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. 2022 Apr;48(2):721-729.
doi: 10.1007/s00068-020-01587-8. Epub 2021 Jan 26.

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

Karoline Weingärtner  1   2 , Philipp Störmann  1 , David Schramm  1   3 , Sebastian Wutzler  1   3 , Kai Zacharowski  2 , Ingo Marzi  1 , Thomas Lustenberger  4
Affiliations

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

Karoline Weingärtner et al. Eur J Trauma Emerg Surg. 2022 Apr.

Abstract

Background: Every year, ~ 210,000 initial implantations of hip endoprostheses are carried out in Germany alone. The "bone cement implantation syndrome" (BCIS) is considered a severe peri- and early-postoperative complication when implanting cemented prostheses. The origin of the BCIS and its impact on the clinical outcome are still uncertain. This study investigates the clinical progression after BCIS cases in patients with cemented hemiarthroplasty. Risk factors for the occurrence of BCIS are evaluated.

Material and methods: Clinical data of all patients with a proximal femur fracture and which received a cemented hemiarthroplasty within a period of 9.5 years have been collected. BCIS (+) patients and BCIS (-) patients were compared with respect to their demographics and clinical outcome. Risk factors for the development of BCIS were identified.

Results: A total of 208 patients could be included with complete data sets. The mean age was 81.1 ± 10.0 years. Overall, 37% of the patients showed symptoms of BCIS. In comparison to BCIS (-) patients there was a significantly higher rate of cardiovascular complications (27.3% vs. 13.7%, p = 0.016) and a higher in-hospital mortality rate (15.6% vs. 4.6%, p = 0.006) in BCIS (+) patients. Age, absence of a femoral borehole and ASA status were identified as statistically significant risk factors of BCIS.

Conclusion: BCIS is frequently observed and in some cases severe complication. The therapy is exclusively symptomatic; identifying preventional measures might reduce the occurrence of BCIS.

Keywords: Bone cement implantation syndrome; Hip hemiarthroplasty; Outcome; Palacos reaction; Risk factors.

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Conflict of interest statement

Weingärtner K, Störmann P, Schramm D, Wutzler S, Zacharowski K, Marzi I, and Lustenberger T declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
Change in systolic blood pressure during cement application stratified by BCIS severity. (Δ RR systolic = RR systolic after − RR systolic before cement application) (mean values ± standard deviation)
Fig. 3
Fig. 3
Change in diastolic blood pressure during cement application stratified by BCIS severity. (Δ RR diastolic = RR diastolic after − RR diastolic before cement application) (mean values ± standard deviation)
Fig. 4
Fig. 4
Change in oxygen saturation during cement application stratified by BCIS severity. (Δ SaO2 = SaO2 after – SaO2 before cement application) (mean values ± standard deviation)
Fig. 5
Fig. 5
In-hospital mortality stratified by BCIS severity
See this image and copyright information in PMC

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