Bone Cement and Its Anesthetic Complications: A Narrative Review

Abstract

The concept of bone cement implantation syndrome (BCIS) is not yet fully understood. In patients undergoing cemented hip arthroplasty, it is a significant factor in intraoperative mortality and morbidity. It may also manifest in a milder form postoperatively, resulting in hypoxia and confusion. In the older population, hip replacement surgery is becoming more prevalent. The risks of elderly patients suffering BCIS may be increased due to co-existing conditions. In this article, we present a narrative review of BCIS including its definition, incidence, risk factors, etiology, pathophysiology, clinical features, prevention, and management, all from an anesthetic point of view.

Total Knee Arthroplasty Revision in the Setting of Periprosthetic Joint Infection Resulting in Bone Cement Implantation Syndrome (BCIS), Pulseless Electrical Activity (PEA) Arrest, and Intraoperative Death: A Case Report and Literature Review

“…PMMA, sometimes referred to as MMA or bone cement , was first used in orthopedic surgery in 1965 and later received approval from the U.S. Food and Drug Administration (FDA) in 1970 [ 1 ]. In 1970, Powell et al.…”

“…This mechanism proposes that when activated for use in orthopedic surgery, MMA results in a very strong exothermic reaction that results in the rapid expansion of the bone cement within the desired bone cavity in which it is placed. It has been postulated that MMA has very strong direct cardiopulmonary depressant effects and is rapidly absorbed into the bloodstream via the bone marrow, resulting in a rapid and noxious bolus to the heart and lungs once placed in the patient [ 1 ]. In vitro studies demonstrated direct vasodilatory effects of MMA; however, in vivo animal studies failed to demonstrate sufficient plasma concentration of MMA following cemented hip arthroplasty to achieve the significant cardiopulmonary effects commonly seen in BCIS [ 1 , 3 ].…”

“…It has been postulated that MMA has very strong direct cardiopulmonary depressant effects and is rapidly absorbed into the bloodstream via the bone marrow, resulting in a rapid and noxious bolus to the heart and lungs once placed in the patient [ 1 ]. In vitro studies demonstrated direct vasodilatory effects of MMA; however, in vivo animal studies failed to demonstrate sufficient plasma concentration of MMA following cemented hip arthroplasty to achieve the significant cardiopulmonary effects commonly seen in BCIS [ 1 , 3 ]. This discrepancy led to the more recently developed and proposed embolus-mediated model.…”

“…The aforementioned particles are rapidly absorbed into the bone marrow due to a combination of high intramedullary chemical pressure (resulting from the exothermic reaction) and mechanical pressures applied during the cementing process of the new prosthesis into its desired location. This well-known phenomenon results in the observable showering of emboli to the right heart and subsequently to the lungs, which is characteristically seen in intraoperative TEE in cases of BCIS [ 1 ]. These showers of pulmonary emboli (and bone particles) are thought to cause hypoxia and RV dysfunction, ultimately leading to hypotension, characteristic of BCIS.…”

Zn-Doped Calcium Magnesium Phosphate Bone Cements Based on Struvite and Their Antibacterial Properties

“…Bone cement was originally named "materials based on polymethyl methacrylate" and are currently used in clinical practice [8]. Nevertheless, these materials have several disadvan-tages, such as an exothermic setting reaction (which can lead to damage to adjacent tissues) and the need for revision surgery [9].…”