ABSTRACT
The goal of this study is to assess the efficacy of a modified surgical technique, designed to limit the increase in intramedullary pressure during insertion of the prosthesis and to reduce intra-operative embolic events. Forty patients treated with total hip replacement in Tanta university hospitals divided into 2 groups [group 1] treated with conventional cementing technique and [group 2] treated with a modified cementing technique with a cannula inserted into the intertrochanteric region of the femur to decrease the intramedullary pressure to avoid the increase of the intramedullary pressure after application of the cement and insertion of the stem. There was a significant difference between the incidence of embolism and increased pulmonary artery pressure [detected by trans-thoracic Echocardiography] between both groups of patients where the incidence of both were found to be much lower when the modified technique was used. Also the changes in the hemodynamic parameters [heart rate, blood pressure, and central venous pressure] accompanying the appearance of emboli in Echocardiography especially grades 2 and 3 embolism were found to be significant in the conventional cementing group [p<0.05]. The changes in the respiratory parameters [decreased oxygen saturation, decreased arterial oxygen tension, decreased end tidal CO2, and increased arterial CO2] accompanying the appearance of emboli in Echocardiography especially grades 2 and 3 embolism were found to be significant in the conventional cementing group [p<0.05]. Modified surgical technique [A vacuum drainage of the proximal femur along the linea aspera] was found to be effectively reducing the incidence of embolization during cemented hip arthroplasty