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Monitoring of blood pressure during total hip arthroplasty using the interface bioactive bone cement (IBBC) technique
Hiroshi Fujita1, Tomoo Okumura, Hiroaki Hara
1Department of Orthopedic Surgery, Institute for Joint Replacement, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan, hfshoot@aol.com.
Insights
This study monitored blood pressure during primary total hip arthroplasty (THA) with bone cement. Complete bleeding control on the acetabular side during THA reduced the tendency for blood pressure to decrease, preventing major hypotension.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Biomaterials Science
Background:
- Cement implantation syndrome, characterized by hypotension, hypoxemia, and cardiac events, is a known complication.
- Monitoring blood pressure during primary total hip arthroplasty (THA) is crucial for patient safety.
Purpose of the Study:
- To monitor and analyze blood pressure changes following bone cement application during primary total hip arthroplasty (THA).
- To investigate factors influencing blood pressure fluctuations during THA procedures.
Main Methods:
- The study involved 178 cases (204 joints) undergoing primary THA under general anesthesia.
- Systolic arterial blood pressure was measured at regular intervals post-cementation.
- Maximum Regulation Ratio (MRR) was calculated to quantify blood pressure changes.
Main Results:
- Blood pressure initially increased post-cementation, then gradually returned to pre-application levels.
- Mean MRR was 11.2% on the acetabular side and 6.4% on the femoral side.
- Complete bleeding control on the acetabular side correlated with a reduced tendency for blood pressure decrease.
Conclusions:
- No major hypotensive episodes occurred during the observed primary THA procedures.
- Effective bleeding control during acetabular cementing is vital for stabilizing blood pressure.
- The interface bioactive bone cement (IBBC) technique appears safe regarding blood pressure management when bleeding is controlled.
Background:
Cement implantation syndrome, which is characterized by hypotension, hypoxemia, and cardiac arrhythmia or arrest, has been reported in the literature. The purpose of the present study was to monitor the blood pressure changes that occur after cementing during primary total hip arthroplasty (THA).
Methods:
The present study examined 178 cases in which 204 joints were treated with primary THA. Study subjects had a mean age at the time of surgery of 64.5 years (range 35-89). Under general anesthesia, both hip components were cemented in place using an anterolateral approach. After cementing, systolic arterial blood pressure was measured at 1-min intervals for 5 min and then again at 10 min. The maximum regulation ratio (MRR) was calculated as follows: (maximum change in blood pressure - blood pressure before cement application) divided by blood pressure before cement application.
Results:
No major complications, such as cardiac arrest, occurred in most cases; blood pressure increased until 4 mins on the acetabular side and until 2 min on the femoral side, and then gradually returned to the level observed prior to cement application. On the acetabular side, the mean MRR was 11.2 % [standard deviation (SD): 15.9; range -26 to -80], whereas it was 6.4 % (SD: 14.9; range -31 to -65) on the femoral side. Correlations were detected between MRR classification on the acetabular side and the subject's age at the time of the operation or bleeding control status on the acetabular side. When bleeding control was judged as complete, the tendency for blood pressure to decrease was reduced. Conversely, when bleeding control was judged as good, blood pressure showed a greater tendency to decrease.
Conclusion:
In the present study, no episodes of major hypotension occurred. During THA involving the interface bioactive bone cement (IBBC) technique, when bleeding control on the acetabular side was judged as complete the tendency for blood pressure to decrease was reduced.
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