The Journal of Arthroplasty
Volume 16, Issue 3 , Pages 288-292, April 2001

Systemic fat and thrombus embolization in patients undergoing total knee arthroplasty with regional heparinization☆☆☆

Presented in part at The Canadian Orthopaedic Association, Annual Meeting, June 1998, Ottawa; the 9th Annual Scientific Sessions, American Society of Echocardiography, June 1998, San Francisco; and The Canadian Anesthesiologists' Society Annual Meeting, June 1998, Toronto.

From the Divisions of *Orthopaedic Surgery, †Cardiology, and Departments of ‡Anesthesiology, and §Laboratory Medicine, The Ottawa Hospital, General Campus; and the ∥University of Ottawa, Ottawa, Ontario, Canada

Received 31 March 2000; accepted 8 November 2000.

Abstract 

A double-blind, randomized, controlled study was undertaken to determine if a technique of intraoperative anticoagulation would decrease the incidence or severity of venous embolization after tourniquet release during total knee arthroplasty. Sixty-six patients were randomized to receive either the heparin or placebo treatment. Transesophageal echocardiography was performed before and after tourniquet release to detect embolic material in the right atrium. Transient opacification of the right atrium was observed in all patients within the first 30 seconds after tourniquet release. Regional limb heparinization is not effective in reducing the intensity of right atrium opacification because much of the echogenic material was composed of fat rather than thrombus.

Keywords:  echogenic material, systemic heparinization, total knee arthroplasty

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☆ Funds were received from Johnson & Johnson Inc. and Hip Hip Hooray (Canadian Orthopaedic Association Foundation) in partial support of the research material described in this article.

☆☆ Reprint requests: A. Alan Giachino, MD, The Ottawa Hospital, General Campus, 501 Smyth Road, Suite 5004, Ottawa, Ontario K1H 8L6. E-mail: agiachino@ottawahospital.on.ca.

PII: S0883-5403(01)39192-1

doi:10.1054/arth.2001.21457

The Journal of Arthroplasty
Volume 16, Issue 3 , Pages 288-292, April 2001

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