title: Paradoxic cerebral embolism after cemented knee arthroplasty: a report of 2 cases and prophylactic option for subsequent arthroplasty.
abstract: Major orthopaedic procedures that involve instrumentation of the medullary canal are well known to produce showers of embolic debris including fat, bone fragments, marrow constituents, and cement. A growing literature has identified paradoxic cerebral embolism as a rare but serious consequence of the passage of these emboli through an intracardiac right-to-left shunt to the cerebral arterial circulation. We report 2 cases of paradoxic cerebral embolism after cemented total knee arthroplasty and propose a novel treatment plan to prevent recurrent stroke during subsequent surgery.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Yeon
authors.forename: Arun
authors.initials: A
authors.lastname: Ramappa
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Landzberg
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Thornhill
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002484:Cementation; D004452:Echocardiography; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged