Comparative assessment of bone cement implantation syndrome in cemented bipolar hemiarthroplasty: impact in patients with and without preexisting heart disease.

Abstract

Background: With the increasing incidence of hip fractures in older adults, hip replacement with a cemented femoral stem has become a viable treatment option. However, concerns regarding potential complications, particularly bone cement implantation syndrome (BCIS), especially in patients with preexisting medical conditions, have prompted orthopedic surgeons to explore alternative approaches.

Objective: The research question of this retrospective study is whether BCIS incidence in patients with preexisting heart disease undergoing cemented bipolar hemiarthroplasty is higher than that of patients without preexisting heart disease.

Methods: We retrospectively analyzed data from 311 patients undergoing cemented bipolar hemiarthroplasty, including 188 without preexisting heart disease and 123 with heart disease. Anesthetic records were reviewed to assess parameters related to BCIS. BCIS severity was graded systematically, emphasizing key metrics, such as hypotension, arterial desaturation, and the loss of consciousness.

Results: Among the patients, no perioperative deaths occurred. Grade 1 BCIS was observed in 13 patients (4.18 %), without instances of grade 2 or 3. Notably, grade 1 BCIS was observed in only 2 patients with preexisting heart disease (1.63%) and 11 patients (5.85%) without preexisting heart disease.

Conclusion: BCIS incidence after cemented bipolar hemiarthroplasty was minimal, with a predominantly low severity. Importantly, preexisting heart disease did not pose a significant increase in the risk of BCIS. This finding confirms the safety of cemented bipolar hemiarthroplasty in older adults.

Level of evidence: III.