Catastrophic cement reaction following cementation for megaprosthesis for proximal femoral fracture

Abstract

Bone cement implantation syndrome (BCIS) is a well-described and potentially fatal complication of orthopaedic surgery involving pressurised bone cement. Although also described for certain spinal procedures, it is most commonly associated with cemented hip and knee arthroplasty and with cemented hemiarthroplasty following neck of femur fracture in particular.Donaldson proposed the definition of BCIS as a syndrome "characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery". Other features include increased vascular resistance, cardiac arrhythmias and cardiac arrest post cement use.We describe a case of a patient who suffered a catastrophic reaction to cement during surgery for a comminuted proximal femoral fracture.

Intriguing Periprosthetic Fracture of Hip Stem and Proximal Femoral Replacement

“…The use of proximal femoral replacement prostheses for peri-prosthetic fracture is becoming more common with the rising incidence of peri-propsthetic fractures, in particular for those patients with poor femoral bone stock, but there are important factors to consider before choosing this procedure [ 2 - 3 ]. Most importantly, a discussion should take place between the surgeon and the patient to establish appropriate expectations and requirements.…”

“…Proximal femoral replacement is a form of device generically known as megaprosthesis or endoprosthesis [ 3 - 4 ]. The modern version of these devices is highly modular, and can be customized according to the patient's native anatomy, with multiple options for offset, neck length and version..…”

Bone Cement Implantation Syndrome: Key Concepts for Perioperative Nurses

“…This case study has been created from a composite of cases published in the literature . All patients have been deidentified for this example.…”

Successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: A case report

“…Although not fully understood, the pathophysiology of BCIS is thought to involve several pathways, including anaphylaxis, pulmonary embolization, complement activation, and histamine release, combining to increase pulmonary vascular resistance, and potentially ventilation/perfusion mismatches with resultant acute hypoxia, right ventricular failure and cardiogenic shock [ 4 ].…”