[Hemodynamic complications of cemented hip arthroplasty]

(1) Find out the incidence of serious hemodynamic complications in patients that warranted admission to the intensive care unit after cemented hip arthroplasty at the ABC hospital during a ten-year period. (2) Review the literature to know the pathophysiology of the hemodynamic changes that occur during the cementing process of a hip prosthesis. (3) Emphasize the occurrence of these complications so that the surgical team can provide timely diagnosis and treatment.

Retrospective, observational and cross-sectional study. The medical records of patients who underwent cemented hip replacement, had hemodynamic complications during the cementing process and required admission to the ICU or died as a result of this cause were reviewed. Gender, age, preoperative diagnosis, comorbidities and diagnosis upon ICU admission were recorded.

Twenty-eight patients were studied; 19 females and 9 males, with a mean age of 72 years. The preoperative diagnosis was hip fracture in 8 cases, prosthetic loosening in 6 cases and coxarthrosis in 15 patients. Cementing technique: a gun was used in 9 cases, and pressure-lavage of the medullary cavity was used in 19. Comorbidities: 5 cases had hypertension, 4 had diabetes mellitus, 4 had heart disease, and 12 cases had combinations of the former. Diagnosis upon admission to the ICU: intraoperative hypotension in 18 cases, pulmonary thromboembolism in 6 cases, respiratory failure in 3 cases, hypovolemic shock in one patient. Three patients died.

Pulmonary thromboembolism is caused by the increase in femoral intramedullary pressure and not by the action of bone cement. Hemodynamic changes may lead to the critical status of patients and may even cause death. The surgical team should be alert to make the timely diagnosis of this complication and provide proper treatment. In our hospital setting the incidence rate of hemodynamic changes was 6.7% and the mortality rate 0.07%.