The risk of fat embolism during cemented total hip replacement in the elderly patient

The increase in intramedullary pressure in the femur is the most decisive pathogenic factor for the development of embolic phenomena during total hip replacement. The aim of this study was to assess the risk of embolism and its clinical relevance during surgery by means of transesophageal echocardiography, hemodynamic and hemogasanalytic monitoring. A total of 65 arthroplasties entered the clinical trial. Total hip arthroplasty was cemented conventionally. The right heart was monitored intraoperatively by an echocardiography probe positioned in the patient's esophagus. Hemodynamic and hemogasanalytic monitoring were performed. Severe embolism occurred in 91% of the cases during implantation of the femoral component. Emodynamic and respiratory parameters showed significant changes after major embolism. The timing suggests a nearly immediate cause-and-effect relationship. Acute hypotension was observed in 62% of the cases. Mean pulmonary shunt values increment was 30.5%. Patients with intraoperative embolism who had pre-existing associated diseases showed more severe and persistent cardiopulmonary dysfunction than healthy patients. The surgeon's proclivity to deny the clinical relevance of fat and bone marrow during during total hip arthroplasty is directly related to his awareness of and attempt to avoid embolism. Patients at risk require more intensive monitoring to obtain detailed information about hemodynamic and oxymetric parameters.