Pulmonary embolism associated with canine total hip replacement.

OBJECTIVE To determine by pulmonary perfusion scans and ultrasonography if embolemia occurs during total hip replacement (THR) surgery in dogs. STUDY DESIGN Prospective clinical study. ANIMALS Forty client-owned dogs that had THR surgery. METHODS Thoracic radiographs were taken immediately after THR and immediately after completion of (99m)Tc-MAA lung scans. Scintigraphy was performed in 28 dogs, 48 hours after THR. Intraoperative ultrasonography (intercostal or transesophageal) was performed in another 12 dogs that had THR. The right atrium and ventricle and pulmonary outflow tract were observed during and for 5 to 8 minutes after femoral component insertion into medullary canals prepared by reaming, and lavage and aspiration of debris before filling with polymethylmethacrylate in dough stage. A modified Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) classification system was used to evaluate lung scans. RESULTS No pulmonary radiographic abnormalities were identified. Segmental and subsegmental perfusion defects occurred in 23 (82%) dogs and were classified as severe in 9 (32%) dogs, moderate in 11, and mild in 3. There was no particular lobe predilection. Patchy mulberry-appearing defects, indicative of fat embolism, were most common. Embolemia was observed by ultrasound in 10 dogs. Variable-sized particles occurred in 8 dogs, particles and bubbles in 2 dogs, and no emboli were observed in 2 dogs. Embolemia was observed within 10 seconds after femoral stem insertion and lasted < 1 minute. Pneumoemboli remained in the right atrium for > 8 minutes before dislodgement. CONCLUSIONS Embolemia of either air, particles, or both occurs in most dogs during THR surgery. CLINICAL RELEVANCE Most dogs seemingly spontaneously recover from pulmonary embolism that occurs during THR. The risk of clinical complications from this pulmonary embolism should be taken seriously, even though the exact morbidity and mortality rates are unknown.

[1]  E. Schemitsch,et al.  Femoral bone blood flow after reaming and intramedullary canal preparation: a canine study using laser Doppler flowmetry. , 1999, The Journal of arthroplasty.

[2]  T. Kallos,et al.  Intramedullary pressure and pulmonary embolism of femoral medullary contents in dogs during insertion of bone cement and a prosthesis. , 1974, The Journal of bone and joint surgery. American volume.

[3]  M. Runkel,et al.  Pathogenesis and prophylaxis of circulatory reactions during total hip replacement , 2004, Archives of Orthopaedic and Trauma Surgery.

[4]  Klaus Draenert,et al.  Prophylaxis of Fat and Bone Marrow Embolism in Cemented Total Hip Arthroplasty , 1998 .

[5]  M. Olmstead.  The canine cemented modular total hip prosthesis. , 1995, Journal of the American Animal Hospital Association.

[6]  P. Pellicci,et al.  The Safety and Efficacy of Intraoperative Heparin in Total Hip Arthroplasty , 2000, Clinical orthopaedics and related research.

[7]  R. Byrick,et al.  Cardiopulmonary function and pulmonary microemboli during arthroplasty using cemented or non-cemented components. The role of intramedullary pressure. , 1987, The Journal of bone and joint surgery. American volume.

[8]  J. Parvizi,et al.  Thirty-Day Mortality After Elective Total Hip Arthroplasty , 2001, The Journal of bone and joint surgery. American volume.

[9]  J. Schnader,et al.  Pulmonary microvascular cytology sampling confirms the lung scan finding of "contour mapping". , 1995, Clinical Nuclear Medicine.

[10]  R. Byrick,et al.  The role of lavage in preventing hemodynamic and blood-gas changes during cemented arthroplasty. , 1983, The Journal of bone and joint surgery. American volume.

[11]  M. Mcguire,et al.  Fatal marrow embolization following a porous-coated bipolar hip endoprosthesis. , 1994, The Journal of arthroplasty.

[12]  S. Oh,et al.  Prevalence of Fat Embolism Following Bilateral Simultaneous and Unilateral Total Hip Arthroplasty Performed with or without Cement: A Prospective, Randomized Clinical Study , 2002, The Journal of bone and joint surgery. American volume.

[13]  Sankey V. Williams,et al.  A Meta-Analysis of Thromboembolic Prophylaxis Following Elective Total Hip Arthroplasty* , 2000, The Journal of bone and joint surgery. American volume.

[14]  R. Pitto,et al.  The Clinical Relevance of Embolic Events Detected by Transesophageal Echocardiography During Cemented Total Hip Arthroplasty: A Randomized Clinical Trial , 2001, Anesthesia and analgesia.

[15]  H. Fredin,et al.  Scintigraphy and chest radiography in the screening of pulmonary embolism after total hip replacement. , 1985, Respiration; international review of thoracic diseases.

[16]  R. Byrick,et al.  Transpulmonary systemic fat embolism. Studies in mongrel dogs after cemented arthroplasty. , 1994, American journal of respiratory and critical care medicine.

[17]  T. Kallos,et al.  Elevation of intramedullary pressure when methylmethacrylate is inserted in total hip arthroplasty. , 1974, The Journal of bone and joint surgery. American volume.

[18]  J Thrall,et al.  Ventilation-perfusion scintigraphy in the PIOPED study. Part I. Data collection and tabulation. , 1993, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[19]  U. Matis,et al.  Changes in cardiopulmonary variables and platelet count during anesthesia for total hip replacement in dogs. , 1994, Veterinary surgery : VS.

[20]  J. Nolan.  Arterial oxygenation and mean arterial blood pressure in patients undergoing total hip replacement: cemented versus uncemented components , 1994, Anaesthesia.

[21]  R. Byrick,et al.  High-volume, high-pressure pulsatile lavage during cemented arthroplasty. , 1989, The Journal of bone and joint surgery. American volume.

[22]  J Thrall,et al.  Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations. , 1993, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.