Intraoperative transesophageal two-dimensional echocardiography in total hip replacement

Abstract

A number of studies in medical literature suggest that during implantation of hip prostheses pulmonary embolism of medullary contents and of air may occur. Proof of this suggestion was based on histological examination of lung tissue in animal experiments as well as on post mortem examinations of human tissue. In vivo evidence of this suspected embolism has been lacking so far, since an appropriate technique has not been available. Using transesophageal two-dimensional echocardiography, continuous imaging of the right atrium and the right ventricle can be performed in order to prove this suspected embolization in vivo. Thus, in a prospective randomized study of 26 patients undergoing hip surgery, the right atrium and right ventricle were continuously imaged. Simultaneously, the end-expiratory CO2 partial pressure was recorded. The medical literature suggests that a venting hole in the shaft of the femur prevents the rise in pressure in the medullary space and thus also averts embolism. Therefore, prior to the implantation of the shaft prosthesis, and in order to vent the medullary space, in 13 patients a 4.5-mm lateral borehole was drilled into the femoral shaft, located two finger breadths distal to the point were the end of the prosthesis would be positioned. In 12 of 13 patients in the control group without boreholes, transesophageal two-dimensional echocardiography revealed that air bubbles formed during the implantation of the shaft. In the group with boreholes, however, presence of air could be demonstrated in only four patients (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Consequences and Prevention of Inadvertent Internal Fixation of Primary Osseous Sarcomas

“…In certain circumstances, with the collaborative effort of a skilled musculoskeletal pathologist and an orthopaedic oncologist, a definitive diagnosis can be rendered through frozen-section analysis, allowing for definitive treatment at the time of biopsy. Finally, canal reamings are not appropriate biopsy material because the act of reaming may damage the cellular elements, complicating pathologic diagnosis, and may result in intramedullary and systemic tumor dissemination, particularly to the lungs through embolic phenomena [7,15,25,27]. Therefore, six patients in our series (four of whom did not have metastasis at referral) potentially were exposed to malignant emboli through intramedullary reaming at the index procedure.…”

Verminderung von schweren kardialen Komplikationen w�hrend der Implantation von zementierten H�fttotalendoprothesen bei Oberschenkelhalsfrakturen

“…Die Genese dieser Komplikationen ist als multifaktoriell beschrieben und reicht von der Luftembolie [2,3,4,8,9] über die Fett-und Knochenmarksembolie [14,15,17,21,22] durch den Druckanstieg im Femurkanal bei Einbringen des Prothesenschafts [18,31,39] bis zur Freisetzung von Mediatoren, insbesondere von Histamin durch Methylmethacrylat (Palacos) [20,26,38,41].…”

Einfluss des Prothesendesigns auf die intramedull�re Druckentwicklung bei der Femurschaftimplantation von zementierten H�ftendoprothesen

“…Verschiedene Verbesserungen sind das distale Entlüftungsloch [12] bei der Implantation von Femurschaftprothesen wie auch mittlerweile häufig verwendete Markraumsperrer oder ver- Trotz Teilzementierung kann der Prothesenschaft Option 3000 sofort und voll belastet werden, was gerade für den Einsatz bei geriatrischen Patienten sehr wichtig ist. Biomechanische Untersuchungen haben keine Unterschiede in der initialen Festigkeit zwischen vollzementierten Schäften und diesem teilzementierten Schaft ergeben [1].…”