Incidence and risk for Cement Implantation Syndrome after hemiarthroplasty

Background: Bone Cement Implantation Syndrome (BCIS) is a highly under-reported rare fatal complication of cementation, characterized by hypoxia, hypotension, cardiac arrhythmias, and cardiac arrest. With aim to alert surgeons about rare, but serious harm due to BCIS and its risk, clinical features, preventive measures and management, we evaluated the incidence and risk factor associated for BCIS in cemented hemiarthroplasty for fractures around hip.

Material & methods: All patients of fracture neck of femur or intertrochanteric, operated with cemented hemiarthroplasty, who sustained BCIS during or within 24 hrs of the cementation were included in the study. The BCIS was diagnosed, when the patient had hypoxia (SpO2 <94%) or fall in systolic blood pressure > 20mm. these patients were evaluated for presence of risk factors like age, sex, osteoporosis, use of diuretics, poor preexisting physical reserve, pre-operative cardiopulmonary function etc.

Results: In 430 patients of cemented hemiarthroplasty done of fractures around hip, 13 sustained BCIS. The mean age in these patients was 84.3 years. Severity was grade 1 in 7 patients, grade 2 in 4 patients and grade 3 in 2 patients. All the patients of the grade 1 and grade 2 were revived successfully, whereas none of the patients of the grade 3, could be revived. Age and poor cardiac reserves were most commonly associated with BCIS.

Conclusion: BCIS is a rare, preventable, fatal complication of cementation which can diagnosed early by constant monitoring. Management is supportive and preventive is best way by surgical modification with modern cementing techniques, especially in high risk patients.