Comparision Of Fixation Of The Femoral Component With Conventional Cementting Technique With Use Of Difference Of Cementing Technique For The Preventation Of Cement Implantation Syndrome During Total Hip Arthroplasty

Backgroud: The cement implantation syndrome is a well-recognized complication of total hip arthroplasty, characterized by systemic hypotension, hypoxemia, cardiac arrest, and sudden death at the time of cement and prosthesis insertion. The most commen symptoms of cement implantation syndrome is systemic hypotension and hypoxemia. The presence of intravascular fat, bone marrow, bone debris is presumed to be the main cause of cement implantation syndrome. The purpose of the present study was to compare the effects of fixation of the femoral component with conventional cement technique with those of fixation with difference of cement techniques on the severity of hypotension and cardiopulmouary impairment during total hip arthroplasty of rabbits.Animals and Methods: (1)48 Belgium rabbits of either sex, 1.8-2.4 kg body weight, were anaesthetized with intravenous pentobarbitone sodium (30 mg/kg body weight) and anaesthesia was maintained by additional doses of pentobarbitone sodium. The 48 rabbits(48 hips) were assigned to 8 groups randomly. The control group consisted of 6 rabbits who had a femoral component inserted with conventional cementing technique; group A-G treated the medullary cavity with adrenaline(1:10000), drilling holes in femur ,Fibrin Sealant or combined before having cement and femoral component inserted. Group A: adrenaline(+) drilling holes(-) fibrin sealant(-); Group B: adrenaline(-) drilling holes(+) fibrin sealant(-); Group C: adrenaline(-) drilling holes(-) fibrin sealant(+); Group D: adrenaline(+) drilling holes(+) fibrin sealant(-); Group E: adrenaline(-) drilling holes(+) fibrin sealant(+); Group F: adrenaline(+) drilling holes(-) fibrin sealant(+); Group G: adrenaline(+) drilling holes(+) fibrin sealant(+). Arterial blood pressure was recorded from the carotid artery, central venous pressure from the external jugular vein, respiration from the tracheal cannula. Compared the extent that the blood pressure dropped and the increase of respiratory rate during the insertion process during total hip arthroplasty of each group with the control group. (2)12 Belgium rabbits of either sex, 1.8-2.4 kg body weight were assigned to 2 groups randomly. During the process of total hip arthroplasty, before having bone cement and the prosthesis inserted, Group 1 treated the medullary cavity with adrenaline of 1:1000,Group 2 treated the medullary cavity with adrenaline of 1:10000. Compared the extent that the blood pressure dropped during the insertion process during total hip arthroplasty.Results: (1)From the perspective of the drop of blood pressure, the drop of blood pressure of group C,D,G are lower than the control group; as for the duration of the drop of blood pressure, group A,C,E,F,G are shorter. When having the femoral components inserted, the respiratory rate was increased and the systemic blood pressure was increased a bit first and then dropped significantly. (2) The descent of blood pressure during the insertion process of total hip arthroplasty of group 1 and group 2 are similar.Conclusions: (1) The present study showed that severe cement implantation sydrome and intraoperative cardiopulmonary impairment are common when a femoral component is fixed with use of a conventional cementing technique. The results of the present study demostrated a low risk of embolic events when the medullary cavity is treated with adrenaline, fibrin sealant, combined use of adrenaline, fibrin sealant and drilling holes to the femur before having the femoral components inserted. (2) The effect of using adrenline of both consistency(1:1000 and 1:10000) are similar.