Cemented Hip Arthroplasty: Dealing with Bone Cement Implantation Syndrome

Abstract

Bone Cement Implantation Syndrome (BCIS) is a rare but potentially fatal complication of cemented orthopedic surgery, 0.5 – 1.7% resulting in cardiovascular collapse. BCIS characterized by hypoxia and/or hypotension, pulmonary hypertension, arrhythmias, loss of consciousness, and the worst is cardiac arrest. We experienced two cases with fatal outcomes. Methods: Two case report were reviewed from medical record and meeting discussion between orthopedic and anesthesiologist department. Case Presentation: Hip hemiarthroplasty was performed in two patients on February and March 2019. A 90-years-old man had history of cemented hemiarthroplasty on his left hip two years ago, low back pain, and osteoporosis, and a 77-years-old woman had no history of cemented hemiarthroplasty, controllable diabetic, corrected hypo-albumin. Both of them have same BCIS high risk comorbidity as right intertrochanter fracture, geriatric, and ASA III. Five minutes after cementation, the patients suffered a cardiac arrest and anesthesiology’s team start CPR with advanced cardiac life support protocols, surgeon finished the surgery immediately, and patients transferred to Intensive care, but the patient didn’t survive. Discussion: These cases urge us to pay more attention to BCIS and some recommendation must be made to improve better management and increasing the survival chances. With agreement of final theory of BCIS etiology is multimodal model, the understanding of cement behavior and cementing techniques are the keys of orthopedic role. Preparation, closely observation at peri-cementing to 24 hours post-surgery, and appropriate management are the keys of anesthesiologist role. As a concrete recommendation that our discussed, BCIS risk assessment tools made by Cheryl and Angela at AORN journal are believed to be able to increase alertness and preparation to manage severe BCIS. Conclusion: Propose a pre-operative BCIS risk assessment tool based on Cheryl and Angela’s tool to minimalized fatality of BCIS incidence is being our concern. Alongside that, communication and suggestion protocol between surgeon and anesthesiologist, knowing the BCIS clinical features, timing of BCIS incident, and informed concern are important to BCIS management.