Bone cement implantation syndrome: a scoping review

Abstract

Background: Bone cement implantation syndrome comprises the occurrence of hypoxaemia, hypotension, unexpected loss of consciousness, or cardiac arrest occurring around the time of cementation, prosthesis insertion, or reduction of the joint in arthroplasty. As the yearly number of arthroplasties will increase, the number of complications including bone cement implantation syndrome is also expected to increase. Therefore, a good understanding of this syndrome is important. This scoping review aims to provide a comprehensive overview of the current knowledge of bone cement implantation syndrome.

Methods: This scoping review was conducted based on the PRISMA-ScR Checklist. A literature search was done in PubMed, Cochrane, and Embase. A total of 85 studies were included in the study.

Results: The incidence of bone cement implantation syndrome during cemented hip or knee arthroplasty varied from 15.4% to 46.7% and 27.5% to 70.7%, respectively. The incidence in shoulder arthroplasty was 16.2%. In uncemented hip arthroplasty, the incidence ranged from 0.0% to 21.8%. Risk factors identified for bone cement implantation syndrome included advanced age, ASA physical status 3 or 4, and primary lung cancer or lung metastasis.

Conclusions: Bone cement implantation syndrome is a potentially severe complication that can occur during both cemented and uncemented arthroplasty. Moreover, the occurrence of bone cement implantation syndrome is not dependent on the use of cement. However, the severity does seem to have an association with the fixation method.

Keywords: bone cement implantation syndrome; cementation; cemented arthroplasty; desaturation; hypotension; hypoxia; uncemented arthroplasty.