Acute hypotension, hypoxemia, cardiac arrhythmias, cardiac arrest, (or a combination of these), and sudden death are well-recognized complications of the cemented hip arthroplasty procedure. Collectively, these are known as the bone cement implantation syndrome (BCIS). The endogenous cannabinoids, anandamide (ANA) and 2-arachidonylglycerol (2-AG), are reported to be strong vasodilators and play a role in the hypotension associated with hemorrhagic and septic shock. In the present study, a potential role for the endogenous cannabinoids in influencing hemodynamic variables in BCIS was investigated. Thirty-five patients (35 hips) entered a prospective, randomized clinical trial. The patients were divided into two groups. Group 1 comprised 16 patients who had the component inserted using a conventional cementing technique, whereas group 2 consisted of 19 patients who had the femoral component inserted without cement. Blood samples were taken at six consecutive time points: before anesthesia, after reaming the femur, 2 min after insertion of stems with or without cement into the femur, and 10 min, 20, and 30 min after stem insertion. In group 1 (with cement), the mean levels of ANA and 2-AG significantly increased after stem insertion. In a comparison of each group after stem insertion, mean ANA and 2-AG levels in group 1 also significantly differed from those in group 2. By contrast, in group 2 (without cement) neither ANA nor 2-AG levels exhibited a significant increase or change at any point in time. In conclusion, we have shown for the first time that endogenous cannabinoids are candidates for lipid mediators of BCIS.

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We perfomed cementless total hip arthroplasty (THA) with block bone grafting for acetabular dysplasia in 24 hips since 1988 and reviewed radiographic findings for them. The average period of follow-up was 8.1 years (range 5.2 to 11.4 years). The average age at operation was 58.5 years (range 38 to 69). The types of radiographic fixation were classified according to the criteria of Engh et al as follows : optimum fixation in 17 hips, suboptimum fixation in 5 hips, and unstable fixation in 2 hips.Although the area of the cup covered by graft bone was less than 30%, 2 hips were unstable.These results suggest that not only cup coverage ratio but other factors may affect fixation.

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