J Korean Hip Soc.  2006 Dec;18(5):454-458. 10.5371/jkhs.2006.18.5.454.

Treatment of Femoral Neck Fractures in Patients with Ischemic Heart Disease by Cemented Hemiarthroplasty

• Kim YS
• Choi NY
• Kwon SY
• Hwang JT
• Han SK

• KMID: 1512831
• DOI: http://doi.org/10.5371/jkhs.2006.18.5.454

Abstract

PURPOSE
There is a controversy about whether the use of polymethylmethacrylate (PMMA) in orthopedic reconstructive surgery can increase the possibility of cardiovascular dysfunction. This study was undertaken to determine if cemented hemiarthroplasty is safe for treating femoral neck fracture in patients with ischemic heart disease. MATERIAL AND METHODS: Between March 1999 and February 2004, we performed cemented hemiarthroplasties for displaced femoral neck fractures in 158 consecutive patients. This retrospective study consisted of 44 patients with ischemic heart disease (group 1) and 58 age matched control patients (group 2). We compared the mortality rate, the incidence of deep vein thrombosis (DVT), pulmonary embolism, cerebrovascular disease, dislocation and deep infection, the amount of postoperative blood loss and the grade of cementation according to the schema of Barrack on the radiograph between the two groups.
RESULTS
No difference was found in the perioperative mortality rate, the deep infection rate, the incidence of DVT or pulmonary embolism, the newly developed heart ischemic events or brain hemorrhagic lesions between the two groups. But there was a greater incidence of dislocation related to weakness from past brain ischemic lesion and the newly developed brain ischemia in group 1 than in group 2 (p<0.05). More importantly, six patients in group 1 had transient symptoms of dyspnea, signs of hypotension and bradycardia within two days postoperatively, which raises suspicions of embolic phenomenon, even though this was not confirmed.
CONCLUSION
Close and careful observations should be done for the occurrence of dislocation related to previous brain ischemia, or newly developed brain ischemic lesion or embolic phenomenon. Appropriate thromboprophylaxis is necessary in patients with ischemic heart disease after cemented hemiarthroplasty for the treatment of femoral neck fracture.

Keyword

Ischemic heart disease; Femoral neck fracture; Cemented hemiarthroplasty

MeSH Terms

Bradycardia
Brain
Brain Ischemia
Cementation
Dislocations
Dyspnea
Femoral Neck Fractures*
Femur Neck*
Heart
Hemiarthroplasty*
Humans
Hypotension
Incidence
Mortality
Myocardial Ischemia*
Orthopedics
Polymethyl Methacrylate
Postoperative Hemorrhage
Pulmonary Embolism
Retrospective Studies
Venous Thrombosis
Polymethyl Methacrylate