Cemented Versus Noncemented Total Hip Arthroplasty—Embolism, Hemodynamics, and Intrapulmonary Shunting

Ereth, Mark H.; Weber, J.; Abel, Martin; Lennon, Robert L.; Lewallen, David G.; Ilstrup, Duane M.; Rehder, Kai

doi:10.1016/s0025-6196(12)61121-5

Cited by 188 publications

(104 citation statements)

References 35 publications

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“…The second mechanism may be chemically (cement monomer) induced pulmonary vasoconstriction. 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%

“…Cardiovascular deterioration during FE includes hypotension, hypoxemia, arrhythmia, cardiac arrest and sudden death. Fat embolism is observed intraoperatively during cemented and cementless hip and knee arthroplasty (Herndon et al 1974, Fahmy et al 1990, Ereth et al 1992, Parmet et al 1993, Christie et al 1994, Morawa et al 1996, during intramedullary nailing of fractured long bones (Talucci et al 1983, Pell et al 1993) and also during vertebroplasty (VP) (Aebli et al 2002, Chen et al 2002. Intraoperative cardiac arrest during hip arthroplasty has been noted in 0.6-10% of patients and intraoperative deaths have been reported in 0.02-0.5% (Coventry et al 1974, Duncan 1989, Patterson et al 1991, Hofmann et al 1999, Parvizi et al 1999.…”

mentioning

confidence: 99%

“…Cardiac arrest appears to be more common during hemiarthroplasties for femoral neck fractures than during total hip arthroplasty (Christie et al 1994). Furthermore, cementless prostheses have been reported to cause less severe hypotension and fewer cardiac arrests than cemented ones (Ereth et al 1992).…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

et al. 2005

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“…However, a growing body of evidence supports the use of cementless femoral components with many studies having long-term outcomes equal to those using contemporary cemented fixation [8,[23][24][25]36]. Moreover, some authors suggest cementless implants benefit patients in terms of reduced operative time and reduced likelihood of fat embolism or venous thromboembolic disease [9,11,16,30].…”

Section: Introductionmentioning

confidence: 99%

Cementless Femoral Prostheses Cost More to Implant than Cemented Femoral Prostheses

Unnanuntana

Dimitroulias

Bolognesi

et al. 2008

Clin Orthop Relat Res

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Prosthetic cost contributes greatly to the overall expense of THA. A key question, therefore, in the selection of implant technique is whether any price difference exists between a cementless and a cemented femoral prosthesis. We evaluated the price difference between the most commonly used cemented and cementless femoral stems at three high-volume academic medical centers. Each hospital's costs for prostheses from the manufacturers were recorded. The average cost of implanting a cementless femoral prosthesis was $296 more than the average cost of implanting a cemented femoral stem, even with the additional expense of two batches of bone cement and the accessories commonly used to achieve a third-generation cementing technique. The price difference was less variable if the cost of the prostheses from only the primary implant supplier for each institution was considered. As the number of THAs performed per year continues to escalate, implantation of a cemented femoral component remains an attractive method of fixation from an economic standpoint.

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“…Transoesophageal echocardiography (TEE) has demonstrated that these changes are associated with visualisation of echogenic material in the right ventricle (RV). [3][4][5][6][7] Although nearly all patients demonstrate echogenic material during CA, most patients tolerate the embolic load and compensate for the increased RV afterload. However, descriptions of profound hypotension leading to cardiac arrest and sudden death continue to be reported.8, 9 Clinical reports of this rare event have not clearly delineated the relationship between RV opacification on TEE and acute pulmonary hypertension with decreased cardiac output.…”

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confidence: 99%

Relationship of fat embolism to haemodynamic and echocardiographic changes during cemented arthroplasty

et al. 1997

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Pressudsation of the medullary cavity during cemented arthroplasty causes "intravasation" of marrow fat, The purpose of this study was to examine the relationship between the amount of pulmonary intravascular fat and the haemodynamic and echocarcliog~ohic changes. Methods: ~sed mongrel dogs (n= 16) undenwent bilateral cemented arthroplasty (BCA) to create a large embolic load, Haemodynamic measurements included blood pressure (BP), pulmonary artery pressure (PAP), right atrial pressure and cardiac output as well as t~soesophageal echocardiographic (TEE) assessment of right ventricular (RV) and lelt ventricular (LV) areas, Using quantitative morphometry on postmortem lung spedmens, the proportion of lung tissue ocduded by fat was measured. Re~ts: Mean BP decreased within one minute of BC_..A coindding with the appearance of echogenic material in the RV. The RV area increased by 56% (P < 0.05) and LV area decreased by 34% (P < 0.05) while PAP increased from 15 -+ 3 mmHg to 39 + I 0 mmHg within one minute (P < 0.001). The PAP remained elevated throughout the study 00 min). Stroke volume decreased in 14/15 dogs, yet cardiac output was maintained by increased heart rate. There was a curvilinear relationship (r=0.87) between the maximum increase in PAP and the proportion of lung occupied by fat. Conclusion: In this model, stroke volume decreased within one minute of BCA when fat embolism accompanied prosthesis insertion. The TEE detected an increased RV area and reduced LV area associated with decreased stroke volume. The maintenance of cardiac output after intraoperative fat embolism depends primarily on the ability to increase heart rate.Objectis La pressurisation de la cavit6 n~ullalre pendant I'arthroplastie dmentC~ provoque F.intravasation. de ia graisse rn~lullaire clans la drculation. Cette Etude visait A examiner ia relation entre ia quantit6 de graisse intravasculalre interceptL~ au poumon et ses cons~uences hEmodynamiques et &hocardiographiques. M~h~ll~ : Des chiens de race commune anest~iEs ont subi (n= 16) une arthroptastie dment~ae bilatErale (ACB) dans le but provoquer une forte d~ha~ embolique. Les mesures h~modynamiques comprenaient la tension art~rielle (TA), la pression artErielle pulrnonalre (PAP), la mesure par I'&hographie transoesophagienne (E~I'O) des surfaces du ventdcule droit (VD) et du ventricule gauche (VG), La morphornEtrie qua~-~Gtatlve rEalisC~e sur des Sl:~ci-mens de pournons isotEs a permis de mesurer la proportion du tissu pulmonaire obstnJE par la gralsse. ]L~1~1~11~113 : La TA moyenne a diminu~ en moins cl'une minute de rACB, ce qui cO'ncidait avec I'apparition de materiel Echc~ne dans le VD. La surface clu VD a augment~ de 56% (P < 0,05) et celle du VD a diminu~ de 34% (P < 0,05) alors que la PAP augrnentait de 15 -+ 3 mmHg ~ 39 -10 mmHg en moins d'une minute (P < 0,00 I), La PAP demeurait ~levc~e pendant toute I'Etude 00 min). Le volume d'Ejection diminuait chez 14 des 15 chiens rnais I'augmentation de la fr~luence assurait le maintien du debit cardiaque. La relation entre I'augme...

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Cemented Versus Noncemented Total Hip Arthroplasty—Embolism, Hemodynamics, and Intrapulmonary Shunting

Cited by 188 publications

References 35 publications

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

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

Cementless Femoral Prostheses Cost More to Implant than Cemented Femoral Prostheses

Relationship of fat embolism to haemodynamic and echocardiographic changes during cemented arthroplasty

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