Revision total hip arthroplasty is consistently associated with intracardiac embolization of bone marrow debris, which can cause acute right ventricular dysfunction and increased pulmonary artery pressures.
May warrant TEE vigilance during femoral arthroplasty; leaves open whether embolization alters management or outcomes in larger studies.
Total hip arthroplasty (THA) is associated with pulmonary embolization of cement-bone marrow debris leading to cardiopulmonary complications including cardiac arrest. These complications are more prevalent during revision THA. This report assessed right ventricular function using a right ventricular ejection fraction pulmonary artery catheter (RVEF) and transesophageal echocardiography (TEE) in 18 patients undergoing revision THA. During femoral prosthesis insertion, all patients exhibited hemodynamic changes, but most of these were small and clinically insignificant. Four patients demonstrated a decrease in RVEF >or=to 10% and an increase in mean pulmonary artery pressure >or=to 10 mm Hg, requiring physician intervention. Two of these patients exhibited signs of pulmonary embolization postoperatively. All patients studied by TEE had detectable intracardiac emboli during femoral arthroplasty. The acute decreases in RVEF and increases in mean pulmonary artery pressures during hip arthroplasty, suggest a role for the embolization of bone marrow debris in the development of the "bone cement implantation syndrome." (Anesth Analg 1996;82:1225-9)
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Gordon et al. (1996) studied this question.
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