Clinical characteristics of hypertensive patients undergoing total hip or knee replacement

Introduction. Orthopaedic surgeries are major procedures, often associated with perioperative risk. They are especially challenging for elderly patients afflicted with several comorbidities and cardiovascular risk factors. Currently, one of the most frequent types of orthopaedic surgeries is joint alloplasties of hip or knee. The aim of this study was to establish the clinical characteristics of hypertensive patients undergoing total hip or knee replacement and to describe the frequency of the early complication of the surgery, which is a need for blood transfusion. Material and methods. The study enrolled 199 consecutive patients who underwent hip or knee alloplasty. From this group patients with previous diagnosis of hypertension were selected for further assessment. All patients were screened for presence of cardiovascular risk factors and cardiovascular disease, according to the current guidelines. All patients were also followed for the necessity of blood transfusion during the hospitalisation. Results. From the screened population 135 patients had previous diagnosis of hypertension and met inclusion criteria (mean age 69.0 } 9.3 years, 30.4% male). From those patients, 70 (48.1%) underwent knee replacement, and 65 (51.9%) had hip replacement. As for the prevalence of cardiovascular disease, 16 (11.9%) had coronary artery disease, 5 (3.7%) had a history of previous myocardial infarction and 2 (1.5%) had diagnosed heart failure. Cardiovascular risk factors were also highly prevalent in the study population, 26 (19.3%) patients had diagnosed dyslipidemia, 27 (20.0%) had diabetes and 58 (43.0%) were obese. There were no statistical differences in the prevalence of those factors between patients with hip and knee replacement. 33 (24.4%) had blood loss during the operation, which led to a need for blood transfusion (19 (29.2%) patients in hip replacement group, and 14 (20%) in knee replacement group, p = 0.05). We found no differences in the prevalence of cardiovascular disease and cardiovascular risk factors between patients who required and did not require blood transfusion (p > 0.05). Conclusions. Hypertensive patients who undergo hip or knee replacement have high prevalence of cardiovascular risk factors and other cardiovascular disease, therefore are at high perioperative risk. No differences are seen between patients with hip and knee replacement. There is also a high frequency of blood transfusions in this group

Assessment of cardiovascular risk in patients undergoing total joint alloplasty: the CRASH-JOINT study

Wstęp: Ocena ryzyka ma szczególne znaczenie u pacjentów poddawanych interwencjom chirurgicznym. Zabiegi ortopedyczne, w szczególności całkowita alloplastyka stawów, są operacjami związanymi z wysokim ryzykiem okołooperacyjnym, jak również jednym z najwyższych odsetków powikłań. Cel: Celem niniejszej pracy było określenie częstości występowania klasycznych i nieklasycznych czynników ryzyka sercowo-naczyniowego u pacjentów poddawanych całkowitej alloplastyce stawu biodrowego lub kolanowego. Metody: CRASH-JOINT (Cardiovascular Risk Assessment ScHeme in JOINT alloplasty) było prospektywnym badaniem epidemio­logicznym przeprowadzonym u pacjentów poddawanych operacji całkowitej alloplastyki stawu biodrowego lub kolanowego. Chorzy włączeni do projektu byli badani pod kątem klasycznych i nieklasycznych czynników ryzyka sercowo-naczyniowego i przeprowadzono u nich całodobowe pomiary wartości ciśnienia tętniczego. Wyniki: Do badania włączono 98 osób. Podczas wstępnej ewaluacji 8 pacjentów zostało wykluczonych z badania i wyłączonych z zabiegu, w większości z powodu przyczyn sercowych. U 65 chorych przeprowadzono wymianę stawu biodrowego i 25 stawu kolanowego (średni wiek 63,7 ± 12,2 roku, 62,2% kobiet). Wśród klasycznych czynników ryzyka zwracało uwagę 50 (55,6%) osób z rozpoznaniem nadciśnienia tętniczego w przeszłości, 10 (11,1%) pacjentów miało cukrzycę, 2 (2,2%) wystąpił zawał serca w przeszłości, a u 24 (26,7%) w wywiadzie rodzinnym zanotowano choroby sercowo-naczyniowe. Średni wskaźnik masy ciała (BMI) wynosił 28,0 ± 5,1 kg/m2, nadwagę zaobserwowano u 39 (43,3%) pacjentów, a u 28 (31,1%) — otyłość. Pacjenci poddawani wymianie stawu biodrowego byli istotnie młodsi (61,8 ± 12,6 vs. 68,5 ± 10,0 lat; p = 0,02), byli częś­ciej palaczami tytoniu (24,6% vs. 4,0%; p = 0,03), mieli istotnie niższe BMI (26,8 ± 4,5 vs. 31,2 ± 5,3 kg/m2, p < 0,0001) i rzadziej byli otyli (18,5% vs. 64,0%, p < 0,0001). Nie stwierdzono istotnych różnic między pacjentami zakwalifikowanymi do operacji pierwotnej i ponownej reoperacji. Wnioski: Badanie wykazało, że czynniki ryzyka sercowo-naczyniowego u osób poddawanych całkowitej alloplastyce stawu biodrowego lub kolanowego są obecne częściej niż w populacji ogólnej, co może potencjalnie przyczynić się do podwyższonego ryzyka rozwoju powikłań okołooperacyjnych.Background: Risk assessment is of particular importance for patients undergoing surgical interventions. Orthopaedic procedures, especially total joint alloplasty, are major procedures associated with high perioperative risk, as well as one of the highest rates of complications. Aim: The aim of the present study was to establish the prevalence of classical and non-classical cardiovascular risk factors in patients undergoing total hip or knee alloplasty. Methods: The CRASH-JOINT (Cardiovascular Risk Assessment ScHeme in JOINT alloplasty) was a prospective, epidemiological study performed in consecutive patients scheduled for total joint (hip or knee) replacement surgery. Patients enrolled into the study were screened for cardiovascular risk factors and had ambulatory blood pressure performed for the diagnosis of hypertension. Results: The present study enrolled 98 patients. During initial screening eight patients were disqualified from the study and the surgery, in the majority due to the cardiac causes. Sixty-five patients had a hip joint replacement and 25 had knee joint replacement (mean age 63.7 ± 12.2 years, 62.2% female). Fifty (55.6%) patients were diagnosed with arterial hypertension in the past, ten (11.1%) patients had diabetes mellitus, two (2.2%) had a history of myocardial infarction, and family history of cardiovascular disease was present in 24 (26.7%) cases. Mean body mass index (BMI) was 28.0 ± 5.1 kg/m2 and 39 (43.3%) patients were overweight, while 28 (31.1%) were obese. Patients undergoing hip replacement were significantly younger (61.8 ± 12.6 vs. 68.5 ± 10.0 years; p = 0.02), were more often current smokers (24.6% vs. 4.0%; p = 0.03), had significantly lower BMI (26.8 ± 4.5 vs. 31.2 ± 5.3 kg/m2; p < 0.0001), and were less often obese (18.5% vs. 64.0%; p < 0.0001). There were no significant differences between patients scheduled for primary surgery and reoperation. Conclusions: The study showed that classical cardiovascular risk factors in patients undergoing total hip or knee alloplasty have a higher prevalent than in the general population, which can potentially contribute to the higher risk of development of perioperative complications

Hip joint implants - survey of numerical modeling

In the paper the discussion of the modeling of hip joint implants is presented. the historical attempts to implant construction finally led to complex solutions. To date almost all experiences have learned from clinic observation and rather tests and trial methods than systematic research. Numerical simulations have been limited to simple stress analysis. All phenomena responsible for the damage in the treated joint are not fully explained. The comlexity of the problem is presented in the paper. The stress concentration in the region of rigid inclusion is pointed as one of the mechanical destructive factors. The change of the stem form and material rigidity cuuld reduce extremal stresses by 10-20%.W pracy omówiono modelowanie implantów stawu biodrowego. Historyczne próby ich konstruowania doprowadziły do bardzo złożonych rozwiązań. Dotąd niemal wszystkie doświadczenia zdobywano w obserwacjach klinicznych i próbach, a nie w wyniku systematycznych badań. Numeryczne symulacje ograniczono do prostej analizy stanu naprężenia. Większość zjawisk odpowiedzialnych za uszkodzenia badanych stawów nie jest w pełni wyjaśniona. W pracy zwrócono uwagę na złożoność zagadnienia. Za jeden z czynników niszczących uznano koncentracje naprężeń w strefach sztywnych wtrąceń. Zmiana kształtu trzpienia i sztywności materiału pozwala zmniejszyć ekstremalne naprężenia o 10-20%