Cardiopulmonary collapse in frail patients treated with cemented and uncemented hemiarthroplasty

BACKGROUND: Peri-operative cardiopulmonary collapse (CPC) poses an increased risk of in-hospital mortality, especially in frail patients. Bone Cement Implantation Syndrome (BCIS) is CPC following, cemented, arthroplasty, characterized by hypoxia and/or hypotension. The main objective of this study was to evaluate the association between cemented hemiarthroplasty and CPC, in patients with a femoral neck fracture (FNF) and increased pre-operative risk, and identify other risk factors for cardiopulmonary collapse. METHODS: This retrospective cohort study included patients with a FNF treated with a cemented or uncemented hemiarthroplasty, aged ≥ 80 years, with ASA score ≥ 3 and ≥ 1 cardiac or pulmonal comorbidity. CPC was defined as hypoxia/hypotension grade ≥ 2 according to Donaldson's criteria. Multivariable logistic regression analysis was used to adjust for confounding in the relation between cemented hemiarthroplasty and CPC, and to identify other risk factors for CPC in patients with a cemented hemiarthroplasty. RESULTS: The incidence of CPC was 51.1% in 221 cemented hemiarthroplasty patients compared to 23.3% in 73 uncemented hemiarthroplasty patients (p < 0.001). The use of cement increased the risk for CPC almost threefold (adjusted odds ratio [aOR] 2.87, 95% confidence interval [CI] 1.46-5.64). Preoperative reduced left ventricle ejection fraction (aOR 3.03, 95% CI 1.50-6.14) was another independent risk factor for CPC. CONCLUSION: Cementation increases the risk of CPC in frail FNF patients treated with hemiarthroplasty. Emphasis on euvolemia and avoidance of excessive pressurization, and careful consideration of an indicated cemented hemiarthroplasty in frail hip fracture patients may be advised for patients with an increased preoperative risk for BCIS.