Blood-pressure changes and outcomes associated with cemented bipolar hemiarthroplasty for displaced femoral-neck fractures

Abstract

The purpose of this retrospective cohort study was to investigate the cementing effects on intraoperative blood pressure and the clinical and radiographic outcomes in elderly patients with femoral-neck fracture undergoing bipolar hemiarthroplasty using a polished, tapered stem. This retrospective cohort study included 38 patients with acute displaced femoral-neck fractures (mean age, 76.2 years; mean follow-up, 21.4 months (68 % follow-up rate)). Intraoperative systolic blood pressure decreased significantly, both during cementing (109.1 mmHg) and after stem insertion (101.6 mmHg), compared with the level before rasping (122.2 mmHg; p = 0.0036 and p = 0.0001, respectively). Diastolic blood pressure decreased significantly after stem insertion (57.9 mmHg versus 67.3 mmHg before rasping; p = 0.003). Hypoxia did not occur. Nineteen patients were Donaldson’s grade 1, 16 were grade 2, and none were grade 3. Twenty-three patients (74 %) maintained their preoperative activity level; 15 (26 %) worsened after surgery. Stem subsidence significantly increased over time: 0.32 mm at 6 months, 0.53 mm at 1 year, 0.91 mm at 2 years, 1.08 mm at 3 years, and 1.13 mm at 4 years. Cemented bipolar hemiarthroplasty for displaced femoral-neck fracture in elderly patients leads to hypotension, unchanged arterial oxygen saturation, favorable clinical outcomes, and acceptable stem subsidence.