[Reduction of severe cardiac complications during implantation of cemented total hip endoprostheses in femoral neck fractures]

Abstract

Intraoperative circulatory and pulmonary problems occuring during the repair of femoral neck fractures with cemented hip arthroplasty are a common problem, that cannot be ultimately explained. As a possible reason for this problem is air embolism during the polymerisation of the methylmethacrylat discussed. We started a prospective randomised clinical examination with 72 patients to prove the efficiency of palacos mixed in vacuum, with respect to the reduction of severe cardiovascular complication during endoprosthetic repair of femoral neck fractures. In the control group with 36 patients, surgical repair was performed with palacos mixed conventionally. In the second group (vacuum group), also consisting of 36 patients, surgical repair was performed with palacos mixed in vacuum. Invasive hemodynamic monitoring and transesophageal echocardiography was performed in all cases. In the control group pulmonary embolism occurred echocardiographically in 86% of the cases vs. 14% in the vacuum group. 53% of the control patients--vs. 11% of the vacuum patients--showed clinical complications in form of significant decrease of arterial oxygenation and circulatory insufficiency with the need of catecholamines. Clinical complications occurred in the control group in 80% of the patients--vs. 13.7% in the vacuum group--whose pulmonal arterial pressure was higher than 30 mmHg preoperatively and only in 18.8% of the cases--vs. 7.1% in the vacuum group--with a normal pulmonal arterial pressure. Mortality in the control group amounted to 13.8% in the vacuum group to 2.8%. Through the use of methylmethacrylate mixed in vacuum for surgical repair of femoral neck fractures with cemented hip arthroplasty, the incidence of severe cardiac complications could be reduced significantly. Patients with increased pulmonal arterial pressure have the highest risk for cardiac complications.