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Segmental Wall Motion Abnormalities in Patients Undergoing Total Hip Replacement

1993; Lippincott Williams & Wilkins; Volume: 77; Issue: 4 Linguagem: Inglês

10.1213/00000539-199310000-00015

1526-7598

Jon W. Propst, Lawrence C. Siegel, Ingela Schnittger, Linda E. Foppiano, Stuart B. Goodman, John G. Brock‐Utne,

Orthopedic Infections and Treatments

We examined the effect of methylmethacrylate cement on venous embolization and cardiac function in 20 patients having total hip arthroplasty under general anesthesia. Segmental wall motion abnormalities and intracardiac targets (presumably emboli) were investigated by making videotaped recordings of the transgastric short axis and longitudinal 4-chamber views of the heart with transesophageal echocardiography at different points during surgery. The incidence of segmental wall motion abnormalities was the most frequent during insertion of cemented femoral prostheses (8 of 14 patients had wall motion abnormalities). This was significantly different from baseline measurements taken at the beginning of surgery (P < 0.05). In addition, there were also significantly more segmental wall motion abnormalities in patients having a cemented femoral component compared to those having an uncemented femoral prosthesis (P < 0.05). The incidence of wall motion abnormalities during acetabular and femoral reaming and during wound closure was not significantly different from baseline. Intracardiac targets (emboli) were seen in all 20 patients during surgery. The largest number of emboli occurred during reaming of the femur and during insertion of the femoral prosthesis. Significantly more emboli were seen with cemented components (P < 0.02). Most emboli were small ( 5 mm) emboli that appeared to be solid material. One patent foramen ovale was detected (5% incidence). There were no adverse cardiac or neurologic events, and heart rate and arterial blood pressure remained within normal limits throughout surgery. This study shows that the use of methylmethacrylate cement in total hip arthroplasty appears to be associated with an increased amount of intraoperative pulmonary embolism and segmental or global wall motion abnormalities. The reversibility of the wall motion abnormalities we observed implies a process which is self-limited and does not produce adverse effects in most patients.