The Journal of Bone and Joint Surgery, Vol 71, Issue 9 1331-1336, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
High-volume, high-pressure pulsatile lavage during cemented arthroplasty
RJ Byrick, RS Bell, JC Kay, JP Waddell and JB Mullen
Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.
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.
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