title: Complications of cemented long-stem hip arthroplasty in metastatic bone disease revisited.
abstract: BACKGROUND
  The literature suggests that a cemented long-stem femoral arthroplasty is associated with increased intraoperative and perioperative risks. Embolic events may precipitate cardiopulmonary complications and even death; by contrast, others have reported that the use of a cemented long-stem femoral arthroplasty in patients with metastatic bone disease is a safe procedure.
  
  
  OBJECTIVE
  Specifically, in this study, we sought to identify (1) intraoperative complications potentially attributable to the use of cemented long-stem femoral components, and (2) early postoperative complications potentially attributable to the use of cemented long-stem femoral components in patients having an arthroplasty for metastatic bone disease.
  
  
  METHODS
  In this study, we performed a retrospective chart review of 42 patients (44 arthroplasties), in which the same surgical technique was used. The primary outcome measure was perioperative complications, including intraoperative cement-associated desaturation, cement-associated hypotension, sympathomimetic administration, postoperative hypotension/desaturation, and death.
  
  
  RESULTS
  In this series, 19% of the patients had cement-associated hypotension and sympathomimetics were administered to 48%. Two patients required prolonged intubation. One death occurred during hospitalization but there were no cardiopulmonary events.
  
  
  CONCLUSIONS
  This study showed that some patients experienced postoperative desaturation, prolonged intubation, and increased use of sympathomimetics, however, these events were short-lived and did not result in patient mortality. Although there are significant risks to cemented long-stem femoral arthroplasty, it can be performed with a low risk of fatal cardiopulmonary complications and remains a surgical option when treating patients with metastatic bone disease.
  
  
  METHODS
  Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics Sarcoma Services, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
authors.forename: Shawn L
authors.initials: SL
authors.lastname: Price
authors.forename: M Aabid
authors.initials: MA
authors.lastname: Farukhi
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Jones
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Aoki
authors.forename: R Lor
authors.initials: RL
authors.lastname: Randall
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000401:mortality; D001843:Bone Cements; D001859:Bone Neoplasms / Q000556:secondary / Q000601:surgery*; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D005260:Female; D006621:Hip Joint / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011475:Prosthesis Failure; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements