PMID- 36645495
OWN - NLM
STAT- MEDLINE
DCOM- 20230727
LR  - 20230727
IS  - 1432-1068 (Electronic)
IS  - 1633-8065 (Linking)
VI  - 33
IP  - 6
DP  - 2023 Aug
TI  - Intraoperative unfractionated heparin before femoral component cementation should 
      be avoided in femoral neck fracture treated with hybrid total hip arthroplasty.
PG  - 2547-2554
LID - 10.1007/s00590-023-03472-7 [doi]
AB  - PURPOSE: To compare the incidence of perioperative thromboembolic events in 
      femoral neck fracture (FNF) patients treated with hybrid total hip arthroplasty 
      (THA) with intraoperative unfractionated heparin (UFH) versus a control group 
      without intraoperative UFH before femoral component cementation. METHODS: We 
      compared 139 cases without UFH (group A) versus 134 who received 10 UI/kg UFH 
      (group B). Indication of UFH before cementation depended on the preferences of 
      the anaesthesiologists in each case. We assessed intraoperative bone cement 
      implantation syndrome (BCIS) and 30-day thromboembolic events, and 90-day and 
      1-year mortality. BCIS was classified as per Donaldson et al.'s classification 
      according to the degree of hypotension, arterial desaturation or loss of 
      consciousness. RESULTS: BCIS was observed in 51 (18%) cases, including 37 (13%) 
      grade 1 and 14 (5%) grade 2. Forty-seven BCISs (35%) were observed in group B and 
      4 (3%) in group A (p < 0.001). Multivariate regression showed that intraoperative 
      UFH (OR = 18, CI 95% 6-52) and consumption of oral anticoagulants (OR = 3.3, CI 
      95% 1-10) increased the risk of BCIS. Five patients further developed a 30-day 
      pulmonary embolism in group B, while 2 presented this complication in group A 
      (p = 0.231). No association between BCIS and 30-day thromboembolic events was 
      found (p = 0.62). 90-day (1% each, p = 0.98) and 1-year (2% vs. 3%, p = 0.38) 
      mortality were similar. CONCLUSIONS: BCIS was a frequent finding in FNF patients 
      treated with hybrid THA. We found a paradoxically significant increase in BCIS 
      with the use of UFH. Heparin did not seem to prevent BCIS, other thromboembolic 
      events and mortality in this group of patients.
CI  - (c) 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, 
      part of Springer Nature.
FAU - Garcia-Mansilla, Agustin
AU  - Garcia-Mansilla A
AD  - Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. 
      Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St, C1199ABH, Buenos 
      Aires, Argentina.
FAU - Castro Lalin, Agustina
AU  - Castro Lalin A
AD  - Department of Anaesthesiology, Italian Hospital of Buenos Aires, Buenos Aires, 
      Argentina.
FAU - Holc, Fernando
AU  - Holc F
AUID- ORCID: 0000-0002-1224-3312
AD  - Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. 
      Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St, C1199ABH, Buenos 
      Aires, Argentina. fernando.holc@hospitalitaliano.org.ar.
FAU - Molho, Nicolas Martin
AU  - Molho NM
AD  - Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. 
      Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St, C1199ABH, Buenos 
      Aires, Argentina.
FAU - Vescovo, Anibal
AU  - Vescovo A
AD  - Department of Anaesthesiology, Italian Hospital of Buenos Aires, Buenos Aires, 
      Argentina.
FAU - Slullitel, Pablo Ariel
AU  - Slullitel PA
AD  - Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. 
      Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St, C1199ABH, Buenos 
      Aires, Argentina.
FAU - Buttaro, Martin Alejandro
AU  - Buttaro MA
AD  - Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. 
      Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St, C1199ABH, Buenos 
      Aires, Argentina.
LA  - eng
PT  - Journal Article
DEP - 20230116
PL  - France
TA  - Eur J Orthop Surg Traumatol
JT  - European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
JID - 9518037
RN  - 9005-49-6 (Heparin)
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Humans
MH  - Heparin/adverse effects
MH  - *Arthroplasty, Replacement, Hip/adverse effects
MH  - Cementation
MH  - Anticoagulants/adverse effects
MH  - *Thromboembolism/etiology
MH  - *Femoral Neck Fractures
OTO - NOTNLM
OT  - Bone cement implantation syndrome
OT  - Femoral neck fracture
OT  - Intraoperative heparin
EDAT- 2023/01/17 06:00
MHDA- 2023/07/27 06:43
CRDT- 2023/01/16 11:15
PHST- 2022/11/20 00:00 [received]
PHST- 2023/01/09 00:00 [accepted]
PHST- 2023/07/27 06:43 [medline]
PHST- 2023/01/17 06:00 [pubmed]
PHST- 2023/01/16 11:15 [entrez]
AID - 10.1007/s00590-023-03472-7 [pii]
AID - 10.1007/s00590-023-03472-7 [doi]
PST - ppublish
SO  - Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2547-2554. doi: 
      10.1007/s00590-023-03472-7. Epub 2023 Jan 16.