Patient Safety Topics
Bone Cement Implantation Syndrome

Although cardiac arrest and death are the most catastrophic symptoms associated with cemented arthroplasty, bone cement implantation syndrome is a well-recognized complex of sudden physiologic changes that occur within minutes of the use of methyl methacrylate cement to secure a prosthetic component into the femur. Surgeons and anesthesiologists can use reported interventions, including patient assessment, anesthetic techniques, and surgical technigues, to reduce the risk of bone cement implantation syndrome.

Key Data and Statistics

As of a December 2006 publication, the Pennsylvania Patient Safety Reporting System had received reports of six intraoperative cardiac arrests in patients—five resulting in death—associated with hip arthroplasties using bone cement to implant prostheses.  

An elderly female presented via ambulance following a fall at home. She was diagnosed as having a fracture of the left femoral neck. The patient was medically cleared for surgery based upon physical examination, normal lab work, and a normal electrocardiogram. An urgent left hemiarthroplasty was performed under spinal anesthesia. Intraoperatively, after cementing of the prosthesis, the patient developed hypotension, bradycardia, and cardiac arrest. The surgical field was covered, and the patient was placed in supine position for cardiopulmonary resuscitation. The patient did not respond to resuscitative measures, and she expired.

The preceding account from an event reported through PA-PSRS is an example of the onset of some BCIS symptoms in a patient.

Figure 1. Diseased Right Hip and Total Arthroplasty Left Hip with Acetabular and Femoral Prostheses

Excerpted from: Bone cement implantation syndrome. PA PSRS Patient Saf Advis 2006 Dec.

Educational Tools

Pocket Guide
This pocket guide can provide handy reference to clinicians about risk factors (patient- and technique-related) and risk reduction strategies related to bone cement implantation syndrome.


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