Abstract
Purpose
This case report describes a cardiac arrest during a cemented hip arthroplasty procedure. Hemodynamic instability during methylmethacrylate use in arthroplasty surgery can be explained by fat embolization rather than the inherent toxicity of the monomer.
Clinical features
A 78-yr-old woman required a cemented hemiarthroplasty for a pathologic left subcapital fracture. The patient’s past medical history included stable angina, diet-controlled type II diabetes and metastatic breast cancer. During the cementing of the canal and insertion of the femoral prosthesis, desaturation, hypotension and cardiac arrest occurred. The patient underwent a successful intraoperative resuscitation and was transferred to the intensive care unit where she subsequently developed disseminated intravascular coagulopathy. The patient died 24 hr later and autopsy confirmed the cause of death as fat embolization.
Conclusion
The deleterious cardiovascular effects of methylmethacrylate have been discussed in the literature. However, clinical evidence supports fat embolization during arthroplasty surgery as a greater determinant of hemodynamic compromise. Surgical precautions are paramount in minimizing the sequelae of Bone Implantation Syndrome and anesthetic treatment consists of supportive care.
Résumé
Objectif
Rapporter un arrêt cardiaque survenu pendant l’arthroplastie de la hanche cimentée. L’instabilité hémodynamique notée pendant l’utilisation de méthyle méthacrylate pour une arthroplastie peut être secondaire à une embolie graisseuse plutôt qu’à la toxicité inhérente au monomère.
Éléments cliniques
Une femme de 78 ans devait subir une hémiarthroplastie cimentée pour une fracture sous-capitale gauche. L’histoire médicale de la patiente indiquait une angine stable, un diabète de type II sous contrôle diététique et un cancer du sein métastatique. Pendant la cimentation de la fracture et l’insertion de la prothèse fémorale, une désaturation, une hypotension et un arrêt cardiaque sont survenus. La patiente a été réanimée avec succès et dirigée à l’unité des soins intensifs. Une coagulopathie intravasculaire disséminée s’est ensuite développée et la patiente est décédée 24 h plus tard. L’autopsie a confirmé que l’embolie graisseuse avait causé le décès.
Conclusion
Les effets cardio-vasculaires nocifs du méthyle méthacrylate sont connus. Toutefois, des preuves cliniques démontrent que l’embolie graisseuse pendant l’arthroplastie constitue un facteur déterminant, plus important, des altérations hémodynamiques. Il est essentiel de prendre toutes les précautions chirurgicales pour réduire les séquelles du syndrome de l’implant intra-osseux. Le traitement anesthésique est essentiellement un traitement de soutien.
Article PDF
Similar content being viewed by others
References
Newman JR. Orthogeriatrics. Comprehensive Orthopaedic Care for the Elderly Patient, 1st ed. Oxford: Butterworth-Heinemann Ltd, 1992: 149–50.
Duthie EH Jr, Katz P. Practice of Geriatrics. Philadelphia: WB Saunders Company, 1998.
Orsini EC, Byrick RJ, Mullen JBM, et al. Cardiopulmonary function and pulmonary microemboli during arthroplasty using cemented or non-cemented components. J Bone Joint Surg 1987; 69: 822–31.
Patterson BM, Healey JH, Cornell CN, Sharrock NE. Cardiac arrest during hip arthroplasty with a cemented long-stem component. J Bone Joint Surg 1991; 73: 271–7.
McLaughlin RE, DiFazio CA, Hakaka M, et al. Blood clearance and acute pulmonary toxicity of methylmethacrylate in dogs after simulated arthroplasty and intravenous injection. J Bone Joint Surg 1973; 55: 1621–8.
Murphy P, Edelist G, Byrick RJ, Kay JC, Mullen JB. Relationship of fat embolism to haemodynamic and echocardiographic changes during cemented arthroplasty. Can J Anaesth 1997; 44: 1293–1300.
Wheelwright EF, Byrick RJ, Wigglesworth DF, et al. Hypotension during cemented arthroplasty. Relationship to cardiac output and fat embolism. J Bone Joint Surg Br 1993; 75: 715–23.
Charnley J. Systemic effects of monomer.In: Charnley J (Ed). Acrylic Cement in Orthopaedic Surgery. Baltimore: Williams and Wilkins, 1970: 72–8.
Homsy CA, Fullos HS, Anderson MS, Diferrante NM, King JW. Some physiological aspects of prosthesis stabilization with acrylic polymer. Clin Orthop 1972; 83: 317–28.
Lafont ND, Kostucki WM, Marchand PH, Michaux MN, Boogaerts JG. Embolism detected by transoesophageal echogardiography during hip arthroplasty. Can J Anaesth 1994; 41: 850–3.
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.
Byrick RJ, Bell RS, Kay JC, Waddell JP, Mullen JB. High-volume, high-pressure pulsatile lavage during cemented arthroplasty. J Bone Joint Surg 1989; 71: 1331–6.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fallon, K.M., Fuller, J.G. & Morley-Forster, P. Fat embolization and fatal cardiac arrest during hip arthroplasty with methylmethacrylate. Can J Anesth 48, 626–629 (2001). https://doi.org/10.1007/BF03016194
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03016194