Thermotoxicity of palacos cement. Clinical observation

In total hip joint replacement with cemented prostheses, Palacos (polymethyl methacrylate, PMMA) involves a high perioperative risk for the patient, on account of the effects on both the systemic and the pulmonary circulation. Data were assembled retrospectively from the records of 203 patients who underwent hip joint operation with Palacos implantation in the Inner City Surgical Clinic and the Surgical Polyclinic of the University of Munich from 1982 to 1986. In the hemiarthroplasty series, hemiarthroplasty was performed in 61% of patients in risk group III, whereas in the risk groups I and II it was done in 31% of cases. The mortality following hemiarthroplasty was greater than that following implantation of total prostheses in risk groups I and II. In risk groups II and III the mortality was 17% with surgery on the day of injury, lower, at only 10%, when the operation was performed on the day after injury, and markedly higher, at 31% and 38%, respectively, when surgery was postponed to the 2nd or 3rd day. It has been shown in burn research that the prostanoid levels in the plasma of untreated animals show a typical curve with two peaks, the first on the day of the injury and the second on the 3rd day after injury. Our observations support the assumption that the effect of trauma and surgical treatment are complementary.