Effects of methyl methacrylate on liver function in patients undergoing total hip or total knee replacement

In an unselcted group of patients undergoing total hip or total knee replacement, it was shown that liver changes occur postoperatively in those in whom polymethyl methacrylate was used. The changes are transient and return to normal by two weeks after operation. These liver changes are seen more frequently in patients also receiving halothane. Elevations in the serum alkaline phosphatase level are secondary to increases in the isoenzyme levels from liver and not bone. A routine SMA study should be supplemented by routine preoperative tests specific for liver function, such as the enzyme gamma glutamyl transpeptidase or others. Patients with abnormal liver test results before total joint replacement with cement probably should not be given halothane as an anesthetic.