Pulmonary embolism associated with canine total hip replacement.
OBJECTIVE
To determine by pulmonary perfusion scans and ultrasonography if embolemia occurs during total hip replacement (THR) surgery in dogs.


METHODS
Prospective clinical study.


METHODS
Forty client-owned dogs that had THR surgery.


METHODS
Thoracic radiographs were taken immediately after THR and immediately after completion of (99m)Tc-MAA lung scans. Scintigraphy was performed in 28 dogs, 48 hours after THR. Intraoperative ultrasonography (intercostal or transesophageal) was performed in another 12 dogs that had THR. The right atrium and ventricle and pulmonary outflow tract were observed during and for 5 to 8 minutes after femoral component insertion into medullary canals prepared by reaming, and lavage and aspiration of debris before filling with polymethylmethacrylate in dough stage. A modified Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) classification system was used to evaluate lung scans.


RESULTS
No pulmonary radiographic abnormalities were identified. Segmental and subsegmental perfusion defects occurred in 23 (82%) dogs and were classified as severe in 9 (32%) dogs, moderate in 11, and mild in 3. There was no particular lobe predilection. Patchy mulberry-appearing defects, indicative of fat embolism, were most common. Embolemia was observed by ultrasound in 10 dogs. Variable-sized particles occurred in 8 dogs, particles and bubbles in 2 dogs, and no emboli were observed in 2 dogs. Embolemia was observed within 10 seconds after femoral stem insertion and lasted < 1 minute. Pneumoemboli remained in the right atrium for > 8 minutes before dislodgement.


CONCLUSIONS
Embolemia of either air, particles, or both occurs in most dogs during THR surgery.


CONCLUSIONS
Most dogs seemingly spontaneously recover from pulmonary embolism that occurs during THR. The risk of clinical complications from this pulmonary embolism should be taken seriously, even though the exact morbidity and mortality rates are unknown.
Liska
William D
WD
Gulf Coast Veterinary Specialists, Houston, TX 77027, USA.
Poteet
Brian A
BA
D000818:Animals; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000662:veterinary*; D004283:Dog Diseases / Q000601:surgery*; D004285:Dogs; D011183:Postoperative Complications / Q000662:veterinary; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000662:veterinary*; D011859:Radiography; D011877:Radionuclide Imaging; D013438:Sulfhydryl Compounds; D013668:Technetium Tc 99m Aggregated Albumin; D014463:Ultrasonography
D013438:Sulfhydryl Compounds; D013668:Technetium Tc 99m Aggregated Albumin; C082426:technetium Tc99m-mercaptoacetyl albumin