title: Complications of cemented long-stem hip arthroplasties in metastatic bone disease.
abstract: It is controversial whether a cemented long-stem femoral arthroplasty is a safe surgical option for patients with meta-static bone disease of the hip. Cemented long stems increase the risk of embolic cascades and may cause subsequent cardiopulmonary complications, particularly in patients with metastatic disease. We retrospectively reviewed results of 29 long-stem cemented femoral arthroplasties in 27 patients in which surgical techniques that minimized intramedullary debris and canal pressurization were used. The surgical techniques minimized intraoperative cement-related emboli with aggressive medullary lavage, intraoperative canal suctioning during cementation, use of early low-viscosity polymethylmethacrylate, and slow, controlled insertion of the long-stem prosthesis. Cement-associated hypotension occurred in four (14%) patients, sympathomimetics were administered in nine (31%) patients, and a worsening mental status occurred postoperatively in one (3%) patient. There were no cement-associated desaturation events, cardiac arrests, or intraoperative deaths. No patients required prolonged intubation, and there were no postoperative cardiopulmonary events. Cemented long-stem femoral arthroplasty is a safe procedure for patients with high-risk metastatic disease. Increased awareness of cement-related cardiopulmonary pathophysiology, and modifying conventional surgical techniques can minimize cement-associated complications.
  
  
  METHODS
  Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Huntsman Cancer Institute, Department of Orthopaedics, Salt Lake City, UT 84112, USA. r.lor.randall@hsc.utah.ed
authors.forename: R Lor
authors.initials: RL
authors.lastname: Randall
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Aoki
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Olson
authors.forename: Steven I
authors.initials: SI
authors.lastname: Bott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D001843:Bone Cements / Q000009:adverse effects; D001859:Bone Neoplasms / Q000556:secondary* / Q000601:surgery; D002484:Cementation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D013566:Sympathomimetics / Q000627:therapeutic use
chemical_list: D001843:Bone Cements; D013566:Sympathomimetics