Bone Cement Implantation Syndrome during Cemented Hemiarthroplasty Surgery: A Case Report

Dary Gunawan, Anak Agung Ngurah Ronny Kesuma, I Komang Mahendra Laksana M

Abstract: Introduction: The increase of life expectancy makes the elderly population increase. This is also related to the degeneration of bones and joints and the increasing number of patients requiring arthroplasty, as well as morbidity and mortality. Cemented arthroplasty is still an option in this treatment. However, in practice a cement reaction or Bone Cement Implantation Syndrome (BCIS) can occur. BCIS can present with symptoms such as hypoxia, hypotension or both, and decreased consciousness or even worse cardiac arrest. Case description: This case report describes an 83 year old woman who underwent a cemented hemiarthroplasty bipolar surgery. During the operation, the patient is in a stable condition until the moment cement was inserted, the patient's hemodynamics gradually become unstable. Handling was done quickly and precisely, thereafter, hemodynamic stability was achieved. Discussion: Several risk factors that play a role in the occurrence of BCIS such as history of cardiovascular disease and pulmonary disease, advanced age, osteoporosis, fracture type, metastatic bone disease, femoral canal diameter of more than 21mm, previously non-instrumented femoral canal, and patent foramen ovale. The use of appropriate inotropes, vasopressors, and surgical techniques can reduce the risk of BCIS. Conclusions: Appropriate management and collaboration between the surgeon and anesthesiologist can prevent worsening of BCIS. Administration of high levels of oxygen fractions, as well as inotropes and vasopressors are useful for preventing intravascular volume depletion.

Keywords: cemented arthroplasty, fracture, cement reaction