The Clinical Relevance of Embolic Events Detected by Transesophageal Echocardiography During Cemented Total Hip Arthroplasty: A Randomized Clinical Trial

Abstract

Use of conventional cementing techniques is associated with echocardiographic evidence of embolism in 93% of patients and with a significant increase in pulmonary shunting. The incidence of embolism and change in shunting are reduced with a modified cementing technique that limits increases in intramedullary pressure.

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

“…Previous in vivo studies suggest there are no negative effects of removing the fat and bone marrow in the femoral intramedullary canal [2,12,18]. Also, removal of healthy cortical bone through reaming into a narrow femoral intramedullary canal could have some consequences; these biomechanical effects of removing healthy cortical bone cannot be ignored.…”

Non-Thrombotic Pulmonary Embolism

“…Embolic showers of circulating fat globules have been demonstrated in up to 41% of patients following surgical nailing of long bone fractures (Talbot & Schemitsch, 2006). However, only a small percentage of these patients develop FES (406th Medical General Laboratory, Professional Section, 1951;Deland, 1956;Gossling & Pellegrini, 1982;Gurd & Wilson, 1974;Koessler et al, 2001;Levy, 1990;Lozman et al, 1986;Palmovic & McCarroll, 1965;Peltier, 1969;Shier & Wilson, 1980;Talbot & Schemitsch, 2006). The incidence of posttraumatic FES can range from 0.25% (Peltier, 1969) to 35% (Gurd & Wilson, 1974;Lindeque et al, 1987;Riska & Myllynen, 1982).…”

Fat embolism and postoperative coagulopathy

“…3 La signification clinique de ces incidents emboliques demeure controversée. En effet, quels facteurs déterminent si un patient va subir les conséquences, significatives au plan clinique, de "l'intravasation" de produits de la moelle survenue pendant une intervention orthopédique?…”

“…7 Cela a été vérifié dans des études cliniques qui ont modifié la technique chirurgicale. 3 Le ciment de méthyle méthacrylate agit principalement comme un produit d'étanchéité de la cavité médullaire, ce qui entraîne de fortes pressions dans le canal médullaire pendant l'insertion de la composante fémorale, poussant le contenu médullaire vers le système veineux. Les résultats d'autopsie confirment souvent la présence de graisse intravasculaire, de thrombine et de cellules médullaires dans les poumons des patients qui décèdent immédiatement après l'arthroplastie cimentée.…”

“…7 This has been verified in clinical studies that modified the surgical technique. 3 The primary role of methylmethacrylate cement appears to be as a sealant of the medullary cavity, which results in high medullary canal pressures during insertion of the femoral component, forcing marrow contents into the venous system. Autopsy findings often confirm the presence of intravascular fat, thrombin and cellular marrow products in the lungs of patients who die immediately after cemented arthroplasty.…”