MEDULLARY LAVAGE REDUCES EMBOLIC PHENOMENA AND CARDIOPULMONARY CHANGES DURING CEMENTED HEMIARTHROPLASTY

We randomised 24 patients before they had a cemented hemiarthroplasty for hip fracture to receive either thorough or minimal saline lavage o f the femoral canal, We then determined the effect in each group on th e thromboembolic and cardiopulmonary responses to the pressurised inse rtion of cement, using transoesophageal echocardiography to show the e chogenic embolic response. We found a statistically significant reduct ion in both the duration of the response and the number of large embol i in patients who had had thorough lavage as compared with the control group with minimal lavage. There was also less disturbance of pulmona ry function, as assessed by the change in end-tidal CO2 levels and oxy gen saturation, in patients who had had thorough lavage, Three patient s had a significant fall in blood pressure during cement insertion; al l had only minimal lavage. We consider that thorough lavage should be an essential part of the preparation of the proximal femur before ceme nt insertion.