[Hemodynamic and respiratory changes during hip and knee arthroplasty. An echocardiographic study].
BACKGROUND
The "bone cement implantation syndrome" is a rare but severe complication observed especially during the insertion of cemented prostheses in hip and knee replacement surgery. Several mechanisms are involved: effects of methylmethacrilate, embolism of fat, air and bone marrow, and release of tissue thromboplastin during acetabular and femoral reaming. Aim of this study was to detect embolic events, right heart impairment, hemodynamic and respiratory changes during hip and knee replacement surgery.


METHODS



METHODS
Prospective study, between February-May 2001.


METHODS
Orthopedic Operative room.


METHODS
Twenty-one patients who underwent total hip or knee arthroplasty under general anesthesia. Patients were divided in methylmethacrylate cemented prostheses groups (CEM, n=10) and totally uncemented prostheses (NON CEM, n=11).


METHODS
Standard anesthesia monitoring and omniplane TEE were performed. TEE probe was positioned in order to obtain "inflow-outflow" views of right heart. Measurements were obtained after anesthesia induction (T1), during femoral realing (T2) at prostheses insertion (T3), and at the end of surgery (T4).


RESULTS
Hemodynamic and respiratory parameters measured in different phases of surgical procedures were not different within groups and between groups. Fourtheen patients had TEE evidence of emboli, and the phenomenon was more evident in CEM group (Z= -347; p<0.001). During prostheses insertion, a slight, not significant increase in right ventricular dimensions was observed in both groups, without any right ventricular wall kinetic abnormality. No difference was observed between groups. No adverse cardiac or cerebrovascular events in intra- and postoperatory period were observed.


CONCLUSIONS
In normal patients total hip or knee arthroplasty is associated with embolic phenomena, without any significant change in systemic and right heart hemodynamics. Insertion of cemented prostheses does not modify hemodynamic profile. It remains to be elucidated if the occurrence of emboli has a critical role in patients with cardiorespiratory disease.
Dambrosio
M
M
Cattedra di Anestesia e Rianimazione, Università degli Studi, Foggia, Italy. m.dambrosio@unifg.it
Tullo
L
L
Moretti
B
B
Patella
V
V
Simone
C
C
Calò
M N
MN
Dalfino
L
L
Cinnella
G
G
D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements / Q000009:adverse effects*; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D020366:Methylmethacrylate / Q000009:adverse effects; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D015656:Respiratory Mechanics / Q000502:physiology*
D001843:Bone Cements; D020366:Methylmethacrylate