Intraoperative blood pressure changes during cemented versus uncemented bipolar hemiarthroplasty for displaced femoral neck fracture: a multi-center cohort study : The effect of bone cement for bipolar hemiarthroplasty in elderly patients.

INTRODUCTION: The purpose of this study was to compare the cemented bipolar hemiarthroplasty with uncemented about the change of intraoperative blood pressure and the incidence of major complications in elderly patients with femoral neck fracture. MATERIALS AND METHODS: This multiple center prospective cohort study included only patients with acute displaced femoral neck fracture (Garden stage III or IV). All patients were treated with cemented or uncemented bipolar hemiarthroplasty using modified Hardinge or Watson-Jones approach in the lateral decubitus position. Baseline data, medical history, type of anesthesia, FiO2 value, the number of vasopressor using during operation, femoral component, intraoperative blood pressure, SaO2, and major complications were evaluated. RESULTS: Of 164 patients (45 males and 119 females), 86 underwent cemented and 78 underwent uncemented bipolar hemiarthroplasty. Baseline medical histories were similar in both groups. In both the cemented and uncemented groups, intraoperative systolic blood pressure significantly decreased during cementing or rasping (106.3 and 103.6 mmHg) and after femoral component insertion (103.3 and 99.1 mmHg) compared to before rasping (120.7 and 116.4 mmHg) (p < 0.0001, respectively). Donaldson's grade seemed more favorable in uncemented group than in cemented group during cementing or rasping, during stem insertion; however, no patients experienced the lethal complication in both groups. CONCLUSIONS: Intraoperative blood pressure did not change during cemented and uncemented bipolar hemiarthrplasty for displaced femoral neck fracture. If the standard modern cement technique was performed during operation, bone cement is a safe and acceptable for elderly patients who have a lot of medical histories.

The influence of bone cement and American Society of Anesthesiologists (ASA) class on cardiovascular status during bipolar hemiarthroplasty for displaced femoral-neck fracture: A multicenter, prospective, case-control study.

BACKGROUND: Little is known about how bone cement and American Society of Anesthesiologists (ASA) classification influence the cardiovascular system in elderly patients with femoral-neck fractures treated with cemented hemiarthroplasty. Therefore, we performed a case-control study to investigate these questions and compared the following:≥ASA III with≤ASA II patients who underwent cemented hemiarthroplasty; and cemented with cementless hemiarthroplasty in≥ASA III patients. HYPOTHESIS: ASA classification influences the cardiovascular system during cemented hemiarthroplasty and bone cement influences intraoperative blood pressure [IBP] in patients rated≥ASA III. MATERIALS AND METHODS: This multicenter, prospective study included patients with acute displaced femoral-neck fractures. Baseline data, medical history, anesthesia, FiO2, vasopressor use, femoral component, IBP, SpO2, and complications were evaluated. Of 200 patients, 100 were cemented (mean age, 77±10 years), and 100 were cementless (mean age, 78±9 years). Cemented hemiarthroplasty employed a third-generation technique (plugging, irrigating, drying and filling the canal with cement under pressurization). RESULTS: Systolic blood pressure (SBP) decreased significantly during cementing, versus pre-rasping in≤ASA II patients (from 117.9±24.5 [range, 65-199] to 106.9±20.3 [range, 59-172]; p=0.007), in≥ASA III patients (from 129.5±21.0 [range, 90-169] to 110.4±17.9 [range, 79-157]; p=0.006), and post-stem-insertion, versus pre-rasping in≤ASA II patients (from 117.9±24.5 [range, 65-199] to 103.9±20.7 [range, 53-178]; p=0.0004), and in≥ASA III patients (from 129.5±21.0 [range, 90-169] to 111.2±24.6 [range, 70-156]; p=0.009). In≥ASA III patients, SBP decreased significantly during cementing or rasping, versus pre-rasping in cemented patients (from 129.5±21.0 [range, 90-169] to 110.4±17.9 [range, 79-157]; p=0.006), in cementless patients (from 115.0±17.7 [range, 85-150] to 100.7±15.7 [range, 75-142]; p=0.004), and post-stem-insertion, versus pre-rasping in cemented patients (from 129.5±21.0 [range, 90-169] to 111.2±SD [range]; p=0.009), and in cementless patients (from 115.0±17.7 [range, 85-150] to 89.4±17.5 [range, 58-140]; p<0.0001). There were no lethal complications. CONCLUSIONS: This study indicate a similar hemodynamic change intraoperatively between≤ASA II patients and≥ASA III patients in the cemented group, and between patients with cemented and cementless hemiarthroplasty in the≥ASA III patients. With modern hemiarthroplasty techniques, bone cement might be as safe as cementless techniques in elderly,≥ASA III patients. LEVEL OF EVIDENCE: III, multicenter case-control cohort study.

Novel ankle orthosis with elastomer-embedded flexible joint.

In this study, we propose a new ankle orthosis with elastomer-embedded flexible joints (EEFJ), composed of C-shaped springs and 3D-printed circular elastomer. This orthosis was designed to reduce burden on the tibialis anterior muscle (TA) and to achieve clearance between the tip of the toe and the ground. Fabrication method, strength testing, and gait analysis were conducted. According to the results of strength testing, the combination of the C-spring with 0.3 mm and 0.5 mm thickness and the elastomer with 30% and 60% filling density performs a supporting torque of 0.7-2.3 Nm to plantarflexion. In contrast, torques in the other directions were relatively small. According to the results of gait experiments in seven healthy young subjects, the proposed orthosis successfully reduced activation of TA on initial contact and in the swing phase, and range of motion on initial contact.

Ankle-foot orthosis using elastomer-embedded flexible joint.

We proposed a new ankle-foot orthosis using elastomer-embedded flexible joints (EEFJ), composed of C-shaped springs and 3D-printed circular elastomer. This orthosis was designed to reduce burden on the tibialis anterior muscle (TA) and to achieve clearance between the tip of the toe and the ground. Strength testing, and gait analysis were conducted for the orthosis. According to the results of strength testing, the combination of the C-spring with 0.3 mm and 0.5 mm thickness and the elastomer with 30% and 60% filling density performs a supporting torque of 0.7-2.3 Nm to plantarflexion. In contrast, torques in the other directions were relatively small. According to the results of gait experiments in seven healthy young subjects, the proposed orthosis successfully reduced the TA activation on initial contact and in the swing phase, and range of motion on initial contact.

Association of dental status with blood pressure and heart rate in 80-year-old Japanese subjects.

Periodontal disease is one of the main reasons for the loss of teeth in elderly subjects, and it has been reported that periodontal disease is a potential risk factor for cardiovascular disease. However, little data is available regarding the association between dental status and blood pressure or heart rate in elderly individuals, particularly in subjects over 80 years old. We studied the cross-sectional association between dental status and blood pressure or heart rate in 499 Japanese (195 men and 304 women) who were 80 years old. The subjects were divided into 4 groups according to the number of original teeth; ie, edentulous (n = 176), 1 to 9 teeth (n = 141), 10 to 19 teeth (n = 109), and more than 20 teeth (n = 73). Mean systolic and diastolic blood pressures did not differ among the groups. However, heart rate decreased from 71.6 and 72.2 /min in the edentulous and I to 9 teeth groups, respectively, to 67.3 and 67.4 /min in the 10 to 19 teeth and more than 20 teeth groups, respectively (test for trend, P = 0.0008). In multiple regression analysis, the inverse association between the number of teeth and heart rate was statistically significant independently of other confounding factors. These results are the first to show a close inverse relationship between the number of teeth and heart rate in octogenariars, although the underlying mechanisms have not been determined.