The Journal of Bone and Joint Surgery. British volumeVol. 76-B, No. 2 ArticlesFree AccessHypotension during cemented arthroplastyAW McCaskie, WM Harper, PJ GreggAW McCaskieSearch for more papers by this author, WM HarperSearch for more papers by this author, PJ GreggSearch for more papers by this authorPublished Online:21 Feb 2018https://doi.org/10.1302/0301-620X.76B2.8113314AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Vol. 76-B, No. 2 Metrics Downloaded 79 times History Published online 21 February 2018 Published in print 1 March 1994 InformationCopyright © 1994, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

A study of the spatial and temporal parameters of gait was performed on 134 normal children, 68 boys and 66 girls, aged between three and 18 years. Normal gait showed a clear asymmetry; gait was considered to be abnormally asymmetrical if differences between left and right measurements exceeded 8 to 10 per cent. In addition, there was a definite bias comparing left and right sides, which may relate to individual laterality.

An episode of hypotension is common during cemented joint replacement, and has been associated with circulatory collapse and sudden death. We studied the mechanism of hypotension in two groups of six dogs after simulated bilateral cemented arthroplasty. In one group, with no lavage, the insertion of cement and prosthesis was followed by severe hypotension, elevated pulmonary artery pressure, decreased systemic vascular resistance and a 21% reduction in cardiac output. In the other group, pulsatile intramedullary lavage was performed before the simulated arthroplasties. Hypotension was less, and although systemic vascular resistance decreased, the cardiac output did not change. The severity of the hypotension, the decrease in cardiac output and an increase in prostaglandin metabolites were related to the magnitude of pulmonary fat embolism. Pulsatile lavage prevents much of this fat embolism, and hence the decrease in cardiac output. The relatively mild hypotension after lavage was secondary to transient vasodilation, which may accentuate the hypotension caused by the decreased cardiac output due to a large embolic fat load. We make recommendations for the prevention and management of hypotension during cemented arthroplasty.

Temporal and spatial parameters of gait were measured in 72 children with anomalous walking patterns as a result of neuromuscular impairment, 21 with childhood hemiplegia, 27 with congenital paraplegia and 24 with miscellaneous neuromotor disorders. Measurements were compared with those for a group of normal children. In all three groups, step length, average maximum foot-velocity and walking speed were reduced, double support time was increased, while cadence deviated from normal in both directions. Hemiplegic children varied considerably in their measured side-to-side gait asymmetries, suggesting a range of gait abnormalities not specified by subjective means alone. Measured gait parameters were significantly related to Hoffer grade of functional mobility in paraplegic children. Objective gait analysis using established temporal and spatial measurements is of clinical value in the management of childhood neuromuscular disorders.