Bone cement (PMMA) arterio-venogram following total hip arthroplasty - Case series

Dangers with cementation under low-viscosity state: Cement arterio-venogram and bone cement implantation syndrome

Cement arterio-venogram is a rare event with cement extrusion into femoral nutrient vessels. In literature it is known to be benign with no significant clinical sequelae. It is postulated that it is due to high cement implantation pressure, that results in optimal cement filling quality. All previously reported cases were female patients, and it is thought to be a female only phenomenon due to the relatively narrow femoral canal leading to higher pressures during cementation. In this case series we report 3 cases different to existing literature. All 3 patients showed a cement arterio-venogram together with bone cement implantation syndrome and hypotension intraoperatively. It was also observed that during implantation the cement was of low viscosity. We postulate low cement viscosity during implantation with pressurization is also a contributing factor to these phenomena. This case series also demonstrates the first 2 male cases, showing this the even can occur in males too. The cement arteriovenogram is located at 41%–42% femur length which is within the ‘third sixth’ of the length of the femur. Good cementation techniques and prevention is also highlighted in this report.

Cement arteriovenogram after hip arthroplasty

Modern cement implantation techniques during hip arthroplasty rely on high intramedullary pressures which can result in cement extrusion towards femoral nutrient vessels, and thus, the occurrence of a particular image in postoperative radiographs (bone cement arterio-venogram). We report a case series of 14 patients in whom a bone cement arterio-venogram was observed after undergoing a cemented hip arthroplasty. No local or systemic complications developed after cementing nor during a mean follow-up of three years. Bone cement arterio-venogram is a radiologic sign that indicates a good cement pressurisation during surgery and is not associated to medical complications or periprosthetic femoral fractures.

[Progress on reconstruction of proximal femur in the hemiarthroplasty for intertrochanteric fracture with distal fixated long stem]

OBJECTIVE

To summarize the application of distal fixated long stem in the treatment of intertrochanteric fracture (ITF) in the sequence of proximal femoral reconstruction, fixation materials, and other details after operation, in order to improve doctor's attention to the reconstruction of the proximal femur and reduce complications.

METHODS

The related literature about the application of distal fixated long stem in the treatment of ITF was extensively reviewed, summarized, and analyzed.

RESULTS

The sequence of reconstruction is divided into fracture reconstruction priority and prosthesis reconstruction priority. The former is mainly to provide an anatomical reference for the placement of joint prostheses, the latter is mainly to provide support for fracture fixation. The distal fixated cement long stem and cementless long stem have their own characteristics, and materials of reconstruction are used in combination. There is no uniform standard for the sequence and materials of reconstruction.

CONCLUSION

Although the stability of the distal fixated long stem depends on the distal femur, the accurate reconstruction of the proximal femur is still worthy of attention.