Methyl Methacrylate-Related Issues in Geriatric Hip Fractures (Bone Cement Implantation Syndrome)

Bone Cement Implantation Syndrome (BCIS) is an intraoperative and early postoperative complication related to using methyl methacrylate when implanting a prosthesis, especially in cemented hip arthroplasty performed for fractures. Its presentation ranges from mild hypoxia and hypotension to cardiac arrest. One proposed mechanism posits emboli from reaming of canal and increased pressurization of cement during implantation. Other proposed mechanism includes anaphylactic hypersensitivity reaction and complement activation. Recommendations to minimize mortality of BCIS include ensuring appropriate intravascular volume, increasing inspired oxygen concentration during cementation, intensive perioperative monitoring, consideration of low-dose epinephrine, thorough lavage and venting of femoral canal and consideration of low-viscosity cement.