Intraoperative cerebral arterial embolization during total hip arthroplasty.
BACKGROUND
Fat embolism to the pulmonary circulation is known to occur during total hip arthroplasty, especially during insertion of a cemented femoral component. Fat and air bubbles may enter the systemic circulation via a patent foramen ovale or through pulmonary circulation.


METHODS
To determine whether microemboli to the brain were occurring during total hip arthroplasty, 23 patients underwent transcranial Doppler assessment of emboli to the middle cerebral artery during total hip arthroplasty. Surgery was performed with the patient in the lateral decubitus position so that the probe recorded from the nondependent side.


RESULTS
Successful recordings were made in 20 patients, in 8 of 20 patients there were embolic signals, which ranging from 1 to 200. In all eight patients, signals were recorded during impaction of a cemented component or after relocation of the hip. Only one patient showed evidence of emboli with impaction of the acetabulum component. In two patients there were 150 and 200 embolic signals: in both mild respiratory symptoms developed. One patient became overtly agitated during a flurry of emboli.


CONCLUSIONS
Cerebral microemboli can occur during total hip arthroplasty. Whether this contributes to changes in postoperative cognitive function is unknown.
Department of Anesthesiology, The Hospital for Special Surgery, New York, NY 10021, USA. EdmondsC@hss.edu
C R
CR
Edmonds
D
D
Barbut
D
D
Hager
N E
NE
Sharrock
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D003072:Cognition Disorders / Q000209:etiology; D015897:Comorbidity; D004620:Embolism, Fat / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D017585:Ultrasonography, Doppler, Transcranial