BCIS

Q 28 years old motorbike rider, is taken to the Operating Room (OR) after motor vehicle trauma. The patient sustained multiple long bone fractures. Perioperatively, patient developed acute hypotension, severe hypoxia, cardiac arrhythmia and eventually went into cardiac arrest. Diagnosis of bone cement implantation syndrome (BCIS) is made. What is Bone cement implantation syndrome?

Answer:

BCIS is potentially a fatal complication during orthopedic surgeries, mostly associated with polymethylmethacrylate cement. The use of a long-stem femoral component is a significant risk factor. It is characterized by acute hypotension, hypoxia, neurologic symptoms, and cardiac arrhythmias. 

It is probably due to multiple mechanisms, including fat and marrow debris embolization, cement monomer toxicity, anaphylatoxin release, and prostaglandin release. 

Patients require aggressive volume resuscitation, oxygen, and usual care as in any shock situation.

#trauma

#orthopedics

#surgical critical care

References:

1. Saleh KJ, Kassim R, Yoon P, Vorlicky LN. Complications of total hip arthroplasty. Am J Orthop (Belle Mead NJ) 2002; 31:485.

2. Patterson BM, Healey JH, Cornell CN, Sharrock NE. Cardiac arrest during hip arthroplasty with a cemented long-stem component. A report of seven cases. J Bone Joint Surg Am 1991; 73:271.

3. Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth 2009; 102:12.

4. Mudgalkar N, Ramesh KV. Bone cement implantation syndrome: A rare catastrophe. Anesth Essays Res. 2011 Jul-Dec;5(2):240-2. doi: 10.4103/0259-1162.94796. PMID: 25885400; PMCID: PMC4173385.