title: [Influence of prosthesis design on intramedullary pressure formation in femur shaft implants of cemented hip endoprostheses].
abstract: The increase of intramedullary femoral pressure can lead to the intravasation of bone marrow and fat cells into the blood stream of the femoral vein and consequently into the pulmonary circulation. This effect is the same in intramedullary nailing and in the implantation of femoral stem prostheses. In a prospective study we evaluated the intraoperative, intramedullary pressure in the distal femur during the implantation of femoral stem prostheses with two different designs. In eight patients we implanted Müller straight stems and in another eight we implanted stem type Option 3000. Intramedullary pressure was recorded continuously by the implantation of a microtip pressure probe (piezoresistive principle, 50 Hz) in the distal femur. We found markedly higher pressure in Müller straight stem prostheses: range: 590-2,570 mmHg (median = 1,293, SD = 627 mmHg). Intramedullary pressure in stem prosthesis type Option 3000 was much lower: range: 59-574 mmHg (median = 289, SD = 219 mmHg). The differences were statistically significant (p = 0.0008). By changing the designs of femoral stem prostheses, the intramedullary pressure can be markedly reduced. In the case of elderly patients or those with pulmonary illness we recommend femoral stem prosthesis designs, which induce little increase in the intramedullary pressure, in order to reduce cardiopulmonary complications.
authors.affiliation: Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Steinhövelstrasse 9, 89075 Ulm. alexander.beck@medizin.uni-ulm.de
authors.forename: A
authors.initials: A
authors.lastname: Beck
authors.forename: W
authors.initials: W
authors.lastname: Strecker
authors.forename: F
authors.initials: F
authors.lastname: Gebhard
authors.forename: M
authors.initials: M
authors.lastname: Arand
authors.forename: G
authors.initials: G
authors.lastname: Krischak
authors.forename: L
authors.initials: L
authors.lastname: Kinzl
mesh_terms: D001843:Bone Cements; D001853:Bone Marrow / Q000503:physiopathology*; D001863:Bone Screws; D004620:Embolism, Fat / Q000503:physiopathology* / Q000517:prevention & control; D006622:Hip Prosthesis; D006801:Humans; D006874:Hydrostatic Pressure; D007431:Intraoperative Complications / Q000503:physiopathology* / Q000517:prevention & control; D008838:Microcomputers; D016343:Monitoring, Intraoperative / Q000295:instrumentation; D011446:Prospective Studies; D011474:Prosthesis Design; D011655:Pulmonary Embolism / Q000503:physiopathology* / Q000517:prevention & control; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D012984:Software
chemical_list: D001843:Bone Cements