The role of bone cement for the development of intraoperative hypotension and hypoxia and its impact on mortality in hemiarthroplasty for femoral neck fractures

Abstract

Background and purpose — The bone cement implantation syndrome characterized by hypotension and/or hypoxia is a well-known complication in cemented arthroplasty. We studied the incidence of hypotension and/or hypoxia in patients undergoing cemented or uncemented hemiarthroplasty for femoral neck fractures and evaluated whether bone cement was an independent risk factor for postoperative mortality. Patients and methods — In this retrospective cohort study, 1,095 patients from 2 hospitals undergoing hemiarthroplasty with (n = 986) and without (n = 109) bone cementation were included. Pre-, intra-, and postoperative data were obtained from electronic medical records. Each patient was classified for grade of hypotension and hypoxia during and after prosthesis insertion according to Donaldson’s criteria (Grade 1, 2, 3). After adjustments for confounders, the hazard ratio (HR) for the use of bone cement on 1-year mortality was assessed. Results — The incidence of hypoxia and/or hypotension was higher in the cemented (28%) compared with the uncemented group (17%) (p = 0.003). The incidence of severe hypotension/hypoxia (grade 2 or 3) was 6.9% in the cemented, but not observed in the uncemented group. The use of bone cement was an independent risk factor for 1-year mortality (HR 1.9, 95% CI 1.3–2.7), when adjusted for confounders. Interpretation — The use of bone cement in hemiarthroplasty for femoral neck fractures increases the incidence of intraoperative hypoxia and/or hypotension and is an independent risk factor for postoperative 1-year mortality. Efforts should be made to identify patients at risk for BCIS and alternative strategies for the management of these patients should be considered.

The Effect of TBB, as an Initiator, on the Biological Compatibility of PMMA/MMA Bone Cement

“…Although the above-mentioned additive measures to counteract the negative physicochemical properties of bone cements were effective to improve its biocompatibility, cytotoxicity and clinical complications still remain significant concerns, due to the fundamental reaction and behavior of PMMA polymerization [8,21,32,[44][45][46]. In addition, adding ingredients can be an additional source of toxicity, like in the case of residual DmpT [41,47].…”

The mechanism by which enoxaparin sodium–high-viscosity bone cement reduces thrombosis by regulating CD40 expression in endothelial cells

“…The application of high-viscosity bone cement in clinical practice is accompanied by BCIS [ 2 , 8 ], which has an incidence rate as high as 28%. One of the causes of BCIS is embolism caused by bone cement implantation, including pulmonary embolism and lower limb venous embolism [ 9 ].…”

Bone cement implantation syndrome in cemented hip hemiarthroplasty—a persistent risk

“…While embolic material was detected in 61.5% of patients with cemented hip replacement, this was only the case in 5.9% of patients with cementless hip replacement (p < 0.05) [7]. Olsen et al described an incidence of BCIS of 28% [19]. Overall, however, the literature regarding the incidence of BCIS is sparse, mainly due to the fact that a precise definition of BCIS is still not available.…”

“…Olsen et al described an incidence of BCIS of 28% [ 19 ]. Overall, however, the literature regarding the incidence of BCIS is sparse, mainly due to the fact that a precise definition of BCIS is still not available.…”