Bibliographic record
Abstract
We have recently experienced two cases of cardiac arrest during hip hemi-arthroplasty for fractured neck of femur. Both of these occurred shortly after insertion of the bone cement. Hypotension and hypoxaemia are well recognised during hip arthroplasty. Rises in central venous pressure, pulmonary artery pressure, pulmonary vascular resistance and deterioration in pulmonary artery shunt fraction are also recognised. Transoesophageal echocardiography frequently detects the embolic phenomenon, and the severity of the physiological disturbances correlates well with the severity of emboli detected [1–4]. These emboli are thought to be a mixture of thrombo-emboli, fat and marrow emboli [2, 3, 5], and can lead to cardiac arrest and death [4, 5]. The embolic phenomenon and consequent physiological changes are significantly worse during the course of a cemented hip arthroplasty using a conventional cementing technique, when compared with a non-cemented arthroplasty [1, 4–7]. We conducted a telephone survey of all trauma centres in Wales. Of the 12 trauma centres in Wales, six use almost exclusively cemented hemi-arthroplasties, two centres use almost exclusively non-cemented hemi-arthroplasties, two centres decide using a protocol based on the patient's age and mobility, and two come to a decision after discussion between anaesthetist and surgeon regarding the ability of the patient to withstand a cemented hemi-arthroplasty. We also found that there had been 15 cases of intra-operative death during hemi-arthroplasty in the preceding year. All 15 of these deaths occurred in the 847 patients having cemented prostheses. There were no deaths in the 328 patients who did not have cement (information on total cases supplied by Health Solutions Wales). This compares with the results of Parvizi et al.[6], who looked at 38 488 cases of hip arthroplasty at their institution. They found 23 intra-operative deaths in the 23 077 patients who had cemented procedures and no intra-operative deaths in the 15 411 patients who had non-cemented procedures. The ‘on-table’ mortality in the frail population who experience fractured neck of femur (7% in-hospital 30-day mortality; only 50% discharged home by 4 weeks [8]) is different between patients having cemented and non-cemented hemi-arthroplasty. Shouldn't we all try to communicate more effectively pre-operatively with our orthopaedic colleagues (as in two of the centres above), and perhaps use less cemented prostheses?
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".