We aimed to measure cerebral microemboli load during total hip [THA] and knee arthroplasty (TKA) using transcranial Doppler ultrasound (TCD) and to investigate whether cerebral embolic load influences neuropsychiatric outcome. The timing of the microemboli was also related to certain surgical activities to determine if a specific relationship exists and the presence of a patent foramen ovale was investigated.

Patients undergoing primary THA and TKA underwent a battery of ten neuropsychiatric tests pre-operatively and at 6 weeks and 6 months post-operatively. Microembolic load was recorded using TCD onto VHS tape for subsequent analysis. Patent foramen ovale detection was performed using bolus intravenous injection of agitated saline followed by valsalva manoeuvre. The timing of specific surgical steps was recorded for each operation and embolic load calculated for that period. All patients were assessed for quality of life and orthopaedic outcome measures.

To quantify the intraoperative cerebral microemboli load during primary total knee arthroplasty (TKA) using transcranial Doppler ultrasound and to investigate whether a patent foramen ovale influences cerebral embolic load in general.

Patients undergoing primary TKA, with no history of stroke, TIA, ongoing CNS disease or alcoholism were included. All operations were carried out under a standardised general anaesthetic and performed by two consultant orthopaedic surgeons. Microemboli l oad was recorded, using transcranial Doppler ultrasound (TCD), onto VHS tape for subsequent playback and analysis. Patent foramen ovale detection was performed using bolus intravenous injection of agitated saline followed by valsalva manoeuvre technique and TCD. Timing of specific surgical steps was recorded for each operation and emboli load calculated for that period.

Results: 50 TKA patients were studied (31 females, 19 males); 28 right and 22 left TKAs were performed. Cerebral microembolisation occurred in 19 patients (42%). Mean microembolic load was 3.56 per patient (range 0–21). PFO was detected in 9 patients (18%). Two thirds of PFO positive patients displayed cerebral microemboli. However, 36.6% (n=15) of PFO negative patients also displayed microemboli intraoperatively. Deflation of the tourniquet was followed by a larger microembolic load than the other phases of the operation.

Conclusion: Intraoperative cerebral microembolisation occurs in a significant proportion of patients during total knee arthroplasty. The presence of a patent foramen ovale does not appear to influence the incidence microemboli intraoperatively. Specific surgical activities are associated with generating greater embolic loads. These questions will be comprehensively assessed in the larger study currently underway.

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.

Aims: To compare the intraoperative cerebral microemboli load between primary total hip (THA) and knee arthroplsty (TKA) using transcranial Doppler ultrasound and to investigate whether a patent foramen ovale influences cerebral embolic load in general. The timing of the microemboli will be related to certain surgical activities to determine if a specific relationship exists. Methods: Patients undergoing primary TKA or THA, with no history of stroke, TIA, ongoing CNS disease or alcoholism included. All operations 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. Patent foramen ovale detection performed using bolus intravenous injection of agitated saline followed by valsalva manoeuvre technique and TCD. Timing of specific surgical steps recorded for each operation and emboli load calculated for that period. Results: 20 THA and 20 TKA patients were studied. Cerebral microembolisation occurred in 50% of THA and 40% of TKA patients. Total microembolic load for THA patients was 137 (range=0–83) and 50 (range=0–21) for TKA patients. Prevalence of PFO in the THA group was 35%, and 20% in the TKA group. 57.1% of PFO positive THA patients and 75% of PFO positive TKA patients displayed microemboli. Insertion of the femoral component in THA and release of the tourniquet in TKA were associated with higher cerebral microemboli load. Conclusion: Intraoperative cerebral microembolisation occurs in almost half of patients during hip and knee arthroplasty. Patients who have a PFO appear more likely to be associated with cerebral embolisation. Specific surgical activities are associated with larger embolic loads.

Aims: To quantify the intraoperative cerebral microemboli load during primary total hip arthroplasty (THA) using transcranial Doppler ultrasound and to investigate whether a patent foramen ovale influences cerebral embolic load in general. The timing of the microemboli will be related to certain surgical activities to determine if a specific relationship exists.

Methods: Patients undergoing primary THA, with no history of stroke, TIA, ongoing CNS disease or alcoholism were included. All operations were carried out under a standardised general anaesthetic and performed by two consultant orthopaedic surgeons. Microemboli load was recorded, using transcranial Doppler ultrasound (TCD), onto VHS tape for subsequent playback and analysis. Patent foramen ovale detection was performed using bolus intravenous injection of agitated saline followed by valsalva manoeuvre technique and TCD. Timing of specific surgical steps was recorded for each operation and emboli load calculated for that period.

Results: 25 THA patients were studied (18 females, 7 males) 16 right and 9 left THA’s were performed. Cerebral microembolisation occurred in 10 patients (40%). Mean microembolic load was 5.52 per patient (range = 0–83). PFO was detected in 8 patients (32%). 37.5% of PFO positive patients displayed cerebral microemboli. However, 41.1% of PFO negative patients also displayed microemboli intraoperatively.

Insertion of the femoral component was associated with generating a larger microembolic load than the other phases of the operation.

Conclusion: Intraoperative cerebral microembolisation occurs in a significant proportion of patients during total hip arthroplasty. The presence of a patent foramen ovale does not appear to influence the incidence microemboli intraoperatively. Specific surgical activities are associated with generating greater embolic loads. These questions will be comprehensively assessed in the larger study currently underway..