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Related Experiment Videos

Right ventricular function during revision total hip arthroplasty

M K Urban1, R Sheppard, M A Gordon

  • 1Department of Anesthesiology, Hospital for Special Surgery, New York New York, 10021, USA.

Anesthesia and Analgesia
|June 1, 1996
PubMed
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Revision total hip arthroplasty (THA) can cause serious cardiopulmonary events due to cement-bone marrow emboli. This study monitored right ventricular function, finding significant changes in some patients during revision THA.

Area of Science:

  • Orthopedic Surgery
  • Cardiology
  • Anesthesiology

Background:

  • Total hip arthroplasty (THA) carries a risk of pulmonary embolization from cement-bone marrow debris.
  • These complications, including cardiac arrest, are more frequent during revision THA procedures.
  • The "bone cement implantation syndrome" is a recognized, albeit not fully understood, complication.

Purpose of the Study:

  • To assess right ventricular (RV) function during revision THA.
  • To investigate the relationship between hemodynamic changes and cement-bone marrow emboli.
  • To evaluate the utility of right ventricular ejection fraction (RVEF) and transesophageal echocardiography (TEE) in monitoring these events.

Main Methods:

  • Eighteen patients undergoing revision THA were monitored.

Related Experiment Videos

  • Right ventricular function was assessed using a pulmonary artery catheter measuring RVEF.
  • Transesophageal echocardiography (TEE) was used to detect intracardiac emboli.
  • Hemodynamic parameters, including mean pulmonary artery pressure, were continuously monitored.

    • Main Results:

    • All patients experienced hemodynamic changes during femoral prosthesis insertion.
    • Four patients had a significant decrease in RVEF (> or = 10%) and increased pulmonary artery pressure (> or = 10 mm Hg), requiring intervention.
    • Two patients showed postoperative signs of pulmonary embolization.
    • TEE detected intracardiac emboli in all patients during the procedure.

    Conclusions:

    • Acute decreases in RVEF and elevated pulmonary artery pressures occur during hip arthroplasty.
    • Embolization of bone marrow debris likely plays a role in the "bone cement implantation syndrome."
    • RVEF and TEE are valuable tools for monitoring RV function and detecting emboli during revision THA.