Influence du cimentage et du score ASA sur l’état cardiovasculaire pendant une arthroplastie bipolaire pour fracture cervicale fémorale : une étude multicentrique cas-contrôle
Revue de Chirurgie Orthopédique et Traumatologique(2018)
Abstract
Abstract Background Little is known about how bone cement and American Society of Anesthesiologists (ASA) classification influence the cardiovascular system in elderly patients with femoral-neck fractures treated with cemented hemiarthroplasty. Therefore, we performed a case-control study to investigate these questions and compared the following: (1) ≥ ASA III with ≤ ASA II patients who underwent cemented hemiarthroplasty; (2) cemented with cementless hemiarthroplasty in ≥ ASA III patients. Hypothesis ASA classification influences the cardiovascular system during cemented hemiarthroplasty and bone cement influences intraoperative blood pressure [IBP] in patients rated ≥ ASA III. Materials and methods This multicenter, prospective study included patients with acute displaced femoral-neck fractures. Baseline data, medical history, anesthesia, FiO 2 , vasopressor use, femoral component, IBP, SpO 2 , and complications were evaluated. Of 200 patients, 100 were cemented (mean age, 77 ± 10 years), and 100 were cementless (mean age, 78 ± 9 years). Cemented hemiarthroplasty employed a third-generation technique (plugging, irrigating, drying and filling the canal with cement under pressurization). Results Systolic blood pressure (SBP) decreased significantly during cementing, versus pre-rasping in ≤ ASA II patients (from 117.9 ± 24.5 [range: 65–199] to 106.9 ± 20.3 [range: 59–172]; p = 0.007), in ≥ ASA III patients (from 129.5 ± 21.0 [range: 90–169] to 110.4 ± 17.9 [range: 79–157]; p = 0.006), and post-stem-insertion, versus pre-rasping in ≤ ASA II patients (from 117.9 ± 24.5 [range: 65–199] to 103.9 ± 20.7 [range: 53–178]; p = 0.0004), and in ≥ ASA III patients (from 129.5 ± 21.0 [range: 90–169] to 111.2 ± 24.6 [range: 70–156]; p = 0.009). In ≥ ASA III patients, SBP decreased significantly during cementing or rasping, versus pre-rasping in cemented patients (from 129.5 ± 21.0 [range: 90–169] to 110.4 ± 17.9 [range: 79–157]; p = 0.006), in cementless patients (from 115.0 ± 17.7 [range: 85–150] to 100.7 ± 15.7 [range: 75–142]; p = 0.004), and post-stem-insertion, versus pre-rasping in cemented patients (from 129.5 ± 21.0 [range: 90–169] to 111.2 ± SD [range]; p = 0.009), and in cementless patients (from 115.0 ± 17.7 [range: 85–150] to 89.4 ± 17.5 [range: 58–140]; p Conclusions This study indicate a similar hemodynamic change intraoperatively between ≤ ASA II patients and ≥ ASA III patients in the cemented group, and between patients with cemented and cementless hemiarthroplasty in the ≥ ASA III patients. With modern hemiarthroplasty techniques, bone cement might be as safe as cementless techniques in elderly, ≥ ASA III patients. Level of evidence III, multi-center case control cohort study.
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Key words
Intraoperative blood pressure,American Society of Anesthesiologists classification,Cemented,Cementless,Bipolar hemiarthroplasty
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