A monitored cardiovascular collapse during cemented total knee replacement

Abstract

The GUEPAR hinged prosthesis is used for total knee replacement in severely damaged or unstable knees or for revision arthroplasty. The GUEPAR prosthesis requires reaming of both tibial and femoral intramedullary canals and the insertion of long-stemmed (125 and 145 mm) prostheses into both the femur and tibia. In theory the use of two cemented prostheses simultaneously effectively doubles the possibility for marrow embolism that has been reported after total hip arthroplasty. An intraoperative cardiac arrest and death recently occurred in our hospital during insertion of such a prosthesis. Postmortem examination revealed massive pulmonary marrow and fat embolism. Because of this experience, we continuously monitored arterial blood pressure (BP), end-tidal carbon dioxide concentration (PET(CO2)), oxygen saturation, and precordial heart sounds on the next patient having this procedure.