Reduction of fat embolic risks in total hip arthroplasty using cannulated awls and rasps for the preparation of the femoral canal

Fat embolic phenomena during cemented and non-cemented total hip arthroplasty occur even during the preparation of the femoral canal. This should be avoided in order to reduce the rate of fat embolic syndrome. In the present prospective study we demonstrate the benefit of cannulated awls and rasps in the reduction of fat embolic phenomena by means of transoesophageal echocardiography and extended cardiopulmonary monitoring. Two groups of 5 patients each with identical surgical procedures were treated either with cannulated (group 1) or with closed (group 2) awls and rasps. In group 1 no macroemboli but three embolic showers grades 1 and 2 were seen. In contrast to these findings, three macroemboli and four embolic showers grades 1 and 3 were demonstrated in group 2. We recommend cannulated awls and rasps for the preparation of the femoral canal in cemented and non-cemented total hip arthroplasty. They are a simple and inexpensive aid to avoid fat embolic syndrome.