Hemodynamic changes in patients undergoing cemented total hip replacement surgery: A literature review

Abstract

Cemented total hip arthroplasty is believed to offer adequate pain relief, satisfactory walking ability, and activities of daily living as one of the most widely used techniques for treating hip fragility fractures. However, some complications may occur perioperatively, not to mention the catastrophic bone cement implantation syndrome. Thorough assessment, perioperative monitoring, early detection, and treatment plays an essential role to maximalize the result of this procedure, as well as minimalizing morbidity and mortality. Some anesthetic measures that can be done in order to keep the stability of intraoperative conditions are avoiding volatile anesthetic agents in high-risk patients, administering 100% inspired oxygen throughout the procedure, invasive hemodynamic monitoring, and maintenance of normovolemia. A central line placement also provides a rapid route of drug administration if resuscitation becomes necessary. Orthopaedic surgeons should also consider thorough lavage of the femoral medullary canal, especially pulsatile jet lavage, removal of tissues before cementation to minimize the formation of microemboli during the procedure, and using cement restrictor to compartmentalize the bone marrow tissue and blood separately from the cement. Therefore, it can be concluded that understanding hemodynamic changes during this procedure is essential, not only for the operator but also for the anaesthesiologists.