SEGMENTAL WALL-MOTION ABNORMALITIES IN PATIENTS UNDERGOING TOTAL HIP-REPLACEMENT - CORRELATIONS WITH INTRAOPERATIVE EVENTS

We examined the effect of methylmethacrylate cement on venous emboliza tion and cardiac function in 20 patients having total hip arthroplasty under general anesthesia. Segmental wall motion abnormalities and int racardiac targets (presumably emboli) were investigated by making vide otaped recordings of the transgastric short axis and longitudinal 4-ch amber views of the heart with transesophageal echocardiography at diff erent points during surgery. The incidence of segmental wall motion ab normalities was the most frequent during insertion of cemented femoral prostheses (8 of 14 patients had wall motion abnormalities). This was significantly different from baseline measurements taken at the begin ning of surgery (P < 0.05). In addition, there were also significantly more segmental wall motion abnormalities in patients having a cemente d femoral component compared to those having an uncemented femoral pro sthesis (P < 0.05). The incidence of wall motion abnormalities during acetabular and femoral reaming and during wound closure was not signif icantly different from baseline. Intracardiac targets (emboli) were se en in all 20 patients during surgery. The largest number of emboli occ urred during reaming of the femur and during insertion of the femoral prosthesis. Significantly more emboli were seen with cemented componen ts (P < 0.02). Most emboli were small (< 2 mm) and appeared similar to the microbubbles produced by agitating saline with a small amount of air. Six patients also had larger (> 5 mm) emboli that appeared to be solid material. One patent foramen ovale was detected (5% incidence). There were no adverse cardiac or neurologic events, and heart rate and arterial blood pressure remained within normal limits throughout surg ery. This study shows that the use of methylmethacrylate cement in tot al hip arthroplasty appears to be associated with an increased amount of intraoperative pulmonary embolism and segmental or global wall moti on abnormalities. The reversibility of the wall motion abnormalities w e observed implies a process which is self-limited And does not produc e adverse effects in most patients.