MODIFIED SURGICAL TECHNIQUE TO REDUCE BON E-MARROW RELEASE IN UNCEMENTED ENDOPROSTHETIC SURGERY OF THE HIP

Since 1970 the fat embolism syndrome (FES) has been recognised as a se vere complication of cemented total hip arthroplasty (THA). Initially and still today the toxicity of bone cement has been thought to be res ponsible for the cardiorespiratory problems, Meanwhile several reports have confirmed the causal relationship between intramedullary pressur e (IMP), bone-marrow release into the circulation and subsequent cardi orespiratory deterioration during cemented THA. In recent publications it has been reported that bone-marrow release due to increased IMP al so occurs during cementless THA. The clinical implication of these obs ervations is controversial. For this reason in the first part of this paper two autopsy-proven FES deaths and five further clinically manife st FES cases are presented. In the second part of the study, IMP cours es during four different surgical techniques (2 conventional, 2 modifi ed) are compared. The aim of the modified surgical technique developed in our department was to minimize IMP peaks and bone-marrow release d uring cementless THA. Both modified techniques showed significantly lo wer IMPs during opening of the medullary canal, preparation with rasps , and implantation of the prosthesis than the conventional techniques. The observed FES cases for the first time strongly confirm the clinic al relevance of the FES, also during cementless THA. On the basis of t he data presented we recommend the modified surgical technique to redu ce bone-marrow release during cementless THA.