Pharmacokinetics of methylmethacrylate monomer during total hip replacement in man

Abstract

The concentration of methylmethacrylate monomer (MMA) in the blood stream after implantation of the components of 15 total hip prostheses using bone cement was determined in the pulmonary artery, the radial artery, and the superior vena cava after cement application, and correlated with the observed drop in blood pressure and the increase in the pulmonary arterial pressure. In all samples MMA was found. The values ranged from 0.02 micrograms/ml to 59 micrograms/ml. The mean maximum value after implantation of the stem was measured to be 7.8 micrograms/ml in the pulmonary artery, 4.6 micrograms/ml in the radial artery, and 1.75 micrograms/ml in the superior vena cava. After implantation of the cup the values were clearly lower. The simultaneously recorded blood pressure decreased slightly during the first 3 min and then returned to previous values. The pulmonary arterial mean pressure increased from 18 to 20 mmHg during the first 10 min. Although in some patients a drop in blood pressure started at the same time as MMA reached maximum values, high concentrations did not result in a greater effect on the circulatory parameters. Statistical analysis by the Spearman test revealed no correlation between MMA concentrations and the decrease in blood pressure or the increase in the pulmonary arterial pressure.

Toxic effects of methylmethacrylate monomer on leukocytes and endothelial cells in vitro

“…Cytotoxic damage ol' M M A to leukocytes and endothelial cells O~C U I T~~ in this study at concentrations found i n central venous hlood during reconstructive ,joint surgery in 25-100 percent of the patients in differenl studies (Svartling et al 1985, Svartling et al 1986. Wenda et al 1988, Dahl et al 1992a.…”

“…Doses 1 10 p g h L induced obvious changes in rnorphology as early as one minute after the addition of MMA to leukocytes and endothelial cells in vitro, which corresponds to the time taken to reach maximal blood MMA concentrations in central venous blood during cemented THR (Svartling et al 1985, Wenda et al 1988. Dahl et al 1992a.…”

“…Scveral patient studies have shown high blood Ievels of MMA (up to 120 pg/mL) in relation to hip and knee substitute surgery (Svartling 1986, Wenda 1988. It has to he noted that most M M A determinations reported up to now have been performed in the gas phase above plasmdhlood (Svartling et al 1985, Dahl et al 19921).…”

“…compared to non-cemented total joint replacements (Stamatakis et al 1977, Lynch et al 1988, Francis et al 1989, Hogevold et al 1990). Recently we have demonstrated that MMA in doses equivalent to blood concentrations found in patients during total hip replacement (THR) (Svartling et al 1985, Wenda et al 1988, Dahl et al 1992a) modulate blood coagulation triggering in different ways (Dahl et al 1992b).…”

Intra-Operative Fractures in Cementless Bipolar Hemiarthroplasty

“…4,5,[7][8][9][10][11][12][13] Elderly patients with impaired cardiopulmonary function and pulmonary hypertension are especially at risk of cardiopulmonary complications. 14,15 Intraoperative fracture is a potential major complication of cementless hemiarthroplasty. 16 This study reviewed the outcome in 24 patients who had an intra-operative fracture during cementless bipolar hemiarthroplasty.…”