Pathogenesis of circulatory reactions triggered by nervous reflexes during the implantation of bone cements

Abstract

Circulatory and respiratory reactions during the implantation of joint endoprostheses have been observed for years. The components of the bone cements used for anchoring (methyl methacrylate monomer) or the outpour of bone marrow substances from the affected bone marrow cavity are thought to be chiefly responsible for these effects. However, our previous investigations demonstrated unambiguously that reactions of this type can be attributed to direct nervous-reflex mechanisms triggered by the pressure rise in the medullary canal, and that, in addition, bone marrow embolism plays a part in serious circulatory incidents. The investigations on which the present paper is based have confirmed the mechanism of circulatory reactions triggered by direct nervous reflex and have shown once again that the release of cement monomers is not of any significance, at least not in animal experiments. In regard of the characteristics of these reflex processes, it has been possible to show by both surgical and pharmacologic interventions in the vegetative nervous system, performed before and during pressure experiments, that these reflex processes are caused not so much by an increase of the vagus tone as by a central inhibition of the sympathicus. Neither administrations of atropine nor bilateral cervical vagotomy are able to prevent the reactions. This was only possible under the influence of a ganglion blocker.

Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients

“…There are many reports pointing out the adverse effect of PMMA on the cardiovascular and/or respiratory system in total hip arthroplasty [23][24][25][26][27], while Kaufmann et al demonstrated no association between PMMA injection and systemic cardiovascular derangement in PVP [28]. Actually, we did not notice any significant change in blood pressure, heart rate or blood oxygen saturation during and after PVP.…”

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

“…Other explanations have included a nerve reflex triggered by the increase in pressure within the bone marrow cavity during manipulations (i.e. reaming, cement injection or implant insertion), similar to the carotid sinus reflex (Rudigier and Ritter 1983). Furthermore, cardiovascular changes during FE may be a result of vasoactive mediators from the bone marrow cavity gaining access to the circulation (Byrick et al 1991, Wheelwright et al 1993).…”

“…In the past, different animal models have been used to investigate FE (Breed 1974, Rudigier and Ritter 1983, Orsini et al 1987, Wheelwright et al 1993, Schemitsch et al 1998. Recently, an animal model of vertebroplasty has been developed to investigate FE (Aebli et al 2002).…”

Unipedicular Vertebroplasty for Osteoporotic Compression Fracture Using an Individualized Needle Insertion Angle

“…The earliest indication for PVP was spinal hemangioma. Recently, however, the technique has been applied to other spinal tumors 3,4 and to painful osteoporotic compression fractures. 5,6 These fractures may be osteoporotic or malignant and may cause significant morbidity, as patients have limited mobility or may be bedridden.…”