Bone Cement Implantation Syndrome (BCIS) is a poorly-understood but serious side effect in patients undergoing hip surgery with bone cement. It can rapidly cause pulmonary embolism or death. It can also cause ongoing problems with low oxygen in the bloodstream (hypoxia) and confusion.
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What is Bone Cement Implantation Syndrome?
Bone Cement Implantation Syndrome (BCIS) is a rare but life-threatening condition that most often occurs during hip arthroplasty. BCIS usually occurs within a few minutes after bone cement is injected into a patient’s body. For unknown reasons, the bone releases fat and marrow into the bloodstream. The fat and marrow travel in the bloodstream until they reach the lungs, heart, or other organs, where the clog arteries. This can lead to life-threatening complications, including cardiac arrest.
Causes
No one knows exactly what causes BCIS, but the condition is more common in older patients, especially those who have other health problems. During hip surgery (hemiarthroplasty), it is possible that injecting bone cement pushes marrow contents under high pressure from the femoral canal into the bloodstream. It is also possible that bone cement under high pressure releases methyl methacrylate cement monomers into circulation.
Prevention
Surgeons may be able to prevent BCIS by meticulously cleaning the femoral canal before introducing bone cement, venting the femoral canal to keep pressure low, and slowly inserting the femoral component, according to doctors interviewed by Medscape.
Symptoms
- Sudden decrease in blood pressure (hypotension)
- Abnormal heart rhythm
- Increased pulmonary vascular resistance (PVR)
- Hypoxia (low oxygen in the bloodstream)
- Loss of consciousness
- Confusion
Complications
- Pulmonary embolism: When marrow and fat enter the bloodstream from the lower part of the body, they can travel to the lungs and obstruct arteries.
- Cardiac arrest or heart failure: Condition when the heart suddenly and unexpectedly stops beating.
- Death: In June 2014, the British Medical Journal published a study estimating that 1 in 3,000 people treated with bone cement in hip surgery suffers a severe adverse event. They reported 41 deaths from 2005-2012.
Resources
- Bone Cement Implantation Syndrome — British Journal of Anesthesiology, 2009
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