Document Detail

The Frank Stinchfield Award. Sudden death during primary hip arthroplasty.
MedLine Citation:
PMID:  10611859     Owner:  NLM     Status:  MEDLINE    
The records of 23 patients who died intraoperatively during hip arthroplasty at the authors' institution were reviewed. Of the 38,488 hip arthroplasties in 29,431 patients performed between 1969 and 1997, there were 23 deaths during surgery. There were 15 women and eight men with a mean age of 80.9 years. Preoperative diagnoses were acute hip fracture (13 patients), pathologic fracture (four patients), femoral neck nonunion (one patient), osteoarthritis (four patients), and rheumatoid arthritis (one patient). Eleven patients undergoing cemented total hip arthroplasty died and 12 patients undergoing cemented hemiarthroplasty died. All deaths occurred because of irreversible cardiorespiratory disturbances that were initiated during cementing. There were no deaths among 12,551 patients receiving 15,411 uncemented hip arthroplasties during the 28-year period under review. Autopsy was performed in 13 patients. Bone marrow microemboli were seen in the lungs of 11 of 13 patients in whom an autopsy was performed and methylmethacrylate particles were seen in the lungs of three of 13 patients. These data suggest that elderly patients with preexisting cardiovascular conditions undergoing cemented arthroplasty, especially for fracture diagnosis, are at increased risk for intraoperative death compared with patients undergoing elective hip arthroplasty. In the latter years of the current study, modifications of the operative techniques designed to minimize intramedullary hypertension were associated with a reduction greater than three-fold in overall intraoperative mortality rate. These changes in surgical technique should be considered when cement fixation is used in patients thought to be at risk for having cardiopulmonary disturbances develop from venous embolization of marrow contents.
J Parvizi; A D Holiday; M H Ereth; D G Lewallen
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  -     ISSN:  0009-921X     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  1999 Dec 
Date Detail:
Created Date:  2000-01-14     Completed Date:  2000-01-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  39-48     Citation Subset:  AIM; IM    
Department of Orthopedics, Mayo Clinic, Rochester, MN 55905, USA.
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MeSH Terms
Age Distribution
Aged, 80 and over
Analysis of Variance
Arthroplasty, Replacement, Hip / methods,  mortality*,  statistics & numerical data
Death, Sudden / epidemiology*,  etiology,  pathology
Intraoperative Complications / mortality*,  pathology
Middle Aged
Minnesota / epidemiology
Risk Factors
Sex Distribution
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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