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The Journal of Bone and Joint Surgery 81:108-110 (1999)
© 1999 The Journal of Bone and Joint Surgery, Inc.

Paradoxical Cerebral Embolism Complicating a Major Orthopaedic Operation. A Report of Two Cases*

CRAIG J. DELLA VALLE, M.D.{dagger}, LAITH M. JAZRAWI, M.D.{dagger}, PAUL E. DI CESARE, M.D.{dagger} and DAVID J. STEIGER, M.D.{dagger}, NEW YORK, N.Y.

Investigation performed at the Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases Orthopaedic Institute, New York City


   Introduction
 
Thromboembolism is a frequent complication following major orthopaedic procedures. Cerebrovascular accidents, however, are less commonly seen postoperatively; their prevalence, as reported in the surgical literature, has been between 0.08 percent (twenty of 24,641 operations) and 1.1 percent (four of 354 operations in a series of patients older than sixty years of age)9,16. Paradoxical embolism, the systemic embolization of a venous thrombus through a right-to-left shunt (such as a patent foramen ovale), is an even rarer entity. We report the cases of two patients who had a paradoxical cerebral embolism and a concomitant pulmonary embolism following a major orthopaedic procedure.


   Case Reports
 
CASE 1. A sixty-two-year-old woman had a right hybrid total hip arthroplasty (meaning that the femoral component was inserted with cement and the acetabular component was inserted without cement) under spinal anesthesia for the treatment of osteoarthritis. Her medical history included hypertension, non-insulin-dependent diabetes mellitus, and hypercholesterolemia. She had no . . . [Full Text of this Article]


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