title: The Influence of Bone Cement Implantation in Primary Hip Arthroplasty on S100B Protein Serum Concentration and Patients' Cognitive Functions as Markers of Brain Damage.
abstract: OBJECTIVE
  The objective of the study was to evaluate the influence of the bone cement used during primary hip arthroplasty on brain functions assessed at the biochemical and clinical levels. The S100B protein is a biochemical marker of brain damage. Its plasma concentration was compared with the results of neuropsychological tests, conducted during the perioperative period.
  
  
  METHODS
  Two groups of patients who underwent primary hip arthroplasty were analyzed; group one (n = 30) with the use of bone cement (cemented), group two (n = 30) without (cementless). All of the procedures were under spinal anesthesia with intravenous sedation. In each group, S100B protein concentration was examined before the surgery and just after the operation, and 6, 24, and 72 h after the procedure. Two neuropsychological tests were conducted before the surgery and 24 and 72 h after. The patients with preexisting blood flow disturbances inside the carotid and vertebral arteries and those with intraoperative mean arterial pressure below 50 mmHg were excluded from the study.
  
  
  METHODS
  Data were analyzed using SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA). The two groups were compared using the Mann-Whitney U-test. The comparison between the groups was done with Wilcoxon's signed ranks test. The correlations were analyzed using Spearman's rho test.
  
  
  RESULTS
  There were no significant differences between the two groups in S100B protein concentration before the surgery. Just after the operation, the S100B protein concentration was elevated in both groups, but its level in the cemented group was significantly higher, particularly just after the surgery, and its normalization was slower than in the cementless group. The comparison of time points within each group revealed that there were no significant differences in patients' reaction time in the simple reaction test before and after the surgery (p = 0.056 and 0.163 in the cementless and 0.581 and 0.139 in the cemented groups), but a significantly longer mean reaction time in the choice reaction test was observed within each group after the surgery (p = 0.003 and 0.001 in the cementless and 0.001 and 0.014 in the cemented groups). There were no correlations between S100B protein plasma concentration and the results of the neuropsychological tests.
  
  
  CONCLUSIONS
  There was a relationship between bone cement implantation during primary hip arthroplasty and elevated S100B protein plasma concentration during the short postoperative period, but the results of the neuropsychological tests did not reflect this.
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Central Clinical Hospital of the Department of National Defence, Military Institute of the Health Services, Warsaw, Poland. dtom@mp.pl.|Department of Anesthesiology and Intensive Therapy, Central Clinical Hospital of the Department of National Defence, Military Institute of the Health Services, ul. Szaserów 128, 00-909, Warsaw, Poland. dtom@mp.pl.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Tomaszewski
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Central Clinical Hospital of the Department of National Defence, Military Institute of the Health Services, Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Rybicki
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Central Clinical Hospital of the Department of National Defence, Military Institute of the Health Services, Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Możański
keywords: Bone cement; Cognitive dysfunction; Hip arthroplasty; Neuropsychological tests; S100B protein
references.citation: Anesth Analg. 2003 Dec;97(6):1657-60
references.pmid: 14633537
references.citation: Br J Anaesth. 2003 Oct;91(4):595-7
references.pmid: 14504167
references.citation: Br J Sports Med. 2006 Apr;40(4):313-6
references.pmid: 16556784
references.citation: Restor Neurol Neurosci. 2003;21(3-4):159-69
references.pmid: 14530578
references.citation: Eur J Anaesthesiol. 1998 Nov;15(6):761-4
references.pmid: 9884870
references.citation: Anesthesiology. 2000 Aug;93(2):315-8
references.pmid: 10910475
references.citation: Neurosurgery. 2001 Jun;48(6):1255-8; discussion 1258-60
references.pmid: 11383727
references.citation: Reg Anesth Pain Med. 2005 Mar-Apr;30(2):123-7
references.pmid: 15765453
references.citation: J Neurol Neurosurg Psychiatry. 2001 Jan;70(1):95-100
references.pmid: 11118255
references.citation: Clin J Sport Med. 2003 Sep;13(5):292-302
references.pmid: 14501312
references.citation: J Neurotrauma. 2006 Aug;23(8):1185-200
references.pmid: 16928177
references.citation: Stroke. 1999 Sep;30(9):1869-74
references.pmid: 10471438
references.citation: Restor Neurol Neurosci. 2003;21(3-4):171-6
references.pmid: 14530579
references.citation: Rheumatol Int. 1985;5(6):273-7
references.pmid: 3880183
references.citation: Anesth Analg. 1998 Nov;87(5):1209-10
references.pmid: 9806712
references.citation: Anesthesiology. 2002 Apr;96(4):1027-9
references.pmid: 11964616
references.citation: Anesth Analg. 2001 Nov;93(5):1137-46
references.pmid: 11682383
references.citation: J Trauma. 2005 Jan;58(1):59-61
references.pmid: 15674151
references.citation: Acta Anaesthesiol Scand. 2002 Apr;46(4):384-9
references.pmid: 11952437
references.citation: Acta Orthop Scand. 1996 Feb;67(1):91-107
references.pmid: 8615115
references.citation: Anaesthesist. 2000 Oct;49(10):887-92
references.pmid: 11100253