Serum and Breast Milk Levels of Methylmethacrylate Following Surgeon Exposure During Arthroplasty

Background: Although pregnant personnel are commonly encouraged to leave the operating room during the mixing and application of polymethylmethacrylate, we are not aware of any information regarding the safety of exposure to methylmethacrylate fumes for breastfeeding women. The present study was performed to investigate the concentrations of methylmethacrylate in serum and breast milk following exposure during total joint arthroplasty.

Methods: A survey designed to determine present-day attitudes to polymethylmethacrylate exposure during pregnancy and lactation was sent to members of the Ruth Jackson Orthopaedic Society and the National Association of Orthopaedic Nurses. To define the presence or absence of a scientific basis for this behavior, serum and breast milk samples were collected from two lactating surgeons at selected intervals after exposure to methylmethacrylate during eight total joint arthroplasty procedures. Two healthy breastfeeding women without exposure to methylmethacrylate served as controls. All twenty-five samples were analyzed for methylmethacrylate with use of a previously published headspace gas chromatography protocol.

Results: The gas chromatography protocol detected methylmethacrylate at levels as low as 0.5 part per million. No serum or breast milk sample demonstrated evidence of methylmethacrylate at that level, nor did any surgeon sample test at a higher level than the control specimens. Serum and milk samples spiked with methylmethacrylate yielded the analyte peak as expected, evidencing no interference from either matrix.

Conclusions: Methylmethacrylate was not detectable at the 0.5-part-per-million level in serum or breast milk following inhalational exposure during total joint arthroplasty. Although a controlled longitudinal relative risk analysis was not performed and the sample size was relatively small, pregnant or breastfeeding women may use this information to make an informed decision regarding such exposure.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.