Di. Clark et al., Cardiac output during hemiarthroplasty of the hip - A prospective controlled trial of cemented and uncemented prostheses, J BONE-BR V, 83B(3), 2001, pp. 414-418
Citations number
24
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine","da verificare
In a prospective, controlled study, we measured the effect on cardiac outpu
t of the introduction of methylmethacrylate during hemiarthroplasty for dis
placed fractures of the femoral neck. We treated 20 elderly patients who we
re similar in age, height, weight and preoperative left ventricular functio
n with either cemented or uncemented hemiarthroplasty, Using a transoesopha
geal Doppler probe, we measured cardiac output before incision and at six s
tages of the procedure: during the surgical approach, reaming and lavage of
the femoral canal, the introduction of cement, the insertion of the prosth
esis, and in reduction and closure.
We found that before the cement was introduced, there was no difference in
stroke volume or cardiac output (p > 0.25). Cementation produced a transien
t but significant reduction in cardiac output of 33% (p < 0.01) and a reduc
tion in stroke volume of 44% (p < 0.02). The introduction of cement did not
affect the heart rate or mean arterial pressure, There was no significant
difference in cardiac function on insertion of the prosthesis. Standard non
-invasive haemodynamic monitoring did not detect the cardiovascular changes
which may account for the sudden deaths that sometimes occur during cement
ed hemiarthroplasty.
The fall in stroke volume and cardiac output may be caused by embolism occu
rring during cementation, but there was no similar fall during reaming or i
nsertion of the prosthesis.