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

Abstract

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

Materials and methods: 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.

Results: 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.

Conclusions: 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.