title: Does intramedullary canal irrigation reduce fat emboli? A randomized clinical trial with transesophageal echocardiography.
abstract: The effect of medullary cavity irrigation on fat emboli during total knee arthroplasty (TKA) was evaluated. Thirty female patients with osteoarthritis were randomly assigned to undergo conventional TKA without irrigation (conventional group) or with medullary canal saline irrigation (irrigation group). The four-chamber view was monitored by transesophageal echocardiography (TEE) and echogenic reflections of fat emboli were observed. The grey-scale score and area ratio of fat emboli were calculated during TKA. Hemodynamic parameters were simultaneously monitored and showed no obvious change between two groups (P>0.05). The average grey-scale score (P=0.016) and area ratio (P=0.033) of emboli were significantly decreased in irrigation group. Removal of medullary contents by irrigation could significantly reduce the formation of fat emboli during TKA.
authors.affiliation: Department of Ultrasound, Changzheng Hospital, Second Military Medical University, Shanghai, China. Electronic address: ultrasoundczzjq@163.com.
authors.forename: Jiaqi
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Ultrasound, Changzheng Hospital, Second Military Medical University, Shanghai, China. Electronic address: wintersnow9090@sina.com.
authors.forename: Jianquan
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Ultrasound, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xiufeng
authors.initials: X
authors.lastname: Ji
authors.affiliation: Department of Ultrasound, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Orthopedic, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Qirong
authors.initials: Q
authors.lastname: Qian
authors.affiliation: Department of Computer Science, Institute of Information Engineering, Shanghai, Maritime University, Shanghai, China. Electronic address: qixu@fudan.edu.cn.
authors.forename: Qi
authors.initials: Q
authors.lastname: Xu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004620:Embolism, Fat / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005269:Femur / Q000601:surgery*; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D016037:Single-Blind Method; D007507:Therapeutic Irrigation; D013977:Tibia / Q000601:surgery*
keywords: fat embolism; intramedullary pressure; medullary cavity irrigation; total knee arthroplasty; transesophageal echocardiography