The Journal of Bone and Joint Surgery, Vol 65, Issue 1 97-102, Copyright © 1983 by Journal of Bone and Joint Surgery, Inc
Total hip replacement induces injury to remote veins in a canine model
GJ Stewart, PD Alburger, EA Stone and TW Soszka
The effects of total hip replacement on the condition of the luminal
surface of the jugular and femoral veins and the carotid and femoral
arteries were studied in healthy dogs. Four hours after the completion of
surgery, most of the blood was removed by whole-body perfusion and the
vessels were partially fixed in situ by glutaraldehyde perfusion,
harvested, and prepared for scanning electron microscopy. In control dogs
(held under anesthesia) the luminal surfaces of the veins (including valves
and confluences) and arteries were covered by intact endothelium and were
free of adhering blood cells. The arteries from dogs that were operated on
were also free of damage. In contrast, the veins from dogs that were
operated on showed a series of roughly parallel microtears around 70 to 80
per cent of the confluences of the side branches with the jugular or
femoral vein. The basement membrane as well as the endothelial sheet was
torn, thereby exposing underlying connective-tissue fibers and smooth
muscle cells. The endothelium separated along intercellular junctions. The
tears were infiltrated with many leukocytes and platelets and some
erythrocytes. Subtle endothelial changes and patchy leukocyte adhesion
occurred away from the side branches. The mechanism or mechanisms remain to
be elucidated.
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