Abstract
Purpose
In previous studies the degree of embolization detected by transoesophageal echocardiography (TEE) dunng cemented total hip arthroplasty (THA) did not correlate with changes in haemodynamic variables nor did it result in persistent ventilation-perfusion mismatching. The aim of this study was to record evidence of embolism and to relate the findings to demographic data and the subsequent clinical course of the patients dunng THA.
Method
Forty-eight patients scheduled to undergo elective cemented THA dunng general anaesthesia were monitored. A TEE probe was inserted with special attention to the nght atnum (RA), the nght ventnele (RV). Haemodynamic (heart rate, arterial blood pressure, central venous pressure) and blood-gas vanables were measured repeatedly during the operative procedure (after induction, placement of the acetabular component, placement of the femoral component, relocation of the hip joint). Grading of venous embolism at these times was based on the size of particles detected by TEE (three-minutes video segments of each penods) and correlated with demographic, haemodynamic and blood-gas data.
Results
The TEE monitoring revealed showers of echogenic matenal traversing the RA and RV in all but one patients dunng reaming and cementing of the acetabular and femoral components, and dunng relocation of the hip joint. No correlation was observed between frequency or size of embolic particles and demographic or blood-gas and haemodynamic vanables studied at the same times.
Conclusion
This study failed to show any clinical impact of TEE detected emboli dunng cemented THA.
Résumé
Objectif
Des études anténeures ont montré que le degré de l’embolisation décelé par échographie transoesophagienne (ETO) pendant l’arthroplastie totale de la hanche (ATH) cimentée ne corrélait pas avec les changements des paramètres hémodynamiques et ne provoquait pas d’inégalités persistantes du rapport ventilation-perfusion. Cette étude visait à enregistrer, au cours de l’ATH, l’appantion des embolies et de corréler ces données avec les données démographiques et l’évolution clinique subséquente des opérés.
Méthodes
Quarante-huit patients programmés pour subir une ATH cimentée non urgente étaient monrtorés sous anesthésie générale La sonde ETO était insérée en ciblant spécialement l’oreillette droite (OD) et le ventricule droit (VD). Les paramètres hémodynamiques (fréquence cardiaque, pression arténelle, tension veineuse centrale) et la gazométne étaient mesurés à intervalles fixes pendant l’intervention chirurgicale (après l’induction, pendant l’installation du segment acétabulaire, à l’installation du segment fémoral, et lors de la réduction de la dislocation de la hanche). Le degré d’embolisation veineuse était alors établi selon la grosseur des particules détectées par ETO (enregistrements vidéo de trois minutes pour chacune des périodes) et corrélé avec les données démographiques, hémodynamiques et gazométnques.
Résultats
Le monitorage ETO a révélé que. chez tous les patients, une pluie de maténel échogène traversait l’OD et le VD pendant l’alésage et la cimentation des segments acétabulaire et fémoral et pendant la réduction de la dislocation de la hanche. ll n’y avait pas de corrélation entre la fréquence et la grosseur des particules emboliques et les paramètres démographiques, gazométnques et hémodynamiques enregistrés simultanément.
Conclusion
Cette étude n’a pas montré que les embolies détectées par ETO pendant l’ATH cimentée avaient un impact clinique.
Article PDF
Similar content being viewed by others
References
Ereth MH, Weber JG, Abel MD, et al. Cemented versus noncemented total hip arthroplastyembolism, hemodynamics, and intrapulmonary shunting. Mayo Clin Proc 1992; 67: 1066–74.
Ulrich C, Burri C, Wörsdörfer O, Heinrich H. Intraoperative transesophageal two-dimensional echocardiography in total hip replacement. Arch Orthop Trauma Surg 1986; 105: 274–8.
Lafont ND, Kostucki WM, Marchand PH, Michaux MN, Boogaerts JG. Embolism detected by transoesophageal echocardiography during hip arthroplasty. Can J Anaesth 1994; 41: 850–3.
Wenda K, Henrichs KJ, Biegler M, Erbel R. Nachweis von markembolien während oberschenkelmarknagelungen mittels transösophagealer echokardiographie. (German) Unfallchirugie 1989; 15: 73–6.
Herndon JH, Bechtol CO, Crickenberger DP. Fat embolism during total hip replacement. J Bone Joint Surg Am 1974; 56: 1350–62.
Rinecker H. New clinico-pathophysiological studies on the bone cement implantation syndrome. Arch Orthop Trauma Surg 1980; 97: 263–74.
Patterson BM, Healey JH, Cornell CN, Sharrock NE. Cardiac arrest during hip arthroplasty with a cemented long-stem component. A report of seven cases. J Bone Joint Surg Am 1991; 73: 271–7.
Duncan JAT. Intra-operative collapse or death related to the use of acrylic cement in hip surgery. Anaesthesia 1989; 44: 149–53.
Coventry MB, Beckenbaugh RD, Nolan DR, Ilstrup DM. 2,012 Total hip arthroplasties: a study of postoperative course and early complications. J Bone Surg Am 1974; 56: 273–84.
Byrick RJ, Mullen JBM, Wigglesworth DF. Pulmonary and systemic fat embolism after cemented arthroplasty. Can J Anaesth 1993; 40: A18.
Fitzgerald R, Mason L, Kanumilli V, Kleinhomer K, Sakamoto A, Johnson C. Transient cardiac standstill associated with embolic phenomena diagnosed by intraoperative transesophageal echocardiography during cemented total hip arthroplasty. Anesth Analg 1994; 79: 382–5.
Huemer G, Hofmann S, Kratochwill Ch, Koller J, Hopf R, Salzer S. Perioperative hemodynamic and oxymetric changes due to fatty marrow release (FMR) in uncemented total hip replacement (THR). Anesthesiology 1993; 79: A62.
Orsini EC, Byrick RJ, Mullen JBM, Kay JC, Waddell JP. Cardiopulmonary function and pulmonary microemboli during arthroplasty using cemented or non-cemented components. J Bone Joint Surg Am 1987; 69: 822–32.
Tronzo RG, Kallos T, Wyche MQ. Elevation of intramedullary pressure when methylmethracrylate is inserted in total hip arthroplasty. J Bone Joint Surg Am 1974; 56: 714–8.
Kallos T, Enis JE, Gollan F, Davis JH. Intramedullary pressure and pulmonary embolism of femoral medullary contents in dogs during insertion of bone cement and a prosthesis. J Bone Joint Surg Am 1974; 56: 1363–7.
Modig J, Busch C, Olerud S, Saldeen T, Waernbaum G. Arterial hypotension and hypoxemia during total hip replacement: the importance of thromboplastic products, fat embolism and acrylic monomers. Acta Anaesthesiol Scand 1975; 19: 28–43.
Pell ACH, Christie J, Keating JF, Sutherland GR. The detection of fat embolism by transoesophageal echocardiography during reamed intramedullary nailing. A study of 24 patients with femoral and tibial fractures. J Bone Joint Surg Br 1993; 75: 921–5.
Clements FM, de Bruijn NP. Perioperative evaluation of regional wall motion by transoesophageal two-dimensional echocardiography. Anesth Analg 1987; 66: 249–61.
Savage RM, Litina MG, Koch CG, et al. Educational program for intraoperative transesophageal echocardiography. Anesth Analg 1995; 81: 399–403.
Spiess BD, Sloan MS, McCarthy RJ, et al. The incidence of venous air embolism during total hip arthroplasty. J Clin Anesth 1988; 1: 25–30.
Pell ACH, Hughes D, Keating JF, Christie J, Busuttil A, Sutherland GR. Brief report: fulminating fat embolism syndrome caused by paradoxical embolism through a patent foramen ovale. N Engl J Med 1993; 329: 926–9.
Ware JA, Kang J, DeCenzo MT, et al. Platelet activation by a synthetic hydrophobic polymer, polymethylmethacrylate. Blood 1991; 78: 1713–21.
Urban MK, Sheppard R, Gordon MA, Urquhart BL. Right ventricular function during revision total hip arthroplasty. Anesth Analg 1996; 82: 1225–9.
Propst JW, Siegel LC, Schnittger I, Foppiano L, Goodman SB, Brock-Utne JG. Segmental wall motion abormalities in patients undergoing total hip replacement: correlations with intraoperative events. Anesth Analg 1993;77: 743–9.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lafont, N.D., Kalonji, M.K., Bane, J. et al. Clinical features and echocardiography of embolism during cemented hip arthroplasty. Can J Anaesth 44, 112–117 (1997). https://doi.org/10.1007/BF03012997
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03012997