title: Intraoperative embolism and hip arthroplasty: intraoperative transesophageal echocardiographic study.
abstract: OBJECTIVE
  Cardiopulmonary complications are well known in orthopaedic surgery. The aim of the present study was to evaluate the relevance and the origin of embolization, to correlate the event with the procedure and to establish the clinical relevance of this phenomenon.
  
  
  METHODS
  We performed transesophageal echocardiography (TEE) on 40 patients during total hip arthroplasty, 19 males and 21 females, average age 66 years, with a negative medical history for heart and lung diseases, who underwent an operation for hip prosthesis (22 patients) or surgery for medial fracture (18 patients). Of these, 22 patients received a cemented prosthesis and 18 patients received an uncemented one.
  
  
  RESULTS
  During the placement of the acetabular and femoral components, and during the relocation of the hip joint, a snow flurry appearing in the right heart was followed by several highly echogenic and mobile emboli of various sizes.
  
  
  CONCLUSIONS
  Our data suggest that the presence of emboli detected by TEE in the right heart and pulmonary artery appears to derive principally from the reaming of the femoral canal and the placement of the femoral stem, particularly during the placement of cemented prostheses. However, the passage of embolic material had no adverse sequelae. For these reasons routine, intraoperative TEE cannot be recommended in orthopaedic surgery.
authors.affiliation: Division of Cardiology Hospital of Castrovillari, Castrovillari, Italy. g.sanpasquale@libero.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bisignani
authors.forename: Massimariano
authors.initials: M
authors.lastname: Bisignani
authors.forename: Giovanni San
authors.initials: GS
authors.lastname: Pasquale
authors.forename: Francesco
authors.initials: F
authors.lastname: Greco
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004617:Embolism / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D015588:Observer Variation; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology; D015203:Reproducibility of Results; D014683:Vena Cava, Superior