Abstract
Aims: To assay the intraoperative cerebral microemboli load during primary total knee arthroplasty(TKA) using transcranial Doppler ultrasound. A battery of ten neuropsychiatric tests were carried out pre and post operatively to examine the change in cognitive outcome. The relationship between emboli load and neuropsychiatric outcome was examined.
Methods: Patients undergoing primary TKA, with no history of stroke, TIA, ongoing CNS disease or alcoholism included. Pre (baseline) and post operative (6 weeks and 6 months) neuropsychiatric tests performed. Scores were recorded as “z change” scores compared with baseline. All operations were carried out under a standardised general anaesthetic and performed by two consultant orthopaedic surgeons. Microemboli load recorded, using transcranial Doppler ultrasound (TCD), onto VHS tape for subsequent playback and analysis.
Results: 50 TKA patients were studied. Cerebral microembolisation occurred in 63% of TKA patients. Mean microembolic load for TKA patients was 3.83 (range=0–57).
There was no significant change in neuropsychiatric outcome from baseline in these patients at 6 weeks or 6 months. Those patients that experienced cerebral microembolisation did not significantly differ in neuropsychiatric outcome from those that did not.
Conclusion: Intraoperative cerebral microembolisation occurs in almost half of patients during knee arthroplasty. Emboli loads are low and do not appear to cause early or late changes in neuropsychiatric outcome.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
