PROPHYLAXIS OF FAT AND BONE-MARROW EMBOLISM IN CEMENTED TOTAL HIP-ARTHROPLASTY

The efficiency of a new cementing technique developed to prevent the r isk of intraoperative pulmonary embolism was assessed, Seventy patient s with coxarthrosis entered into a prospective, randomized clinical tr ial. In the control group of 35 cases the total hip replacement was ce mented conventionally. In the second group a proximal drainage placed along the Linea aspera, and a distal drainage placed in the diaphysis, created a vacuum in the medullar cavity of the femur during the inser tion of the stem. The operation was performed with the patient under b lood gas analysis and hemodynamic and transesophageal echocardiography monitoring. Severe transatrial embolic events were observed during th e insertion of the femoral component in 94% of the cases of the contro l group and in 14% of the cases of the vacuum group; the difference is statistically significant. a significant decrease of arterial partial pressure of O-2 (-40.8 mm Hg) and increase of the pulmonary shunt val ues (+28.3%) occurred 5 minutes after the observation of embolic event s in the cases operated on conventionally, but these parameters showed minimal changes in the vacuum group. The rise of intramedullary press ure in the femur is the most decisive pathogenic factor of pulmonary e mbolism during total hip arthroplasty, The logical prophylactic measur e to prevent intravasation of fat and bone marrow is to create suffici ent drainage. The cohorted investigation showed the value of the vacuu m cementing technique for a substantial reduction of intraoperative em bolism and pulmonary impairment.