Influence du cimentage et du score ASA sur l’état cardiovasculaire pendant une arthroplastie bipolaire pour fracture cervicale fémorale : une étude multicentrique cas-contrôle

Abstract

BackgroundLittle 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. HypothesisASA classification influences the cardiovascular system during cemented hemiarthroplasty and bone cement influences intraoperative blood pressure [IBP] in patients rated≥ASA III. Materials and methodsThis multicenter, prospective study included patients with acute displaced femoral-neck fractures. Baseline data, medical history, anesthesia, FiO2, vasopressor use, femoral component, IBP, SpO2, and complications were evaluated. Of 200 patients, 100 were cemented (mean age, 77±10years), and 100 were cementless (mean age, 78±9years). Cemented hemiarthroplasty employed a third-generation technique (plugging, irrigating, drying and filling the canal with cement under pressurization). ResultsSystolic 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<0.0001). There were no lethal complications. ConclusionsThis 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 evidenceIII, multi-center case control cohort study.