open access

Vol 21, No 1 (2017)
ORIGINAL PAPERS
Published online: 2017-03-30
Get Citation

Clinical characteristics of hypertensive patients undergoing total hip or knee replacement

Paweł Łęgosz, Anna E. Płatek, Marcin Kotkowski, Bartosz Krzowski, Filip M. Szymanski, Janusz Sierdziński, Paweł Małdyk, Krzysztof J. Filipiak
DOI: 10.5603/AH.2017.0004
·
Arterial Hypertension 2017;21(1):29-33.

open access

Vol 21, No 1 (2017)
ORIGINAL PAPERS
Published online: 2017-03-30

Abstract

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.

Abstract

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.

Get Citation

Keywords

hypertension, blood transfusion, hip replacement, orthopaedics

About this article
Title

Clinical characteristics of hypertensive patients undergoing total hip or knee replacement

Journal

Arterial Hypertension

Issue

Vol 21, No 1 (2017)

Pages

29-33

Published online

2017-03-30

DOI

10.5603/AH.2017.0004

Bibliographic record

Arterial Hypertension 2017;21(1):29-33.

Keywords

hypertension
blood transfusion
hip replacement
orthopaedics

Authors

Paweł Łęgosz
Anna E. Płatek
Marcin Kotkowski
Bartosz Krzowski
Filip M. Szymanski
Janusz Sierdziński
Paweł Małdyk
Krzysztof J. Filipiak

References (17)
  1. Jones C, Beaupre L, Johnston D, et al. Total Joint Arthroplasties: Current Concepts of Patient Outcomes after Surgery. Rheum Dis Clin North Am. 2007; 33(1): 71–86.
  2. Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br. 2004; 86(4): 561–565.
  3. Helm AT, Karski MT, Parsons SJ, et al. A strategy for reducing blood-transfusion requirements in elective orthopaedic surgery. Audit of an algorithm for arthroplasty of the lower limb. J Bone Joint Surg Br. 2003; 85(4): 484–489.
  4. Ralley FE, Berta D, Binns V, et al. One intraoperative dose of tranexamic Acid for patients having primary hip or knee arthroplasty. Clin Orthop Relat Res. 2010; 468(7): 1905–1911.
  5. Chen AF, Klatt BA, Yazer MH, et al. Blood utilization after primary total joint arthroplasty in a large hospital network. HSS J. 2013; 9(2): 123–128.
  6. Beattie WS, Karkouti K, Wijeysundera DN, et al. Risk associated with preoperative anemia in noncardiac surgery: a single-center cohort study. Anesthesiology. 2009; 110(3): 574–581.
  7. Pulido L, Ghanem E, Joshi A, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008; 466(7): 1710–1715.
  8. Schmied H, Kurz A, Sessler DI, et al. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996; 347(8997): 289–292.
  9. Lee JH, Han SB. Patient Blood Management in Hip Replacement Arthroplasty. Hip Pelvis. 2015; 27(4): 201–208.
  10. Chang CH, Chang Y, Chen DW, et al. Topical tranexamic acid reduces blood loss and transfusion rates associated with primary total hip arthroplasty. Clin Orthop Relat Res. 2014; 472(5): 1552–1557.
  11. Wu Y, Yang T, Zeng Yi, et al. Effect of different postoperative limb positions on blood loss and range of motion in total knee arthroplasty: An updated meta-analysis of randomized controlled trials. Int J Surg. 2017; 37: 15–23.
  12. Vuille-Lessard E, Boudreault D, Girard F, et al. Red blood cell transfusion practice in elective orthopedic surgery: a multicenter cohort study. Transfusion. 2010; 50(10): 2117–2124.
  13. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006; 105(1): 198–208.
  14. Kim JL, Park JH, Han SB, et al. Allogeneic Blood Transfusion Is a Significant Risk Factor for Surgical-Site Infection Following Total Hip and Knee Arthroplasty: A Meta-Analysis. J Arthroplasty. 2017; 32(1): 320–325.
  15. Lieberman L, Maskens C, Cserti-Gazdewich C, et al. A retrospective review of patient factors, transfusion practices, and outcomes in patients with transfusion-associated circulatory overload. Transfus Med Rev. 2013; 27(4): 206–212.
  16. Alam A, Lin Y, Lima A, et al. The prevention of transfusion-associated circulatory overload. Transfus Med Rev. 2013; 27(2): 105–112.
  17. Legosz P, Kotkowski M, Platek AE, et al. Assessment of cardiovascular risk in patients undergoing total joint alloplasty: the CRASH-JOINT study. Kardiol Pol. 2016 [Epub ahead of print].

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl