High-volume, high-pressure pulsatile lavage during cemented arthroplasty

• Published in: Journal of bone and joint surgery. American volume Vol. 71; no. 9; pp. 1331 - 1336
• Main Authors: Byrick, R J, Bell, R S, Kay, J C, Waddell, J P, Mullen, J B
• Format: Journal Article
• Language: English
• Published: Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01-10-1989; Journal of Bone and Joint Surgery Incorporated
• Subjects: Animals; Biological and medical sciences; Blood Pressure; Bone Cements - therapeutic use; Cardiovascular Diseases - physiopathology; Cardiovascular Diseases - prevention & control; Dogs; Embolism, Fat - prevention & control; Hip Prosthesis; Medical sciences; Orthopedic surgery; Pressure; Pulmonary Artery - physiology; Pulmonary Circulation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Therapeutic Irrigation - methods; Vascular Resistance; Fissipedia; Carnivora; Fat embolism; Prosthesis; Diseases of the osteoarticular system; Cardiopulmonary; Washing; Prevention; Vertebrata; Experimental disease; Mammalia; Orthopedic surgery; Animal; Complication; Technique; Dog
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-198971090-00008

To determine the efficacy of high-volume, high-pressure pulsatile lavage in the prevention of cardiopulmonary dysfunction and fat embolism during cemented arthroplasty, we studied twenty-eight mongrel dogs that had had a bilateral cemented arthroplasty. Significant increases in pulmonary-artery pressure and pulmonary vascular resistance, accompanied by decreases in arterial oxygen tension and increases in intrapulmonary shunt fraction (Qs/Qt), characterized cardiopulmonary dysfunction after bilateral cemented arthroplasty when no lavage was used. Low-volume, low-pressure manual lavage did not significantly alter these physiological changes, but there was a significant reduction in the number of fat emboli that were demonstrated in the lungs as compared with the no-lavage group. High-volume, high-pressure pulsatile lavage of the intramedullary cavity after reaming significantly reduced the changes in pulmonary-artery pressure, pulmonary vascular resistance, arterial oxygen tension, and intrapulmonary shunt fraction (Qs/Qt). In the pulsatile-lavage group, the number of fat microemboli that were found in the lungs was reduced to 25.7 per cent of those found in the no-lavage group. We concluded that meticulous high-volume, high-pressure pulsatile lavage reduces both pulmonary physiological derangements and fat emboli during bilateral cemented arthroplasty in dogs.