Clinical Research Directory

Hemodynamic Effects of Bone Cement During Hip Arthroplasty Under Neuraxial Anesthesia

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.

Relationship Between Anesthetic Regimen and Bone Cement Implantation Syndrome (BCIS)

The annual incidence of geriatric hip fractures in the United States is 325,000 and is projected to rise given the aging population.1 The mainstay of treatment is cemented hip hemiarthroplasty. Bone cement implantation syndrome (BCIS) is a serious perioperative complication unique to cemented arthroplasty characterized by hypoxia, hypotension, cardiac arrhythmias, and in severe cases, cardiac arrest. BCIS is associated with significantly higher rates of unplanned intubation, vasopressor use, prolonged hospitalization, and 30-day mortality. Given the rising incidence of hip fractures, the identification of readily modifiable risk factors for BCIS such as anesthetic regimen is crucial to reduce morbidity and mortality. However, a prospective study comparing the rate of BCIS development between general and neuraxial anesthesia is currently lacking. Additionally, no studies have examined how the anesthetic regimen affects histamine and complement levels. Therefore, this pilot study aims to investigate the effect of anesthetic regimen on BCIS development as well as on histamine and complement levels in patients undergoing cemented hemiarthroplasty for hip fracture. The investigators hypothesize that neuraxial anesthesia will be associated with lower rates of BCIS as well as lower histamine and complement levels compared to general anesthesia. The primary objective of this pilot study is to compare the effect of general and neuraxial anesthesia on the incidence and severity of BCIS in patients undergoing cemented hemiarthroplasty for hip fracture. Secondary objectives include examining postoperative outcomes associated with BCIS, such as cardiac arrhythmias, unplanned intubation, hypoxia necessitating supplemental oxygen, altered mental status, and in-hospital mortality. Additional objectives include comparing histamine and complement levels between anesthetic regimens as well as between patients with and without BCIS

Predicting Bone Cement Implantation Syndrome Using Artificial Intelligence Methods

This study aims to predict the development of bone cement syndrome, which may develop due to polymethylmethacrylate cement used to adhere the prosthesis to the bone in arthroplasty surgeries, which may cause intraoperative and postoperative mortality and morbidity, using artificial intelligence methods and to provide a sustainable life comfort to patients in the postoperative period with the standardization predicted in the long term.

Effects of Remote Ischaemic Preconditioning in Cemented Hip Arthroplasty.

Total joint arthroplasty is one of the best treatment options for end-stage osteoarthritis. Cemented hip arthroplasty is mainly indicated for elderly patients with poor bone quality and multiple comorbidities. Bone cement implantation syndrome is associated with cemented hip arthroplasty and it has been shown to increase cardiovascular and renal complication and brain damage postoperatively. The aim of this project is to elucidate whether remote-ischemic preconditioning (RIPC) has multi-organ protective effect in cemented hip arthroplasty patients.