The intramedullary pressure during the bone marrow trauma of total hip replacement surgery.

Abstract

It is known that complications occur frequently in connection with extensive intramedullary operative procedures. The destruction of the medullary circulation is followed by a partial cortical necrosis, which certainly will diminish if the intramedullary pressure during the operation is reduced. There are also general complications with cardio-pulmonary dysfunction possibly caused by pulmonary fat embolism. The same types of complication are likely to occur in connection with total hip replacement surgery, especially during the femoral phase of the operation. In this study it was found that very high intramedullary pressures were always produced when the prosthetic stem was forced down into the femoral cavity filled with acrylic cement, while the duration of the pressure elevations after this procedure showed greater variation. The importance of the high intramedullary pressures for the extent of devascularization and cortical necrosis is discussed, as well as its possible role as an aetiologk factor in the development of general complications such as fat embolism and sudden circulatory crises.