Abstract
Hip and knee replacements are common and successful surgeries in orthopaedics. One of the known complications is fat embolism. Cemented implants used in arthroplasty allow good implant fixation and excellent long term results. However this has been associated with an increased incidence of fat embolism.
This experimental animal study compared the amount of fat embolism following three different surgeries in 30 Sprague Dawley rats. These surgeries simulated hip replacement procedures and included a control surgery, an un-cemented implant and a cemented implant. These animals were then sacrificed at 24 hours. All the lungs were fixed in formalin and then stained using Osmium Tetroxide. The amount of fat was then counted using a light microscope at 40x power.
Both the uncemented implant group (p < 0.001) and the cemented implant groups (p < 0.003) had significantly higher fat emboli from the surgical control group. There were also a significantly higher number of emboli (p < 0.05) in the cemented implant group compared to the uncemented implant group.
We conclude that fat embolism occurs in both the un-cemented and cemented hip replacement. The amount of emboli created by un-cemented hip replacement is less than the cemented hip replacement. The cement itself does not cause the complication of fat embolism. It is the high intramedullary pressure associated with the insertion of the implant, and the cementing process, that contributes to fat embolism. Devices or surgery that minimise this rise in pressure could reduce the amount of fat embolism.
Correspondence should be addressed to Associate Professor N. Susan Stott at Orthopaedic Department, Starship Children’s Hospital, Private Bag 92024, Auckland, New Zealand
