Low-Friction Arthroplasty

To the Editor.— In a recent article on low-friction arthroplasty (218:705-710, 1971), Eftekhar reported that he has "encountered no operative death in the 24 hours after surgery" and, that the use of the methyl methacrylate monomer "does not require any precautionary measure during anesthesia." We are aware of 12 cases of intraoperative cardiac arrest, six of them leading to death, after placement of the self-curing bone cement into patients.1-8The cause of death is not clear, but autopsies have shown fat3-8and air4emboli in the lungs. The embolization of fat seems likely to be related to the high pressures created in the medullary canal by forcing cement into the femur and the high temperature developed while it hardens, particularly if no vent is provided for the blood, marrow, and air to escape. The frequently observed fall in blood pressure,9,10sometimes of large magnitude, may