Comparison of Fixation of the Femoral Component without Cement and Fixation with Use of a Bone-Vacuum Cementing Technique for the Prevention of Fat Embolism.

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Presentation transcript:

Comparison of Fixation of the Femoral Component without Cement and Fixation with Use of a Bone-Vacuum Cementing Technique for the Prevention of Fat Embolism During Total Hip Arthroplasty. A Prospective, Randomized Clinical Trial* by ROCCO PAOLO PITTO, MATTHIAS KOESSLER, and JOERN W. KUEHLE J Bone Joint Surg Am Volume 81(6): June 1, 1999 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1 Drawing showing the position of the proximal drainage cannula that is used in the bone- vacuum cementing technique. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2 Drawing showing the positions of the two 4.5-millimeter-diameter cannulae that are used in the bone-vacuum cementing technique. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 3-A through 3-D: Transesophageal echocardiograms made during total hip arthroplasty, showing the main echogenic patterns. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-B Grade 1. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-C Grade 2. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-D Grade 3. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 4-A and 4-B: Graphs showing the distribution of embolic events observed with transesophageal echocardiography in the three groups of patients. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-B Distribution of embolic events observed a few seconds after the relocation of the hip joint. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5 Graph showing the mean intraoperative values (and standard errors of the mean) of oxygen saturation (SaO2) during total hip arthroplasty, when all patients were receiving 100 percent inspired oxygen, in the three groups of patients. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6 Graph showing the mean levels (and standard error of the mean) of end tidal carbon dioxide (PetCO2) in the three groups of patients. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7 Graph showing the mean perioperative pulmonary shunt values in the three groups of patients. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 8 Graph showing the mean perioperative pulmonary shunt values and the physical status of the sixty patients assessed according to the criteria of the American Society of Anesthesiologists (ASA)1. ROCCO PAOLO PITTO et al. J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.