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- Title
Intraoperative unfractionated heparin before femoral component cementation should be avoided in femoral neck fracture treated with hybrid total hip arthroplasty.
- Authors
García-Mansilla, Agustín; Castro Lalín, Agustina; Holc, Fernando; Molho, Nicolas Martin; Vescovo, Anibal; Slullitel, Pablo Ariel; Buttaro, Martin Alejandro
- Abstract
Purpose: To compare the incidence of perioperative thromboembolic events in femoral neck fracture (FNF) patients treated with hybrid total hip arthroplasty (THA) with intraoperative unfractionated heparin (UFH) versus a control group without intraoperative UFH before femoral component cementation. Methods: We compared 139 cases without UFH (group A) versus 134 who received 10 UI/kg UFH (group B). Indication of UFH before cementation depended on the preferences of the anaesthesiologists in each case. We assessed intraoperative bone cement implantation syndrome (BCIS) and 30-day thromboembolic events, and 90-day and 1-year mortality. BCIS was classified as per Donaldson et al.'s classification according to the degree of hypotension, arterial desaturation or loss of consciousness. Results: BCIS was observed in 51 (18%) cases, including 37 (13%) grade 1 and 14 (5%) grade 2. Forty-seven BCISs (35%) were observed in group B and 4 (3%) in group A (p < 0.001). Multivariate regression showed that intraoperative UFH (OR = 18, CI 95% 6–52) and consumption of oral anticoagulants (OR = 3.3, CI 95% 1–10) increased the risk of BCIS. Five patients further developed a 30-day pulmonary embolism in group B, while 2 presented this complication in group A (p = 0.231). No association between BCIS and 30-day thromboembolic events was found (p = 0.62). 90-day (1% each, p = 0.98) and 1-year (2% vs. 3%, p = 0.38) mortality were similar. Conclusions: BCIS was a frequent finding in FNF patients treated with hybrid THA. We found a paradoxically significant increase in BCIS with the use of UFH. Heparin did not seem to prevent BCIS, other thromboembolic events and mortality in this group of patients.
- Subjects
TOTAL hip replacement; BONE cements; CONFIDENCE intervals; INTRAOPERATIVE care; ACQUISITION of data; RETROSPECTIVE studies; SURGICAL complications; TREATMENT effectiveness; COMPARATIVE studies; HOSPITAL mortality; MEDICAL records; DESCRIPTIVE statistics; THROMBOEMBOLISM; HEPARIN; ODDS ratio; FEMORAL neck fractures; EVALUATION
- Publication
European Journal of Orthopaedic Surgery & Traumatology, 2023, Vol 33, Issue 6, p2547
- ISSN
1633-8065
- Publication type
Article
- DOI
10.1007/s00590-023-03472-7