What is the Incidence of Bone Cement Implantation Syndrome in Elderly patients Undergoing Cemented Stem Hemiarthroplasty ? An Evaluation of 40 Patients

To study the incidence of bone cement implantation syndrome in elderly patients undergoing cemented stem hip arthroplasty with the use of pulse lavage.

40 consecutive patients undergoing cemented stem hip arthroplasty enrolled in the study and intra-operative vitals post induction and post cementing were recorded at 5, 10 and 15 min.

Study depicted an incidence of 32.5%. The incidence of grade 1, 2 ,3 was 22.5%,7.5% and 2.5%, respectively. There was a significant correlation between increased age and those patients suffering from BCIS grade 2 and 3 (p = 0.016). There was no correlation drawn between the comorbidities of the patients and the presence of the condition. However, all the patients with a history of dementia, myocardial infarction and stroke developed the syndrome. A significant correlation was drawn with patients suffering from left ventricular failure (p-value 0.03) pre-operatively. The severity of bone cement implantation syndrome was associated with a significant increase in pre-operative neutrophils (p-value 0.037) and hyponatremia (p-value 0.042) compared to patients with a mild condition, indicated the need for optimisation of the patient. A severe case leading to cardio-pulmonary collapse post cementing was recorded.

BCIS is a commonly occurring under-reported phenomenon in the elderly, leading to significant intra-operative complications. Pre-operative risk assessment along with good coordination between anaesthetist and surgeon is imperative.