Intramedullary Pressure and Pulmonary Function During Total Knee Arthroplasty

Ries, Michael D.; Rauscher, L A; Hoskins, Samuel; Lott, David G.; Richman, Jonathan; Lynch, F. E.

doi:10.1097/00003086-199811000-00022

Cited by 47 publications

(36 citation statements)

References 10 publications

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“…In order to prepare the different bone/bone cement interface specimens, the (20×10×2) dimension bone blocks were placed in the mold first, and then cement was poured on top of it. A set of weights equivalent to 80 kPa pressure (clinically applied range [16] ) were applied to the samples during the curing process. The pressure was initiated at exactly three minutes after the onset of mixing and was sustained throughout the curing period [17] .…”

Section: Methodsmentioning

confidence: 99%

Material Mismatch Effect on the Fracture of a Bone-Composite Cement Interface

Khandaker¹,

Tarantini²

2012

AMSA

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The interfacial mechanics at the bone-implant interface is a critical issue for implant fixation and the filling of bone defects created by tumors and/or their excision. Our previous study found that micron and nano sizes MgO particles improved the fracture toughness of bone-cement interfaces under tension loading. The strength of bonding of different types of bone with different types of implants may not be the same. The aims of this research were to determine the influences of material mismatch due to bone orientation and a magnesium oxide (MgO) filler material for PMMA bone cement on the mechanical strength between bone and bone cement specimens. This research studied the longitudinal and transverse directions bovine cortical bone as different bone materials and poly Methyl MethAcrylate (PMMA) bone cement with and without MgO additives as different implant materials. The scope of work for this study was: (1) to determine the bending strength and modulus of different bone and bone cement specimens, (2) to determine whether inclusion of MgO particles on PMMA has any influence on these mechanical properties of PMMA, and (3) to determine whether bone orientation and inclusion of MgO particles with PMMA has any influence on the interface strength between bone and PMMA. This study showed that bone orientation has statistically significant effect on the bonding strength between bone and bone cement specimens (P value<0.05). This study also found that while MgO additive decreased the bending strength and modulus of PMMA bone cement, but the inclusion of MgO additives with PMMA bone cement has no statistically significant effect on the bonding strength between bone and bone cement specimens (P value>0.05).

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Section: Methodsmentioning

confidence: 99%

Material Mismatch Effect on the Fracture of a Bone-Composite Cement Interface

Khandaker¹,

Tarantini²

2012

AMSA

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“…Soft tissues may increase the resistance to outflow of intramedullary contents, and stripping of these soft tissues may have falsely depressed the intramedullary pressures recorded while inserting instrumentation into the canal. Additionally, there was no recording of the insertion force or speed of the alignment rods; previous experiments have established these two parameters play a role in increasing femoral intramedullary pressure [14,19]. Despite these potential limitations, the maximum intramedullary pressures recorded during insertion of the alignment rod using conventional techniques in our experiment (630.04 ± 320.85 mm Hg proximally and 535.69 ± 261.77 mm Hg distally) were comparable to the values recorded by Ries et al [19] (649.3 ± 218.5 mm Hg) using a similar technique in vivo.…”

Section: Discussionmentioning

confidence: 99%

“…Previous experiments show oversizing the entry hole and using a fluted alignment rod had less increase in femoral intramedullary pressure than not oversizing the entry hole and using a rounded alignment rod [6,19]. Overdrilling, combined with changes in shape and size of the alignment rod, has not yielded consistent reduction in intramedullary pressure below a threshold that may induce embolic phenomena.…”

Section: Introductionmentioning

confidence: 95%

“…When embolism reaches clinically relevant levels, the most commonly observed symptoms are hypoxemia, shortness of breath, petechial rash, or an altered mental status [1,5,20]. If fat embolism becomes life-threatening, it is classified as fat embolism syndrome (FES) [1,4,5,11,19,20]. Although FES is rare and the true incidence and mortality rates are unclear [13,20], reported incidences of FES range from 0.1% to 1% of all TKAs, and mortality rates vary from 5% to 20% of diagnosed cases despite supportive care with anticoagulation therapy and ventilatory support [1,20].…”

Section: Introductionmentioning

confidence: 99%

“…Some researchers have explored the use of different shapes and sizes of TKA intramedullary instrumentation and different surgical steps to prevent elevating the femoral intramedullary pressure during surgery [6,14,19]. Previous experiments show oversizing the entry hole and using a fluted alignment rod had less increase in femoral intramedullary pressure than not oversizing the entry hole and using a rounded alignment rod [6,19].…”

Section: Introductionmentioning

confidence: 99%

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The Reamer/Irrigator/Aspirator Reduces Femoral Canal Pressure in Simulated TKA

Gorp

Falk

Kmiec

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Inserting the femoral intramedullary alignment rod during total knee arthroplasty (TKA) can generate high intramedullary pressure, which increases the risk of intraoperative complications caused by fat embolism. Despite modifications to the surgical procedure, the best method to prevent this increase in pressure remains unknown. The reamer/irrigator/aspirator is a surgical instrument designed for use during femoral canal entry to increase the canal size and remove intramedullary fat and may prevent this pressure increase. We posed two hypotheses: (1) using the reamer/ irrigator/aspirator system will result in lower maximum femoral intramedullary pressure than using only conventional instrumentation during the initial steps of a TKA; and (2) using the reamer/irrigator/aspirator system in the initial steps of TKA will result in a mean maximum intramedullary pressure less than 200 mm Hg. We simulated a TKA on 14 cadaveric femurs to compare the femoral intramedullary pressure using both methods. Considerable decreases in femoral intramedullary pressure of 86% proximally and 87% distally were obtained by using the reamer/irrigator/aspirator system. The mean maximum pressure using the reamer/irrigator/aspirator system was less than 200 mm Hg. Additional clinical studies are needed to confirm any reduction in complications using the reamer/irrigator/aspirator system.

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