| Hip osteoarthritis is an inflammatory disease refers to the long-term imbalanced load which causes degeneration of articular cartilage or change of bone structure change. Patients feel painful for hips, groin and other parts, sometimes the pain radiates to the knee. Others, such as swelling, damage of articular cartilage, bone hyperplasia, dysarthrosis, limited joint mobility, unable to walk and even bedridden, seriously affects patients’daily life. For patients with end-stage hip osteoarthritis, artificial Total hip replacement (Total hip arthroplasty, THA) is the only effective treatment, whose indication is for the patients more than 50 years old, with severe hip pain and limited mobility or deformity. For patients under the age of 50, should choose THA carefully. According to a literature [1], in the recent 50 years, the prevalence rate of hypertension in China has shown a significant rise, one survey data of Chinese residents of nutrition and health in 2002 shows that, prevalence rate of hypertension was 18.8% in adults more than 18s in our country, the estimated number is about 160 million, as the growth of the age, coexisting phenomenon of hypertension and hip osteoarthritis is also very common. When stressed, such as operation and trauma, may affect the blood pressure seriously in patients with primary hypertension due to impaired pressure regulating ability, causing kinds of perioperative complications. Therefore, to explore the range of change of perioperative blood pressure is paramount to avoid occurrence of complications.Objective:To explore the influence between primary THA and the level of blood pressure in patients with primary hypertension, and to investigate the effect of hypertension on perioperative blood loss and short-term effectiveness in primary THA.Method:We retrospectively investigated 30 patients (30 hips) with primary hypertension who underwent THA (observation group) in Qilu hospital during March, 2013 to March,2015, as well as 24 patients (24 hips) without hypertension (control group). The age of observation group ranges from 55 to 72 years, the average age is 62.7 years, includes 12 males (12 hips) and 18 females (18 hips). The age of control group patients ranges from 52 to 71 years, the average age is 61.8 years, there are 10 males (10 hips) and 14 females (14 hips). There is no statistical difference (P> 0.05) of patients’ gender, age, height, Body mass index (Body mass index, BMI) between observation group and control group. All observation group patients were treated with oral drugs, the THA was performed when the blood pressure of resting state showed 110-130/70-90 mmHg. We recorded the blood pressure of resting state at 8am on the operation day, as well as the level of postoperative blood pressure of resting state at 8am in 5 consecutive days after the operation. We also recorded the theoretical total blood loss, dominant blood loss and hidden blood loss between two groups, we compared the clinical parameters of preoperative Harris score and Harris score 1 year after the THA. When P<0.05, the statistical significance was confirmed.Results:All patients underwent unilateral THA for the first time, the blood pressure of resting state of observation group patients was 125.9 ±5.8/70.1±7.1 mmHg at 8am, the duration of operation was 92.3 ± 15.6 min, the average level of blood pressure of resting state at 8am in 4 consecutive days were 152.7±12.8/84.8±10.3mmHg (P< 0.05),138.1±12.9/77.0±8.6mmHg (P< 0.05),132.0±10.0/75.0±8.6mmHg (P< 0.05),131.4±11.2/73.4±6.9mmHg (P< 0.05), compared with preoperative blood pressure values of resting state, statistical significance was found. While the blood pressure of resting state of 5th day was126.7±9.3/71.5±9.9mmHg (P>0.05). Blood transfusion was administrated in 4 cases (13.3%) from observation group and 2 cases (8.3%) from control group, there was no statistical significance between the two groups (P> 0.05). Dominant blood loss in patients of observation group was obviously higher than that of control group (P< 0.05), but no obvious difference was found between the hidden blood loss (P> 0.05). There was statistical significance (P< 0.05) between the theoretical blood loss of two groups, as well as Hb and Hct 2 days after the THA (P<0.05). Meanwhile, both preoperative and postoperative Harris scores in patients of observation group were significantly lower than control group (P < 0.05).Conclusion:For the hip osteoarthritis patients with primary hypertension who underwent THA, the blood pressure value of resting state increased obviously one day after the operation, while the blood pressure values showed a decreased trend after the operation from 2th day to 4th day, gradually subsided to the preoperative level in the resting state 5 days after the operation. For patients suffering from pure hip osteoarthritis, there was no significant difference in preoperative and postoperative blood pressure values. Patients of observation group accepted THA, although no statistical significance was found in the hidden blood loss, the theoretical total blood loss and dominant blood loss were significantly higher than that of control group, indicated that patients with hypertension can increase perioperative blood loss. Compared the preoperative and postoperative HSS scores between the two groups, the preoperative Harris score of patients with primary hypertension was lower than the control group, indicated that the degree of joint injury was heavy relatively, while the Harris score was still lower than the patients suffered from pure hip osteoarthritis lyear after the THA, this may reflect an adverse effect of primary hypertension on short-term effectiveness of THA. |
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