Polymethylmethacrylate causes prolonged pulmonary hypertension during fat embolism: a study in sheep.
BACKGROUND
Fat embolism (FE), the release of bone marrow contents into the circulation and the subsequent cardiovascular changes, is still a potentially fatal com-plication during orthopedic surgery. Different causative factors have been suggested, but the exact pathomechanism of FE still remains unclear. We investigated the role of polymethylmethacrylate (PMMA) in FE during vertebroplasty in sheep.


METHODS
In 8 sheep, two vertebral bodies were augmented alternatively with PMMA or bone wax. Pulmonary and cardiovascular parameters were monitored during the procedure.


RESULTS
The peak response was similar for both groups and characterized by hypotension, a drop in cardiac output and pulmonary hypertension. However, the recovery in pulmonary arterial pressure and pulmonary vascular resistance was quicker in the wax group.


CONCLUSIONS
The injection of PMMA may cause prolonged pulmonary hypertension during vertebro-plasty and also arthroplasty. Surgeons should be aware of this potential cardiovascular complication, especially in patients with impaired pulmonary and cardiovascular function.
Aebli
Nikolaus
N
Department of Orthopaedic Surgery, Princess Alexandra Hospital, Ipswich Road, Woolloongabba Q 4102, Australia.
Schwenke
Daryl
D
Davis
Gerard
G
Hii
Timothy
T
Theis
Jean-Claude
JC
Krebs
Jörg
J
D000818:Animals; D001843:Bone Cements / Q000009:adverse effects* / Q000494:pharmacology; D004620:Embolism, Fat / Q000139:chemically induced*; D006439:Hemodynamics / Q000187:drug effects; D006976:Hypertension, Pulmonary / Q000139:chemically induced*; D007267:Injections; D019637:Orthopedic Procedures / Q000009:adverse effects*; D019904:Polymethyl Methacrylate / Q000009:adverse effects* / Q000494:pharmacology; D012756:Sheep; D013131:Spine / Q000601:surgery*; D014885:Waxes / Q000009:adverse effects / Q000494:pharmacology
D001843:Bone Cements; D014885:Waxes; D019904:Polymethyl Methacrylate