- in some cases, application of pressurized cement is associated w/ an embolization phenomena (either cement elements or fat) which may
result in hypoxia, cardiac arrest, or death;
- risk factors include older age and a patent foramen ovale (paradoxical embolization);
- use of pulsatile lavage may help to prevent this embolization phenomena, by removing fat and marrow from the canal;
- in older co-morbid patients, consider avoiding pressurization of the cement within the canal, since the risk of acute embolization may be higher than late loosening;
- removal of debris from femur:
- may begin cement mixing while preparing bone bed for cement;
- loose cancellous bone debris, blood, and tissue are removed w/ water pick & brush are helpful, & routine mechanical drying of both acetabular &
femoral surfaces is important (continue water pick until returning fluid is clear);
- apply dilute solution of Epi w/ moist sponge (prevents blood interposition)
- Medullary lavage reduces embolic phenomena and cardiopulmonary changes during cemented hemiarthroplasty.
- An in vitro study of femoral intramedullary pressures during hip replacement using modern cement technique.
- High-volume, high-pressure pulsatile lavage during cemented arthroplasty.
- optimize hemodynamics:
- some surgeons will infuse one unit of autologous pRBC at this point to optimize preload and Hct;
- consider increasing FiO2 during the cement application
- Cement Venogram—A Risk of Satisfactory Cement Pressurization.
- Ten-year follow-up study of total hip replacement.
- Is there a difference in perioperative mortality between cemented and uncemented implants in hip fracture surgery?
- Periprosthetic fractures around hip hemiarthroplasty performed for hip fracture.
- Reduction of severe cardiac complications during implantation of cemented total hip endoprostheses in femoral neck fractures
- TEE and clinical features of fat embolism during cemented THA. A randomized study in patients with a femoral neck fracture.
- Prophylaxis against fat and bone-marrow embolism during THA reduces the incidence of postoperative DVT: a controlled, RCT.
- Cardiac output during hemiarthroplasty of the hip. A prospective, controlled trial of cemented and uncemented prostheses.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Clifford R. Wheeless, III, MD on Sunday, February 24, 2013 7:48 am