Echocardiography of transatrial embolism during cemented and uncemented hemiarthroplasty of the hip

Abstract

We performed transoesophageal echocardiography on 20 patients with femoral neck fractures randomly treated with an uncemented Austin-Moore or cemented Hastings hemiarthroplasty. Cemented arthroplasty caused greater and more prolonged embolic cascades than did uncemented arthroplasty. Some emboli were more than 3 cm in length. In some patients the cascades were associated with pulmonary hypertension, diminished oxygen tension and saturation, and the presence of fat and marrow in aspirates from the right atrium.

Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures

“…Thirty-six surgeons performed a median of five operations each (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Patients underwent a bipolar The cemented stem is a straight, collared stem made of a cobalt-chromium alloy.…”

“…An arthroplasty using a cemented implant may be associated with increased mortality compared with an arthroplasty using an uncemented implant [8,24,31,32]. The mechanisms involved are not fully understood but involve cardiorespiratory disturbances caused by venous and pulmonary embolization of bone marrow contents and methylmethacrylate particles [5,6,8,11,32,36,39]. An uncemented implant may be associated with design-specific complications such as stress shielding, thigh pain, and a higher risk of periprosthetic fracture [1,23].…”

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

“…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.…”

“…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. 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).…”

Tribology of Hemiarthroplasty

“…The hemiarthroplasties have been reported as: cemented prostheses provided better stability and lower dislocation rate compared to uncemented prostheses (Kenzora et a/., 1998;Khan et aI., 2002;Foster et aI. , 2005;Parker et a/., 2010) , but the higher risk of hypotension and fat embolism was associated with the cemented hemiarthroplasty (Christie et al, 1994;Ozturkmen et al, 2008) . It has been reported that the average operating room times and blood loss volumes were 95 minutes and 467 mL for the cemented HA, and respectively , 80 minutes and 338 mL for the uncemented HA cohorts , but the postoperative mortality rates , overall complications, and pain were similar (Ahn et aI.…”