Relevance of the drainage along the linea aspera for the reduction of fat embolism during cemented total hip arthroplasty. A prospective, randomized clinical trial.
The aim of this study was to assess the relevance of drainage placed along the linea aspera for the prevention of fat embolism and cardiopulmonary impairment during the insertion of a cemented stem. We studied 40 patients with coxarthrosis randomly allocated to total hip arthroplasty with proximal drainage or without it. The venting hole for the drainage of the medullary cavity was placed posteriorly, between the greater and the smaller trochanter, in the prolongation of the linea aspera. The heart was monitored intraoperatively by a echocardiography probe positioned in the patient's oesophagus. During the operation we monitored the hemodynamics and blood gas values. Severe embolic events were observed in 85% of the control group and in 20% of the drainage group (P = 0.01). Embolism occurred during the insertion of the femoral component and continued after reduction of the hip joint. After major embolism, the pulmonary shunt values increased significantly in the control group (+22.7%), but there were no marked changes in the drainage group (+7.1%). The logical therapeutic measure to avoid intravasation of bone marrow, fat, and bone debris during the insertion of the femoral component is to prevent the rise of intraosseous pressure. The drainage of the venous system located along the linea aspera significantly reduces the risk of intraoperative embolism and cardiopulmonary impairment.
Pitto
R P
RP
Department of Orthopaedic Surgery, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany.
Schramm
M
M
Hohmann
D
D
Kössler
M
M
D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D004322:Drainage; D004620:Embolism, Fat / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011312:Pressure; D011446:Prospective Studies; D016896:Treatment Outcome