Intramedullary epinephrine and surgical hole on femoral cortex before intramedullary Kwire and bone cement insertion resulting in lower amount of PMMA polymethyl methacrylate particles on rabbits myocardium

Background: Cemented hip arthroplasty can result in devastating complication such as Bone Cement Implantation Syndrome (BCIS). BCIS consists of decreased blood pressure, decreased heart rate, a decrease of consciousness, and sudden death. This devastating condition caused by systemic circulation of polymethyl methacrylate (PMMA). Decrease heart rate caused by PMMA reaction with the heart muscle. PMMA reach heart muscle due to the increased intramedullary pressure and the opening of the intramedullary blood vessel during cementation. Aim: The purpose of this study is to prove that intramedullary epinephrine and femoral hole before the insertion of bone cement and K-wire result in the lower amount of PMMA in rabbit’s myocardium. Methods: This research is conducted as experimental research with post-test only control group design with the subject rabbits. A total of 28 research subjects who met the inclusion criteria of the study were randomly divided into treatment and control groups. The control group did not receive epinephrine and femoral hole treatment. Treatment group 1 received epinephrine intramedullary only, treatment group 2 received femoral hole only, and treatment group 3 received intramedullary epinephrine and femoral hole. Results: Statistical analysis using parametric tests one-way ANOVA found a significant difference between treatment and control groups on the amount of rabbit’s heart muscle. The amount of PMMA particle in all treatment groups are lower than the control group with a p-value of 0.000 (p<0.05). The amount of PMMA particle in treatment group 3 (received epinephrine and femoral hole) is lower than the control group with a p-value of 0.000 (p<0.05). Conclusion: The conclusion of this research is intramedullary epinephrine and femoral hole making before the insertion of bone cement and K-wire result in the lower amount of PMMA particle in rabbit’s myocardium