Prophylaxis of Fat and Bone Marrow Embolism in Cemented Total Hip Arthroplasty

Pitto, Rocco P.; Koessler, Matthias; Draenert, K.

doi:10.1097/00003086-199810000-00004

Cited by 64 publications

(35 citation statements)

References 19 publications

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“…This suggests that detection of events of grade 2 or higher by echocardiography is cause for concern. The association between severe embolic events (grade 2 or 3) and changes in hemodynamic and cardiorespiratory indicators observed in the present study is consistent with the findings of previous studies (8,10,23,27,28). Pitto et al (8) used transesophageal echocardiography to study patients with osteoarthrosis of the hip who underwent THA.…”

Section: Discussionsupporting

confidence: 92%

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Effectiveness of the ROBODOC System during Total Hip Arthroplasty in Preventing Intraoperative Pulmonary Embolism

Hagio

Sugano

Takashina

et al. 2002

Medical Image Computing and Computer-Assisted Intervention — MICCAI 2002

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Abstract. Intraoperative pulmonary embolism can occur not only during cemented total hip arthroplasty (THA) but also during cementless THA. In the present study, we demonstrated the usefulness of the ROBODOC femoral milling system in reducing intraoperative pulmonary embolism, as indicated by results of transesophageal echocardiography and hemodynamic monitoring. A prospective clinical trial was conducted with 58 patients (60 hips) who were randomly divided into 2 groups: group 1, 38 patients (40 hips) who underwent cementless THA with preparation of the femoral canal using ROBODOC; group 2, 20 patients (20 hips) who underwent conventional manual cementless THA surgery. During femoral preparation, severe embolic events were observed at a significantly lower frequency in group 1 (0%) than in group 2 (30%) (p<0.0001). During stem insertion, incidence of severe embolic events was significantly lower in group 1 (0%) than in group 2 (20%) (p<0.0001). Moreover, during hip relocation, incidence of severe embolic events was significantly lower in group 1 (8%) than in group 2 (45%) (p<0.0001). The ROBODOC system decreased the incidence of severe embolic events during femoral preparation, resulting in low incidence of severe events during stem insertion and hip relocation. The present results suggest that the ROBODOC femoral milling system may reduce the risk of pulmonary embolism during cementless THA.

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Section: Discussionsupporting

confidence: 92%

“…Evaluation of embolic events using transesophageal echocardiography allows detection of passage of fat or bone marrow through the heart, which has been reported in a number of cases of orthopedic surgery (8,10,(22)(23)(24)(25)(26)(27). However, it is difficult to directly and clearly define the essential nature of echogenic particles.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of the ROBODOC System during Total Hip Arthroplasty in Preventing Intraoperative Pulmonary Embolism

Hagio

Sugano

Takashina

et al. 2002

Medical Image Computing and Computer-Assisted Intervention — MICCAI 2002

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“…The existence of these two mechanisms would explain why FE occurs during both cemented and cementless arthroplasty, but is less severe during cementless arthroplasty (Ereth et al 1992). This is why medullary lavage and venting (with or without applied vacuum) during cemented hip arthroplasty can reduce but not eliminate FE (Wheelwright et al 1993, Pitto et al 1998.…”

Section: Discussionmentioning

confidence: 99%

Polymethylmethacrylate causes prolonged pulmo-nary hypertension during fat embolism: A study in sheep

et al. 2005

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Background Fat embolism (FE), the release of bone marrow contents into the circulation and the subsequent cardiovascular changes, is still a potentially fatal complication during orthopedic surgery. Different causative factors have been suggested, but the exact pathomechanism of FE still remains unclear. We investigated the role of polymethylmethacrylate (PMMA) in FE during vertebroplasty in sheep.Methods In 8 sheep, two vertebral bodies were augmented alternatively with PMMA or bone wax. Pulmonary and cardiovascular parameters were monitored during the procedure.Results The peak response was similar for both groups and characterized by hypotension, a drop in cardiac output and pulmonary hypertension. However, the recovery in pulmonary arterial pressure and pulmonary vascular resistance was quicker in the wax group.Interpretation The injection of PMMA may cause prolonged pulmonary hypertension during vertebroplasty and also arthroplasty. Surgeons should be aware of this potential cardiovascular complication, especially in patients with impaired pulmonary and cardiovascular function.

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“…Fat and bone marrow embolization may therefore occur (Breed 1974, Tronzo et al 1974, Orsini et al 1987, Wenda et al 1993, 1995, Pitto et al 1998, Breusch et al 2000b). Intraoperative fat embolism associated with cemented total hip arthroplasty is a well-known complication, but it remains unclear from the current literature whether the cement viscosity also effects the amount of fat and bone marrow intravasation.…”

Section: Abstract -In a Sh Eep M Od El P Erm Ittin G Stan Dardimentioning

confidence: 99%

Influence of cement viscosity on cement interdigitation and venous fat content under in vivo conditions

Breusch¹,

Heisel²,

Müller³

et al. 2002

Acta Orthopaedica Scandinavica

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Prophylaxis of Fat and Bone Marrow Embolism in Cemented Total Hip Arthroplasty

Cited by 64 publications

References 19 publications

Effectiveness of the ROBODOC System during Total Hip Arthroplasty in Preventing Intraoperative Pulmonary Embolism

Effectiveness of the ROBODOC System during Total Hip Arthroplasty in Preventing Intraoperative Pulmonary Embolism

Polymethylmethacrylate causes prolonged pulmo-nary hypertension during fat embolism: A study in sheep

Influence of cement viscosity on cement interdigitation and venous fat content under in vivo conditions

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