Hemodynamic Effects of Bone Cement During Hip Arthroplasty Under Neuraxial Anesthesia

Overview

Hip arthroplasty is a commonly performed surgical procedure in elderly patients, particularly following proximal femoral fractures. During these operations, significant and sudden changes in blood pressure and heart function may occur, especially during bone cement implantation. These hemodynamic alterations may lead to decreased organ perfusion and potential cardiac or renal complications. Traditional non-invasive monitoring methods may not adequately detect rapid perioperative cardiovascular changes. Advanced arterial waveform analysis allows continuous assessment of cardiac output and other hemodynamic parameters in real time. This observational study aims to evaluate perioperative hemodynamic changes in patients undergoing hip arthroplasty under neuraxial anesthesia, comparing cemented and non-cemented procedures. Hemodynamic parameters will be assessed using a pressure recording analytical method through invasive arterial monitoring. In addition, the study investigates the association between intraoperative hemodynamic changes and early postoperative cardiac and renal biomarkers. The findings may contribute to improved perioperative monitoring strategies and safer anesthetic management in high-risk orthopedic surgery patients.

Perioperative hemodynamic monitoring is a cornerstone of anesthetic management, enabling the assessment of cardiovascular function and optimization of organ perfusion. Hip arthroplasty is frequently performed in elderly patients and is associated with a risk of significant hemodynamic instability, particularly during bone cement implantation. Bone Cement Implantation Syndrome is characterized by hypotension, hypoxia, and cardiovascular collapse, which may result in postoperative organ dysfunction. In this prospective observational study, patients undergoing hip arthroplasty under neuraxial anesthesia are evaluated to characterize perioperative hemodynamic changes using continuous arterial waveform analysis. A pressure recording analytical method is used to measure cardiac output and related hemodynamic parameters through invasive arterial blood pressure monitoring. Patients aged 50 to 90 years with ASA physical status I-III scheduled for elective or fracture-related hip arthroplasty are included. Eligible patients are divided into two groups according to surgical technique: cemented and non-cemented hip arthroplasty. No intervention or randomization is performed; surgical and anesthetic management follow routine clinical practice. Hemodynamic parameters are recorded at predefined time points, including baseline measurements, after neuraxial anesthesia, at surgical incision, before and after cement or prosthesis implantation, during the first hypotensive episode if present, and at the end of surgery. Fluid responsiveness is assessed using Trendelenburg maneuver-induced changes in cardiac output and stroke volume. Arterial blood gas analysis is performed intraoperatively as clinically indicated and routinely at the end of surgery. Postoperative laboratory assessments include serum creatinine, NT-proBNP, and troponin I measured on postoperative day 0, followed by daily measurements on postoperative days 1, 2, and 3. Urine output is monitored during the postoperative period. The primary objective of the study is to evaluate perioperative hemodynamic changes associated with bone cement implantation. Secondary objectives include assessing the relationship between intraoperative hemodynamic alterations and early postoperative cardiac and renal biomarkers. All collected data are analyzed statistically to determine differences between cemented and non-cemented procedures and to explore potential predictors of organ dysfunction.