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Cardiac risks in total hip replacement
K M Peters1, B Nachtsheim, C J Schuster
1Orthopädische Klinik, Rhein-Sieg-Klinik Nümbrecht, Germany.
Insights
Total hip replacement surgery can cause myocardial ischemia, especially in patients with coronary heart disease (CHD). While CHD patients experience more ST depression during surgery, it significantly decreases after the procedure.
Area of Science:
- Cardiology
- Cardiac Surgery
- Anesthesiology
Background:
- Total hip replacement (THR) surgery is associated with intraoperative myocardial ischemia, indicating cardiac strain.
- Patients with coronary heart disease (CHD) face elevated risks during THR procedures.
- Perioperative myocardial ischemia is a critical concern in orthopedic surgery patients.
Purpose of the Study:
- To investigate the occurrence and characteristics of myocardial ischemia during total hip replacement.
- To compare ischemic events between patients with and without coronary heart disease (CHD).
- To evaluate changes in myocardial ischemia from the perioperative to the postoperative stage in CHD patients.
Main Methods:
- Monitoring intraoperative myocardial ischemia using electrocardiography (ECG).
- Quantifying ST-segment depression duration and frequency.
- Comparing ischemic event data between CHD patients and non-CHD patients during THR.
- Analyzing changes in ST-segment depression from perioperative to postoperative periods.
Main Results:
- Patients undergoing THR experienced identifiable myocardial ischemia, signifying myocardial strain.
- CHD patients exhibited significantly longer ST depressions (3348 min vs 454 min) and more episodes (160 vs 36) compared to non-CHD patients.
- CHD patients showed a highly significant reduction in ST-segment depression duration postoperatively.
Conclusions:
- Total hip replacement surgery poses a risk of myocardial ischemia, particularly for CHD patients.
- CHD patients experience a greater burden of myocardial ischemia during the perioperative period of THR.
- Postoperative recovery leads to a significant improvement in myocardial ischemic events for CHD patients.
Abstract:
During total hip replacement, identifiable myocardial ischemia occurs intraoperatively, indicating myocardial strain. Coronary heart disease (CHD) patients are at risk during this type of surgery. Perioperatively, CHD patients had significantly longer ST depressions than patients not suffering from CHD (3348 min vs 454 min). The number of depression episodes was also significantly higher for CHD patients (160 vs 36). Comparing the perioperative with the postoperative stage demonstrated that CHD patients experienced a highly significant shift towards shorter periods of ST-segment depression postoperatively.