Clinical features and echocardiography of embolism during cemented hip arthroplasty

Purpose: In previous studies the degree of embolization detected by transoesophageal echocardigraphy (TEE) during cemented total hip arthroplasty (THA) did not correlate with changes in haemodynamic variables nor did it result in persistent ventilation-perfusion mismatching. The aim of this study was to record evidence of embolism and to relate the findings to demographic data and the subsequent clinical course of the patients during THA. Method: Forty-eight patients scheduled to undergo elective cemented THA during general anaesthesia were monitored. A TEE probe was inserted with special attention to the right atrium (RA), the right ventricle (RV). Haemodynamic (heart rate, arterial blood pressure, central venous pressure) and blood-gas variables were measured repeatedly during the operative (after induction, placement of the acetabular component, placement of the femoral component, relocation of the hip joint). Grading of venous embolism at these times was based on the size of particles detected by TEE (three-minutes video segments of each periods) and correlated with demographic, haemodynamic and blood-gas data. Results: The TEE monitoring revealed showers of echogenic material traversing the RA and RV in all but one patients during reaming and cementing of the acetabular and femoral components, and during relocation of the hip joint. No correlation was observed between frequency or size of embolic particles and demographic or blood-gas and haemodynamic variables studied at the same times. Conclusion: This study failed to show any clinical impact of TEE detected emboli during cemented THA.