Intraoperative Cerebral Arterial Embolization during Total Hip Arthroplasty

Edmonds, Chris; Barbut, Denise; Hager, David N.; Sharrock, Nigel E.

doi:10.1097/00000542-200008000-00006

Cited by 79 publications

(54 citation statements)

References 18 publications

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“…Among the adult studies, the number of patients in each study ranged from 5 to 45. Two of the articles 5,17 did not conform to the consensus criteria for detection of microemboli. 9 Despite the use of automatic HITS counting, 13…”

Section: Resultsmentioning

confidence: 99%

Review of Transcranial Doppler Ultrasound to Detect Microemboli during Orthopedic Surgery

Silbert

Evered

Scott

et al. 2013

AJNR Am J Neuroradiol

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SUMMARY:Transcranial Doppler ultrasonography has been used to detect microemboli in the middle cerebral artery during orthopedic surgery. We conducted a comprehensive systematic literature review of transcranial Doppler ultrasonography in orthopedic surgery to evaluate its status in this setting. Fourteen studies were selected for qualitative analysis. The highest number of patients studied was 45; emboli were detected in all studies, occurring in 20%-100% of patients. Most embolic counts were below 10, but some high counts were noted. No study reported all the technical parameters of the transcranial Doppler ultrasonography. All studies assessed neurologic status, and 6 studies evaluated cognitive function postoperatively. No study identified an association between postoperative cognitive function and embolic count. Six studies sought the presence of right-to-left shunts. ABBREVIATIONS:HITS ϭ high-intensity transient signals; PFO ϭ patent foramen ovale; TCD ϭ transcranial Doppler ultrasonography; TEE ϭ transesophageal

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Section: Resultsmentioning

confidence: 99%

Review of Transcranial Doppler Ultrasound to Detect Microemboli during Orthopedic Surgery

Silbert

Evered

Scott

et al. 2013

AJNR Am J Neuroradiol

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“…Cerebral microembolization does occur in a substantial proportion of patients undergoing THA [29,59]. Studies have attempted to analyze NP outcome, but often the tests used have been unvalidated and perhaps insensitive to the subtle changes in cognitive function that occur.…”

Section: Discussionmentioning

confidence: 99%

“…A couple studies [29,68] reported the incidence of intraoperative cerebral microembolization (of fat and other particulate matter) during total joint arthroplasty as between 40% and 60%, but neither of these studies investigated the effect of microemboli on cerebral function postoperatively. The ultimate fate of these microemboli and their effect is unknown.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Microembolization during Primary Total Hip Arthroplasty and Neuropsychologic Outcome: A Pilot Study

Patel

Stygall

Harrington

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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BackgroundIntraoperative cerebral microembolization occurs in a substantial proportion of patients undergoing THA. Historically, postoperative cognitive dysfunction has been attributed to different factors, including anesthesia, but the influence of the surgery has not been thoroughly examined. Questions/purposes We conducted a prospective, controlled clinical trial to assess intraoperative cerebral microembolization during THA and neuropsychologic outcome. Methods The presence of a patent foramen ovale (PFO) also was investigated, using transcranial Doppler, to determine whether this affected cerebral microembolic incidence and load and whether microemboli occurred as a result of specific surgical activity. Forty-five patients were recruited who underwent THA and neuropsychologic assessment; a battery of tests was administered preoperatively and at 6 weeks and 6 months postoperatively. Results Overall, patients showed improvement in total neuropsychologic change scores at both postoperative intervals. The incidence of cerebral microembolization for THA was 23%. The prevalence of PFO was 37%. PFO did not appear to influence microemboli load or incidence. More microemboli were seen during femoral component insertion and impaction. Conclusions Intraoperative cerebral microembolization occurs in a substantial proportion of patients during THA recorded by transcranial Doppler. The microemboli load is low and is not influenced by the presence of PFO. Certain surgical activities seem responsible for greater cerebral microemboli generation. However, neuropsychologic outcome was not affected postoperatively by microemboli or other operative or patient variables.

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“…The operation technique in both types of hip arthroplasty was similar. The elevated serum S100B protein levels may be a result of the S100B protein release from bone marrow as well as of the transfer of cellular materials from the site of the surgery with the bloodstream into the brain (Edmonds, Barbut, Hager, & Sharrock, 2000;Ozelsel et al, 1998;Sukernik, et al, 2001). Because all patients with intraoperative mean blood pressure dropping below 50 mmHg were excluded from the study, it ruled out hypotension as a possible cause of the elevation of the S100B concentration.…”

Section: S100b Protein In Orthopedic Patientsmentioning

confidence: 99%

Postoperative Cognitive Dysfunction (POCD) and Markers of Brain Damage After Big Joints Arthroplasty

Tomaszewski¹

2012

Recent Advances in Arthroplasty

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Intraoperative Cerebral Arterial Embolization during Total Hip Arthroplasty

Abstract: Cerebral microemboli can occur during total hip arthroplasty. Whether this contributes to changes in postoperative cognitive function is unknown.

Cited by 79 publications

References 18 publications

Review of Transcranial Doppler Ultrasound to Detect Microemboli during Orthopedic Surgery

Review of Transcranial Doppler Ultrasound to Detect Microemboli during Orthopedic Surgery

Cerebral Microembolization during Primary Total Hip Arthroplasty and Neuropsychologic Outcome: A Pilot Study

Postoperative Cognitive Dysfunction (POCD) and Markers of Brain Damage After Big Joints Arthroplasty

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