infections. There was no difference regarding dislocation or peroperative complications. Rates of dislocation were 4.3% (95% CI 0.012–0.07) for cemented and 3.5% (95% CI 0.008–0.06) for uncemented stem (p = 0.72). Rates of peroperative complications were 6.1% (95% CI 0.024–0.1) for cemented and 8.2% (95% CI 0.04–0.12) for uncemented stem (p = 0.1). Discussion: Our results indicate that cemented femoral stem is superior to cementless when rates of reoperation are compared.
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Affiliation(s)
- Michelle Fog Andersen
- Department of Orthopaedic Surgery, The Regional Hospital in Viborg Heibergs Allé 4 8800 Viborg Denmark
| | - Thomas Jakobsen
- Department of Orthopaedic Surgery, The Regional Hospital in Viborg Heibergs Allé 4 8800 Viborg Denmark ; Orthopaedic Research Unit, Aarhus University Hospital Tage-Hansens Gade 2 8000 Aarhus C Denmark
| | - Anne S Bensen
- Department of Orthopaedic Surgery, Odense University Hospital Sdr. Boulevard 29 5000 Odense C Denmark
| | - Niels Krarup
- Department of Orthopaedic Surgery, The Regional Hospital in Viborg Heibergs Allé 4 8800 Viborg Denmark
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238
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McManamon C, de Silva JP, Delaney P, Morris MA, Cross GLW. Characteristics, interactions and coating adherence of heterogeneous polymer/drug coatings for biomedical devices. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 59:102-108. [PMID: 26652354 DOI: 10.1016/j.msec.2015.09.103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 11/25/2022]
Abstract
With this rise in surgical procedures it is important to focus on the mobility and safety of the patient and reduce the infections that are associated with hip replacements. We examine the mechanical properties of gentamicin sulphate as a model antimicrobial layer for titanium-alloy based prosthetic hips to help prevent methicillin-resistant Staphylococcus aureus infection after surgery. A top layer of poly(lactic-co-glycolic acid) is added to maintain the properties of the gentamicin sulphate as well as providing a drug delivery system. Through the use of nanoindentation and micro-scratch techniques it is possible to determine the mechanical and adhesive properties of this system. Nanoindentation determined the modulus values for the poly(lactic-co-glycolic acid) and gentamicin sulphate materials to be 8.9 and 5.2GPa, respectively. Micro-scratch established that the gentamicin sulphate layer is strongly adhered to the Ti alloy and forces of 30N show no cohesive or adhesive failure. It was determined that the poly(lactic-co-glycolic acid) is ductile in nature and delaminates from the gentamicin sulphate layer of at 0.5N.
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Affiliation(s)
- Colm McManamon
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland
| | - Johann P de Silva
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland; School of Physics, Trinity College Dublin, Dublin 2, Ireland
| | - Paul Delaney
- Department of Chemistry, Supercritical Fluid Centre and Materials Section, University College Cork, Cork, Ireland
| | - Michael A Morris
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland; Department of Chemistry, Supercritical Fluid Centre and Materials Section, University College Cork, Cork, Ireland
| | - Graham L W Cross
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland; School of Physics, Trinity College Dublin, Dublin 2, Ireland.
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239
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Mäkinen TJ, Gunton M, Fichman SG, Kashigar A, Safir O, Kuzyk PRT. Arthroplasty for Pertrochanteric Hip Fractures. Orthop Clin North Am 2015; 46:433-44. [PMID: 26410633 DOI: 10.1016/j.ocl.2015.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The mainstay of treatment of pertrochanteric fractures is internal fixation using a sliding hip screw or a cephalomedullary device. However, in patients with ipsilateral hip osteoarthritis or avascular necrosis of the femoral head, or inflammatory arthritis, arthroplasty should be considered as the primary treatment modality to reduce the likelihood of a secondary procedure. Unstable fracture patterns with concomitant poor bone quality represent a challenge for internal fixation, with high rates of lag screw cut-out and hardware failure. Prosthetic replacement for unstable pertrochanteric fractures has therefore been considered as an alternative primary treatment option. Further prospective randomized trials are required.
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Affiliation(s)
- Tatu J Mäkinen
- Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
| | - Matthew Gunton
- Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
| | - Simcha G Fichman
- Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
| | - Aidin Kashigar
- Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
| | - Oleg Safir
- Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
| | - Paul R T Kuzyk
- Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
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240
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Effect of Bone Cement Implantation on Haemodynamics in Elderly Patients and Preventive Measure in Cemented Hemiarthroplasty. BIOMED RESEARCH INTERNATIONAL 2015; 2015:568019. [PMID: 26413535 PMCID: PMC4568059 DOI: 10.1155/2015/568019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 12/17/2022]
Abstract
This study was to investigate the influence of bone cement implantation on haemodynamics and the preventive effect of epinephrine hydrochloride on pulmonary embolism in elderly patients with cemented semihip replacement. 128 patients were retrospectively analyzed. The patients were treated with (group A, 64 cases) or without (group B, 64 cases) epinephrine hydrochloride saline. The monitoring indicators included systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and pulse oxygen saturation (SPO2). The indicators of the two groups were compared before and 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10 minutes after bone cement implantation. Analysis of variance and SNK-q test were used for the statistical analysis. Blood pressure and SPO2 of group B decreased with statistical difference (P < 0.05) and HR increased without statistical significance, comparing with those of group A. In group A, SBP, DBP, MAP, HR, and SPO2 after bone cement implantation did not change significantly at each time point comparing with before implantation (P > 0.05). Bone cement implantation has significant influence on hemodynamics in elderly patients with hemiarthroplasty. Flushing the bone marrow cavity with saline epinephrine hydrochloride is an effective measure to reduce the incidence of bone cement pulmonary embolism.
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Biomarkers of Brain Damage and Postoperative Cognitive Disorders in Orthopedic Patients: An Update. BIOMED RESEARCH INTERNATIONAL 2015; 2015:402959. [PMID: 26417595 PMCID: PMC4568345 DOI: 10.1155/2015/402959] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/24/2014] [Indexed: 01/04/2023]
Abstract
The incidence of postoperative cognitive dysfunction (POCD) in orthopedic patients varies from 16% to 45%, although it can be as high as 72%. As a consequence, the hospitalization time of patients who developed POCD was longer, the outcome and quality of life were worsened, and prolonged medical and social assistance were necessary. In this review the short description of such biomarkers of brain damage as the S100B protein, NSE, GFAP, Tau protein, metalloproteinases, ubiquitin C terminal hydrolase, microtubule-associated protein, myelin basic protein, α-II spectrin breakdown products, and microRNA was made. The role of thromboembolic material in the development of cognitive decline was also discussed. Special attention was paid to optimization of surgical and anesthetic procedures in the prevention of postoperative cognitive decline.
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Jain D, Jain K, Dhillon MS. Does surgical technique add to the risk of bone cement implantation syndrome? Br J Anaesth 2015; 115:477-8. [PMID: 26269476 DOI: 10.1093/bja/aev279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
PURPOSE To compare patients with or without intra-operative fracture during cementless bipolar hemiarthroplasty. METHODS Records of 76 men and 202 women who underwent cementless bipolar hemiarthroplasty for femoral neck fractures were reviewed. Patients with and without intra-operative fractures and patients with different types of intra-operative fractures were compared. RESULTS Two men and 22 women aged 62 to 93 (mean, 80) years sustained intra-operative fractures at the lesser trochanter (n=18), the greater trochanter (n=5), and the subtrochanter (n=1). All 18 lesser trochanteric fractures and 4 of the greater trochanteric fractures were recognised intra-operatively and managed with cerclage wiring (n=21) or conversion to cemented hemiarthroplasty with cerclage wiring (n=1). The remaining 2 fractures were recognised postoperatively on radiographs and managed conservatively or with revision surgery and cerclage wiring and plating on day 4. Intra-operative fractures correlated with female gender (p=0.03) and operative delay to optimise patients (p=0.02), whereas the fracture site correlated with the time of fracture recognition (p=0.01). Postoperatively, 5 patients were allowed partial weight bearing and 18 were instructed to mobilise with a wheelchair for at least 6 weeks. One patient died from an unrelated cause. At one year, 21 patients reported no hip pain and 2 reported minimal pain. 17 could walk with or without aids and 6 were wheelchair-bound. CONCLUSION Surgeons should be familiar with the size difference in trial and actual implants used in bipolar hemiarthroplasty in order to better estimate the extent of broaching required. In most patients with an intra-operative fracture, the one-year outcome was not compromised, despite the poorer short-term outcome.
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Affiliation(s)
- Chung-Liang Kuo
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
| | - Si Heng Sharon Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Haw Chou Lee
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
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Guo W, Zheng Q, Li B, Shi X, Xiang D, Wang C. An Experimental Study to Determine the Role of Inferior Vena Cava Filter in Preventing Bone Cement Implantation Syndrome. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e14142. [PMID: 26557267 PMCID: PMC4632131 DOI: 10.5812/iranjradiol.14142v2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 03/21/2014] [Accepted: 05/05/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inferior vena cava filters (IVCF) are frequently used for preventing pulmonary embolism (PE) following deep venous thromboembolism. OBJECTIVES The present study was designed to investigate whether IVCF could prevent or impede the occurrence of bone cement implantation syndrome (BCIS), since PE is considered as the central mechanism of BCIS. MATERIALS AND METHODS Fifteen sheep were divided into three groups: bone cement free (BCF) group, cement implantation (CI) group and IVCF group. In all the groups, an osteotomy proximal to the greater trochanter of left femur was carried out. In BCF group, the femoral canal was not reamed out or packed with any bone cement. In CI and IVCF groups, the left femoral canals were packed with bone cement, to simulate the cementing procedures carried out in hip replacement. An OptEase(®) filter was placed and released in inferior vena cava, prior to packing cement in the femoral canal in IVCF group, while the IVCF was not released in the CI group. The BCF group was considered as control. RESULTS Systolic blood pressure (SBP), saturation of oxygen (SaO2) and partial pressure of carbon dioxide (PaCO2) declined significantly 10 min after the bone cement packing, in CI group, compared to those in BCF group. This was accompanied by a rise in the arterial pH. However, IVCF prevented those changes in the CI group. On ultrasonography, there were dotted echoes in right atrium in the CI group, after bone cement packing, while such echoes were hardly seen in the IVCF group. CONCLUSION This study demonstrates that IVCF could prevent BCIS effectively, and, as a corollary, suggests that PE represents the leading cause of the constellation of BCIS symptoms.
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Affiliation(s)
- Wangang Guo
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Qiangsun Zheng
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Bingling Li
- Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Xiaoqin Shi
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Dingcheng Xiang
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
- Corresponding authors: Dingcheng Xiang, Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China. Tel: +86-2088653325, E-mail: ; Chen Wang, Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi’an, China. Tel: +86-2984777422, E-mail:
| | - Chen Wang
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- Corresponding authors: Dingcheng Xiang, Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China. Tel: +86-2088653325, E-mail: ; Chen Wang, Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi’an, China. Tel: +86-2984777422, E-mail:
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Yurdakul E, Karaaslan F, Korkmaz M, Duygulu F, Baktır A. Is cemented bipolar hemiarthroplasty a safe treatment for femoral neck fracture in elderly patients? Clin Interv Aging 2015; 10:1063-7. [PMID: 26170644 PMCID: PMC4492650 DOI: 10.2147/cia.s85039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Controversy exists regarding the use of cement in hemiarthroplasty when treating a displaced femoral neck fracture in elderly patients. The primary hypothesis of this study was that the use of cement would afford better visual analog pain and activity scores in elderly patients. METHODS This study included 133 patients over 65 years of age admitted to our clinics from 2006 to 2012 for the surgical treatment of a displaced femoral neck fracture. All patients were treated via hemiarthroplasty. The patients (66 males, 67 females; mean age: 78.16 years; range: 60-110 years) were followed-up regularly. All patients were divided into one of two groups: group A was treated with cement; and group B without. Both groups were compared in terms of preoperative features (demographics and associated diseases), pre- and postoperative complications, mortality rates, pain and activity levels, and hip scores. Hospitalization time, average surgical duration, and time from fracture to operation were also recorded. Mean follow-up duration was 30.9 (range: 5-51) months. RESULTS We found no significant between-groups differences in terms of length of hospital stay, Harris Hip Score, complications, or follow-up mortality rates. Walking ability and pain scores were better in the cemented group in the early follow-up period. Duration of surgery and perioperative mortality rates were somewhat lower in the cementless group, but the difference was not statistically significant. CONCLUSION The use of cement during hip hemiarthroplasty in patients over 65 years of age had no negative impact on mortality or morbidity. Hemodynamic changes during cement application are important, but it is noteworthy that patients fitted with cemented endoprostheses had increased levels of activity and lower pain levels.
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Affiliation(s)
- Emre Yurdakul
- Department of Orthopedics and Traumatology, Osmaniye State Hospital, Bozok University, Yozgat, Turkey
| | - Fatih Karaaslan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Murat Korkmaz
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Fuat Duygulu
- Department of Orthopedics and Traumatology, Kayseri Training Hospital, Kayseri, Turkey
| | - Ali Baktır
- Department of Orthopedics and Traumatology, Modern Dünyam Hospital, Kayseri, Turkey
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No YJ, Roohani-Esfahani SI, Zreiqat H. Nanomaterials: the next step in injectable bone cements. Nanomedicine (Lond) 2015; 9:1745-64. [PMID: 25321173 DOI: 10.2217/nnm.14.109] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Injectable bone cements (IBCs) are biocompatible materials that can be used as bone defect fillers in maxillofacial surgeries and in orthopedic fracture treatment in order to augment weakened bone due to osteoporosis. Current clinically available IBCs, such as polymethylmethacrylate and calcium phosphate cement, have certain advantages; however, they possess several drawbacks that prevent them from gaining universal acceptance. New gel-based injectable materials have also been developed, but these are too mechanically weak for load-bearing applications. Recent research has focused on improving various injectable materials using nanomaterials in order to render them suitable for bone tissue regeneration. This article outlines the requirements of IBCs, the advantages and limitations of currently available IBCs and the state-of-the-art developments that have demonstrated the effects of nanomaterials within injectable systems.
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Affiliation(s)
- Young Jung No
- Biomaterials & Tissue Engineering Research Unit, School of AMME, The University of Sydney, Sydney 2006, Australia
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Griffiths R, White SM, Moppett IK, Parker MJ, Chesser TJS, Costa ML, Johansen A, Wilson H, Timperley AJ. Safety guideline: reducing the risk from cemented hemiarthroplasty for hip fracture 2015: Association of Anaesthetists of Great Britain and Ireland British Orthopaedic Association British Geriatric Society. Anaesthesia 2015; 70:623-6. [PMID: 25866041 PMCID: PMC6681143 DOI: 10.1111/anae.13036] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/28/2022]
Abstract
Concise guidelines are presented for the preparation and conduct of anaesthesia and surgery in patients undergoing cemented hemiarthroplasty for hip fracture. The Working Party specifically considered recent publications highlighting complications occurring during the peri‐operative period 1, 2. The advice presented is based on previously published advice and clinical studies.
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Opperer M, Poeran J, Rasul R, Mazumdar M, Memtsoudis SG. Use of perioperative hydroxyethyl starch 6% and albumin 5% in elective joint arthroplasty and association with adverse outcomes: a retrospective population based analysis. BMJ 2015; 350:h1567. [PMID: 25817299 PMCID: PMC4376265 DOI: 10.1136/bmj.h1567] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine whether the perioperative use of hydroxyethyl starch 6% and albumin 5% in elective joint arthroplasties are associated with an increased risk for perioperative complications. DESIGN Retrospective cohort study of population based data between 2006 and 2013. SETTING Data from 510 different hospitals across the United States participating in the Premier Perspective database. PARTICIPANTS 1,051,441 patients undergoing elective total hip and knee arthroplasties. EXPOSURES Perioperative fluid resuscitation with hydroxyethyl starch 6% or albumin 5%, or neither. MAIN OUTCOME MEASURES Acute renal failure and thromboembolic, cardiac, and pulmonary complications. RESULTS Compared with patients who received neither colloid, perioperative fluid resuscitation with hydroxyethyl starch 6% or albumin 5% was associated with an increased risk of acute renal failure (odds ratios 1.23 (95% confidence interval 1.13 to 1.34) and 1.56 (1.36 to 1.78), respectively) and most other complications. A recent decrease in hydroxyethyl starch 6% use was noted, whereas that of albumin 5% increased. CONCLUSIONS Similar to studies in critically ill patients, we showed that use of hydroxyethyl starch 6% was associated with an increased risk of acute renal failure and other complications in the elective perioperative orthopedic setting. This increased risk also applied to albumin 5%. These findings raise questions regarding the widespread use of these colloids in elective joint arthroplasty procedures.
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Affiliation(s)
- Mathias Opperer
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rehana Rasul
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York
| | - Madhu Mazumdar
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York
| | - Stavros G Memtsoudis
- Weill Cornell Medical College, Department of Healthcare Policy and Research, New York; Department of Anesthesiology, Hospital for Special Surgery, New York; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg
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Schaller G, Black J, Asaad A, Harper N, Webb S, Muirhead-Allwood S. Primary collared uncemented total hip arthroplasties in the elderly: a safe and reliable treatment option. J Arthroplasty 2015; 30:407-10. [PMID: 25456637 DOI: 10.1016/j.arth.2014.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/25/2014] [Accepted: 10/05/2014] [Indexed: 02/07/2023] Open
Abstract
The age of patients undergoing primary Total Hip Arthroplasty (THA) remains fairly constant despite an increasingly elderly population, possibly owing to concern over postoperative complications. This study evaluated 90-day outcomes in patients over 80, undergoing uncemented collared primary THA for osteoarthritis in a high volume unit. Data were recorded from 153 consecutive patients. There were 0.65% mortality rate and 1.3% major systemic complication rate. American Society of Anesthesiologist (ASA) grade was an independent predictor of inpatient complications. Mean preoperative and 90-day postoperative Oxford Hip Score was 24 and 46 respectively. No radiological evidence of femoral stem migration was seen. Our cohort shows low morbidity and mortality rates. ASA not age helps predict inpatient complications. Uncemented collared femoral prosthesis resulted in excellent functional and radiological outcomes.
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Affiliation(s)
| | | | | | | | - Stuart Webb
- King Edward VII's Hospital Sister Agnes, London, England
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Alansari MA, Abdulmomen AA. A 70-year-old man with intraoperative hypoxia and hypotension during total hip replacement. Chest 2015; 146:e160-e162. [PMID: 25367483 DOI: 10.1378/chest.14-0411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A 70-year-old man underwent total hip replacement surgery under general anesthesia, endotracheal intubation, and controlled ventilation, with the patient in left lateral position. Intraoperatively, the patient was hemodynamically stable, with a normal range of pulse, ECG trace, oxygen saturation as measured by pulse oximetry (Spo2), and end-tidal CO2 (etco2). Five minutes after insertion of the hip prosthesis, his heart rate dropped to 30 beats/min, BP to 40/30 mm Hg, Spo2 to 70%, and etco2 to 10 mm Hg.
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Affiliation(s)
- Mariam A Alansari
- From the Department of Adult Critical Care Medicine, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Ahmed A Abdulmomen
- From the Department of Adult Critical Care Medicine, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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