Paradoxic cerebral embolism after cemented knee arthroplasty: a report of 2 cases and prophylactic option for subsequent arthroplasty.

Major orthopaedic procedures that involve instrumentation of the medullary canal are well known to produce showers of embolic debris including fat, bone fragments, marrow constituents, and cement. A growing literature has identified paradoxic cerebral embolism as a rare but serious consequence of the passage of these emboli through an intracardiac right-to-left shunt to the cerebral arterial circulation. We report 2 cases of paradoxic cerebral embolism after cemented total knee arthroplasty and propose a novel treatment plan to prevent recurrent stroke during subsequent surgery.