The effect of air embolization from the femoral canal on hemodynamic parameters during hip arthroplasty

A canine laboratory and clinical study was designed to determine the effect of air embolism during hip arthroplasty. Canine femurs were pressurized with air to 250-300 mm Hg or with low-viscosity cement to 300-900 mm Hg. Pressurization with low-viscosity cement from distal to proximal with a plugged femur revealed no change in pO2, pCO2, pulmonary artery pressure, or end-tidal CO2. Air pressurization resulted in significant increases in pCO2, pulmonary artery pressure, and end-tidal CO2, and a decrease in pO2. Pressurization of the medullary canal with xenon-labeled air was used to document pulmonary embolism. In a clinical setting, two different femoral cementing techniques during total hip arthroplasty were studied to determine their effect on hemodynamic parameters associated with embolic phenomenon. Five patients had a plugged femoral canal filled from proximal to distal with a vent tube, followed by finger-packing. Three of the patients demonstrated a significant drop in pO2 and blood pressure and a rise in pCO2 and end-tidal CO2. Five other patients had their plugged femoral canals filled from distal to proximal, three with regular cement and two with low-viscosity cement, with no significant cardiopulmonary changes. The adverse cardiopulmonary effects reported during hip arthroplasty appear to be avoided by eliminating air during the cementing procedure, by filling a plugged canal from distal to proximal.