Pathological evaluation of venous emboli during total hip arthroplasty

Abstract

One of the possible causes of bone cement implantation syndrome during total hip arthroplasty is pulmonary embolism, as has been suggested by a characteristic image seen during transoesophageal echocardiography, the so-called 'Snow Flurry'. However, the nature of the embolic material has not been definitively determined. We studied seven patients undergoing cemented or uncemented total hip arthroplasty. 'Snow Flurry' images were detected in all patients. Blood was aspirated from the right atrium during 'Snow Flurries' and was subjected to pathological examination. Amorphous, eosinophilic, fine granular material was seen in all specimens. The material did not originate from cement. Fat and bone marrow were not detected. The material seen may consist of fine particles of bone ('bone dust') originating from reamed bone.