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Complications of cemented long-stem hip arthroplasties in metastatic bone disease
R Lor Randall1, Stephen K Aoki, Patrick R Olson
1Huntsman Cancer Institute, Department of Orthopaedics, Salt Lake City, UT 84112, USA. r.lor.randall@hsc.utah.ed
Insights
Cemented long-stem femoral arthroplasty is a safe option for hip metastatic bone disease patients. Modified surgical techniques minimize cement-related complications, reducing cardiopulmonary risks.
Area of Science:
- Orthopedic Surgery
- Oncology
- Biomaterials Science
Background:
- Cemented long-stem femoral arthroplasty is debated for metastatic bone disease due to cardiopulmonary risks.
- Embolic cascades and cardiopulmonary complications are concerns with cemented long stems.
Purpose of the Study:
- To evaluate the safety and efficacy of modified cemented long-stem femoral arthroplasty in patients with metastatic bone disease.
- To assess the incidence of cardiopulmonary complications associated with this procedure.
Main Methods:
- Retrospective review of 29 long-stem cemented femoral arthroplasties in 27 patients.
- Utilized surgical techniques to minimize intramedullary debris and canal pressurization, including medullary lavage, canal suctioning, early low-viscosity polymethylmethacrylate, and controlled prosthesis insertion.
Main Results:
- Four patients (14%) experienced cement-associated hypotension; nine (31%) required sympathomimetics.
- One patient (3%) had a postoperative worsening of mental status.
- No cement-associated desaturation events, cardiac arrests, intraoperative deaths, prolonged intubation, or postoperative cardiopulmonary events occurred.
Conclusions:
- Cemented long-stem femoral arthroplasty, using modified techniques, is a safe procedure for high-risk metastatic bone disease patients.
- Awareness of cement-related cardiopulmonary pathophysiology and modified surgical techniques can minimize complications.
Unlabelled:
It is controversial whether a cemented long-stem femoral arthroplasty is a safe surgical option for patients with meta-static bone disease of the hip. Cemented long stems increase the risk of embolic cascades and may cause subsequent cardiopulmonary complications, particularly in patients with metastatic disease. We retrospectively reviewed results of 29 long-stem cemented femoral arthroplasties in 27 patients in which surgical techniques that minimized intramedullary debris and canal pressurization were used. The surgical techniques minimized intraoperative cement-related emboli with aggressive medullary lavage, intraoperative canal suctioning during cementation, use of early low-viscosity polymethylmethacrylate, and slow, controlled insertion of the long-stem prosthesis. Cement-associated hypotension occurred in four (14%) patients, sympathomimetics were administered in nine (31%) patients, and a worsening mental status occurred postoperatively in one (3%) patient. There were no cement-associated desaturation events, cardiac arrests, or intraoperative deaths. No patients required prolonged intubation, and there were no postoperative cardiopulmonary events. Cemented long-stem femoral arthroplasty is a safe procedure for patients with high-risk metastatic disease. Increased awareness of cement-related cardiopulmonary pathophysiology, and modifying conventional surgical techniques can minimize cement-associated complications.
Level Of Evidence:
Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.
