A1093. MONITORING OF BLOOD PRESSURE DURING TOTAL HIP ARTHROPLASTY USING INTERFACE BIOACTIVE BONE CEMENT TECHNIQUE

Abstract

Purpose: Cement implantation syndrome characterized by hypotension, hypoxemia, cardiac arrhythmia or arrest has been reported in the literature. Pulmonary embolization is thought to be the main reason. In our institute, however, we have not experienced major hypotension during THA. To improve longevity of THA, interface bioactive bone cement technique combined with modern cementing technique has been used in our institute. Main principle of this technique is smearing hydroxyapatite granules on the dry bony surface followed by cement pressurization. The purpose of the present study was to monitor blood pressure soon after cementing.

Method: The present study includes 91 cases of primary THA with an average age at operation of 64 years old (ranging 35 to 85). Under general anesthesia, both components were cemented using antero-lateral approach. Systolic arterial blood pressure was monitored until 5 minutes with 1 minute interval. The maximum regulation (MR%) was calculated as (maximum change blood pressure – blood pressure before cement insertion) divided by blood pressure before cement insertion.

Results: No major complications such as cardiac arrest were observed. In most of the cases, blood pressure increased until 4 minutes for the acetabular side and 2 minutes for the femoral side, and then returned to the blood pressure before cement insertion gradually. In the acetabular side, MR% was 10±13 (−19–40)%. In 52 joints (57.1%), MR% was between 10 to 40 %. In the femoral side, MR% was 5±12 (−20 to 31)%. In 32 joints (35.2%), MR% was between 10 to 31 %.

Conclusion: In the present study, major hypotension was not observed. Blood pressure increases if left ventricle reacts to the pulmonary hypertension caused by micro-embolization. If major pulmonary embolization occurs, blood pressure decrease because left ventricle can not compensate for major pulmonary hypertension caused by mayor pulmonary embolization. By good cementing technique which includes washing out debris or fat and obtaining dry bony surface just before cementing, blood pressure soon after cementing was increased.