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Decrease in pulmonary circulation may be related to cemented THA, age, cholesterol
Investigator advises THA be performed carefully in older patients with high total cholesterol.
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SAN DIEGO – Cemented total hip arthroplasty patients demonstrated a significantly greater decrease in pulmonary circulation than cementless total hip and total knee arthroplasty patients and cemented total knee patients, according to a Japanese investigator speaking here.
Investigators also found that a decrease in pulmonary circulation correlated with older age and higher cholesterol levels, said Koh Shimizu, MD.
“Pulmonary embolism is one of the most severe complications in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The high-pressure cementing technique is usually recommended; however, this may decrease the pulmonary circulation, due to fat and bone marrow embolism,” Shimizu said at the American Academy of Orthopaedic Surgeons 74th Annual Meeting.
Study methods
Shimizu and his colleagues set out to determine the postoperative decrease ratio of pulmonary circulation, or the incidence of blood supply decrease, in 150 patients – including 25 cemented THA patients, 50 cementless THA patients, 25 cemented TKA patients and 50 cementless TKA patients.
Investigators performed 99mTc macroaggregated aluminum pulmonary scintigraphy 2 days to 3 days before surgery and 1 day to 2 days after surgery, Shimizu said.
They also conducted a qualitative analysis using single photon emission CT. Using this information, investigators calculated the decrease ratio of pulmonary circulation.
Overall, “The mean decrease ratio was 8.5%, and the highest decrease ratio of 38% was observed in a patient with cemented THA,” Shimizu said.
Broken down by patient group, investigators found the average decrease ratio of pulmonary circulation was 14.5% in cemented THA patients, 7% in cementless THA patients, 6% in cemented TKA patients and 7% in cementless TKA patients, according to a study abstract.
“In cemented THA, the decrease ratio was much higher than the other patient groups; however, there was no difference in body mass index (BMI), age and total cholesterol between cemented THA groups and other groups,” Shimizu said.
Image: Shimizu K |
Related risk factors
Looking individually at the risk factors, investigators found a greater decrease ratio in older patients, with an evident correlation between age and decrease ratio, Shimizu said. Likewise, the decrease ratio was greater in patients with higher total cholesterol values, and the investigators observed a significant correlation between total cholesterol values and the decrease ratio.
Although BMI has been labeled a cause of deep vein thrombosis, “no correlation [between BMI and greater decrease ratio] was evident, although there was a tendency for a higher decrease ratio in the patients with high BMI,” Shimizu said.
He added: “In older patients with high total cholesterol, cemented THA should be performed with care.”
For more information:Reference:
- Koh Shimizu, MD, can be reached at Chiba Rohsai Hospital, 2-16 Tatsumidai-Higashi, Ichihara City, Chiba prefecture 290-0003, Japan; +1-81-436-74-1111; e-mail: sara@kch.chuo.chiba.jp.
- Shimizu K, Shimizu S, Yamagata M, Saito M. Pulmonary embolism was more frequent in cemented THA than cementless THA and TKA. #163. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18, 2007. San Diego.