[Total hip endoprostheses--characteristic aspects from the anesthesiologic viewpoint]

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Cardiopulmonary Medicine

Context:

• Total hip replacement (THR) is a common procedure with varied techniques (cemented, non-cemented, hybrid).
• Specific risks are associated with each surgical approach, impacting patient management.
• Anesthesiological considerations are paramount for mitigating intraoperative complications.

Purpose:

• To outline the specific anesthetic and surgical risks associated with different total hip replacement techniques.
• To discuss strategies for managing complications such as cardiopulmonary depression, blood loss, thrombosis, and infection.
• To highlight the importance of tailored anesthetic approaches and blood-saving methods.

Summary:

• Cemented THR may cause cardiopulmonary depression, requiring vigilant anesthetic monitoring and intervention.
• Non-cemented THR and revisions often involve significant blood loss, necessitating comprehensive blood-saving protocols.
• Thrombosis (up to 55%) and deep prosthetic infections (often staphylococcal) are significant risks requiring prophylaxis and prompt treatment.
• Both regional and general anesthesia have distinct advantages and disadvantages for THR, with ongoing debate regarding optimal choice.
• Hemodynamic monitoring and Doppler-ultrasound are essential for early diagnosis of embolism in high-risk patients.

Impact:

• Informed anesthetic and surgical planning can reduce THR-related morbidity and mortality.
• Implementation of advanced monitoring and blood conservation techniques improves patient outcomes.
• Understanding specific risks allows for personalized patient care and risk stratification.