Bone cement implantation syndrome in hip arthroplasty: Frequency, severity and prevention

Bonfait, H.; Delaunay, C.; Thomasson, E. de; Tracol, Philippe; Werther, Jean-Roger

doi:10.1016/j.otsr.2021.103139

Cited by 12 publications

(4 citation statements)

References 26 publications

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“…In our department, no scheduled orthopedic intervention presented this accident. A recent study [ 33 ] suggested that this syndrome is six times more frequent in trauma cases than in elective surgeries (0.71% compared to 0.12%), and, more important, mortality was 10 times higher (0.17% compared to 0.017%, p < 0.001). It is clear that the biologic state of the individuals together with the associated comorbidities play an important role in triggering the pathophysiological mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Bone Cement Implantation Syndrome: A Rare Disaster Following Cemented Hip Arthroplasties—Clinical Considerations Supported by Case Studies

Moldovan

2023

JPM

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Severe symptoms such as hypoxemia, hypotension, and unexpected loss of consciousness may develop during surgical interventions that use polymethyl methacrylate (PMMA), or as it is commonly known, bone cement. Physicians recognize this amalgam of clinical manifestations more and more as a distinct entity that bears the name of bone cement implantation syndrome (BCIS). Trauma cases, especially hip fractures, are seen to have a higher incidence of developing this complication compared to orthopedic elective ones. This research aims to present a detailed description of six severe BCIS cases in order to raise awareness and to emphasize its importance. Five of them had fatal outcomes, which demonstrate the necessity of future research on this topic, as little is known about it presently. In the Discussion section, a narrative overview from the scientific literature is performed on potential risk factors, prevention measures, and management strategies. The experience gathered through this case series may aid medical staff in the development of diagnostic and therapeutic protocols, thus improving safety when cemented surgical techniques are used on a high-risk group of patients.

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Section: Discussionmentioning

confidence: 99%

Bone Cement Implantation Syndrome: A Rare Disaster Following Cemented Hip Arthroplasties—Clinical Considerations Supported by Case Studies

Moldovan

2023

JPM

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“…Based on our findings, there is an increased risk of mortality with cemented stem fixation: for every thousand surgeries performed, 107 patients would potentially be saved if they have cementless fixation. Two reasons could explain the higher mortality rate associated with cement: first the physiological reaction induced by cement 39 including hypersensitivity and lung reaction could cause death. Second, the surgeon could choose to use cement due to poor bone quality.…”

Section: Discussionmentioning

confidence: 99%

Reduced mortality associated to cementless total hip arthroplasty in femoral neck fracture

Pangaud,

Pauly,

Jacquet

et al. 2023

Sci Rep

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Mortality related to femoral neck fractures remains a challenging health issue, with a high mortality rate at 1 year of follow-up. Three modifiable factors appear to be under control of the surgeon: the choice of the implant, the use of cement and the timing before surgery. The aim of this research project was to study the impact on mortality each of these risk factors play during the management of femoral neck fractures. A large retrospective epidemiological study was performed using a national database of the public healthcare system. The inclusion criteria were patients who underwent joint replacement surgery after femoral neck fracture during the years 2015 to 2017. All data points were available for at least 2 years after the fracture. The primary outcome was mortality within 2 years following the surgery. We evaluated the association between mortality and the type of the implant hemiarthroplasty (HA) versus total hip arthroplasty (THA), cemented versus non cemented femoral stem as well as the timing from fracture to surgical procedure. A multivariate analysis was performed including age, gender, comorbidities/autonomy scores, social category, and obesity. We identified 96,184 patients who matched the inclusion criteria between 2015 and 2017. 64,106 (66%) patients underwent HA and 32,078 (33.4%) underwent THA. After multivariate analysis including age and comorbidities, patients who underwent surgery after 72 h intra-hospital had a higher risk of mortality: Hazard Ratio (HR) = 1.119 (1.056–1.185) p = 0.0001 compared to the group who underwent surgery within 24 h. THA was found to be a protective factor HR = 0.762 (0.731–0.795) p < 0.0001. The use of cement was correlated with higher mortality rate: HR = 1.107 (1.067–1.149) p < 0.0001. Three key points are highlighted by our study in the reduction of mortality related to femoral neck fracture: the use of hemiarthroplasty a surgery performed after 48 h and the use of cement for femoral stem fixation adversely affect mortality risk.

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“…Although the syndrome is poorly understood and has no standard definition, its clinical presentation is mostly characterized by hypoxia [ 10 , 11 ], systemic hypotension [ 10 , 12 ], pulmonary hypertension [ 12 , 13 ], cardiac arrhythmias [ 14 ], loss of consciousness and eventually cardiac arrest [ 15 , 16 ]. In different published articles, these clinical features were reported to occur at one of the following time points during surgery, which might be cementation, prosthesis insertion, joint reduction or, rarely, limb tourniquet deflation in a patient undergoing cemented arthroplasty [ 8 , 17 , 18 , 19 ].…”

Section: Bone Cement Implantation Syndromementioning

confidence: 99%

Bone Cement and Its Anesthetic Complications: A Narrative Review

Al-Husinat

Jouryyeh

Sharie

et al. 2023

JCM

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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.

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Bone cement implantation syndrome in hip arthroplasty: Frequency, severity and prevention

Cited by 12 publications

References 26 publications

Bone Cement Implantation Syndrome: A Rare Disaster Following Cemented Hip Arthroplasties—Clinical Considerations Supported by Case Studies

Bone Cement Implantation Syndrome: A Rare Disaster Following Cemented Hip Arthroplasties—Clinical Considerations Supported by Case Studies

Reduced mortality associated to cementless total hip arthroplasty in femoral neck fracture

Bone Cement and Its Anesthetic Complications: A Narrative Review

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