INTRAOPERATIVE CEREBRAL MICROEMBOLI DURING TOTAL HIP ARTHROPLASTY – PRELIMINARY DATA

R V Patel; J Stygall; J Harrington; M G Harrison; S Newman; F S Haddad

doi:10.1302/0301-620X.86BSUPP_I.0860078c

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INTRAOPERATIVE CEREBRAL MICROEMBOLI DURING TOTAL HIP ARTHROPLASTY – PRELIMINARY DATA

R V Patel
J Stygall
J Harrington
M G Harrison
S Newman
F S Haddad

INTRAOPERATIVE CEREBRAL MICROEMBOLI DURING TOTAL HIP ARTHROPLASTY – PRELIMINARY DATA

Patel RV, Stygall J, Harrington J, Harrison MG, Newman S, Haddad FS. INTRAOPERATIVE CEREBRAL MICROEMBOLI DURING TOTAL HIP ARTHROPLASTY – PRELIMINARY DATA. Orthop Procs. 2004;86-B(SUPP_I):78-78. doi:10.1302/0301-620X.86BSUPP_I.0860078c

Patel, R V, et al. “INTRAOPERATIVE CEREBRAL MICROEMBOLI DURING TOTAL HIP ARTHROPLASTY – PRELIMINARY DATA.” Orthopaedic Proceedings, vol. 86-B, no. SUPP_I, 2004, pp. 78-78., https://doi.org/10.1302/0301-620X.86BSUPP_I.0860078c

Patel, R. V., Stygall, J., Harrington, J., Harrison, M. G., Newman, S., & Haddad, F. S. (2004). INTRAOPERATIVE CEREBRAL MICROEMBOLI DURING TOTAL HIP ARTHROPLASTY – PRELIMINARY DATA. Orthopaedic Proceedings, 86-B(SUPP_I), 78-78. https://doi.org/10.1302/0301-620X.86BSUPP_I.0860078c

Patel, R. V., Stygall, J., Harrington, J., Harrison, M. G., Newman, S. and Haddad, F. S. (2004) “INTRAOPERATIVE CEREBRAL MICROEMBOLI DURING TOTAL HIP ARTHROPLASTY – PRELIMINARY DATA.” Orthopaedic Proceedings, 86-B(SUPP_I), pp. 78-78. Available at: https://doi.org/10.1302/0301-620X.86BSUPP_I.0860078c

Patel, R V, J Stygall, J Harrington, M G Harrison, S Newman, and F S Haddad. “INTRAOPERATIVE CEREBRAL MICROEMBOLI DURING TOTAL HIP ARTHROPLASTY – PRELIMINARY DATA.” Orthopaedic Proceedings 86-B, no. SUPP_I (2004): 78-78. https://doi.org/10.1302/0301-620X.86BSUPP_I.0860078c

Patel RV, Stygall J, Harrington J, Harrison MG, Newman S, Haddad FS. INTRAOPERATIVE CEREBRAL MICROEMBOLI DURING TOTAL HIP ARTHROPLASTY – PRELIMINARY DATA. Orthop Procs. 2004 Jan 1;86-B(SUPP_I):78-78. https://doi.org/10.1302/0301-620X.86BSUPP_I.0860078c

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Abstract

Aims: To quantify the intraoperative cerebral microemboli load during primary total hip arthroplasty (THA) using transcranial Doppler ultrasound and to investigate whether a patent foramen ovale influences cerebral embolic load in general. The timing of the microemboli will be related to certain surgical activities to determine if a specific relationship exists.

Methods: Patients undergoing primary THA, with no history of stroke, TIA, ongoing CNS disease or alcoholism were included. All operations were carried out under a standardised general anaesthetic and performed by two consultant orthopaedic surgeons. Microemboli load was recorded, using transcranial Doppler ultrasound (TCD), onto VHS tape for subsequent playback and analysis. Patent foramen ovale detection was performed using bolus intravenous injection of agitated saline followed by valsalva manoeuvre technique and TCD. Timing of specific surgical steps was recorded for each operation and emboli load calculated for that period.

Results: 25 THA patients were studied (18 females, 7 males) 16 right and 9 left THA’s were performed. Cerebral microembolisation occurred in 10 patients (40%). Mean microembolic load was 5.52 per patient (range = 0–83). PFO was detected in 8 patients (32%). 37.5% of PFO positive patients displayed cerebral microemboli. However, 41.1% of PFO negative patients also displayed microemboli intraoperatively.

Insertion of the femoral component was associated with generating a larger microembolic load than the other phases of the operation.

Conclusion: Intraoperative cerebral microembolisation occurs in a significant proportion of patients during total hip arthroplasty. The presence of a patent foramen ovale does not appear to influence the incidence microemboli intraoperatively. Specific surgical activities are associated with generating greater embolic loads. These questions will be comprehensively assessed in the larger study currently underway..

Theses abstracts were prepared by Mr Peter Kay. Correspondence should be address to him at The Hip Centre, Wrightington Hospital, Appley Bridge, Wigan, Lancashire WN6 9EP.