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A Patient with Severe Pulmonary Hypertension for Hip Arthroplasty

HSS Journal: Volume 10, Issue 2


Pulmonary arterial hypertension (PAH) is defined as a mean PA pressure ≥25 mmHg at rest or 30 mmHg with exercise without left ventricular failure (left ventricular end diastolic pressure (LVEDP) ≤15). Most patients present with symptoms of progressive exertional dyspnea, which may also include angina and syncopal episodes. If these patients are not treated, the disease will progress to right heart failure, with peripheral edema, ascites, and hepatomegaly.

Pulmonary hypertension is a known risk factor for morbidity and mortality during noncardiac surgery. Stress, pain, acidosis, and hypoxemia which are often encountered during surgery may increase PAH and precipitate right ventricular decompensation. In addition during total hip arthroplasty, the embolization of bone marrow debris and fat to the lungs will further increase pulmonary arterial pressures and acute cor pulmonale. This is a case report of a young patient with severe pulmonary hypertension who died after a noncemented total hip arthroplasty.

This article appears in HSS Journal: Volume 10, Issue 2.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


Headshot of Michael K. Urban, MD, PhD
Michael K. Urban, MD, PhD
Associate Attending Anesthesiologist, Hospital for Special Surgery
Headshot of Kethy M. Jules-Elysee, MD
Kethy M. Jules-Elysee, MD
Associate Attending Anesthesiologist, Hospital for Special Surgery
Clinical Associate Professor of Anesthesiology, Weill Cornell Medical College

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