Bone cement implantation syndrome in hip arthroplasty with cemented femoral component – A review of 459 patients

Abstract

Introduction: Bone cement implantation syndrome (BCIS) is a serious yet underreported complication in cemented hip arthroplasty. This study aims to determine the incidence of severe BCIS in cases with cemented femoral stems in hip arthroplasty (cemented stems) from a local tertiary centre. Methods: This is a retrospective study of patients done in the years 2014-2019. Records were identified from clinical data and recording system (CDARS). Patients with primary hip replacement were included. Patients undergoing revision surgery or patients with pathological fractures were excluded. Cementation was performed with modern technique. Patient clinical records and anaesthetic records were reviewed for any evidence of BCIS. BCIS was defined as hypoxia, hypotension or cardiovascular collapse during procedure. The severity was graded according to classification proposed by Donaldson et al in 2009 from grade 1 to grade 3. Results: A total of 524 patients were identified. 459 patients were included, in which 381 cases were cemented hemiarthroplasties for patients with fractured hip, and the remaining 78 cases cemented primary total hip replacements. The 30-day mortality rate was 1.52%. One patient had grade 2 and two patients had grade 3 BCIS. The incidence of severe BCIS was 0.65% (95% CI 0.21-2.01). All three patients were of American Society of Anaesthesiology (ASA) grade 3, two had pre-existing cardiovascular disease. There was no intraoperative mortality. Discussion: Elderly patients of ASA grade 3, or pre-existing cardiovascular disease may be at higher risk of BCIS. Adequate communication with anaesthetist before and during surgery is important for prevention and amelioration of BCIS.