Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur

IF 3.4 2区医学 Q2 Medicine

Journal of Bone Oncology Pub Date : 2025-03-26 DOI:10.1016/j.jbo.2025.100677

Thea Hovgaard Ladegaard , Jakob Stensballe , Michael Mørk Petersen , Michala Skovlund Sørensen

{"title":"Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur","authors":"Thea Hovgaard Ladegaard , Jakob Stensballe , Michael Mørk Petersen , Michala Skovlund Sørensen","doi":"10.1016/j.jbo.2025.100677","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Patients with bone metastases in the femur (BMf) may experience pathological fractures requiring surgery with cemented endoprostheses (EPR). At cementation and prosthesis insertion, patients are at risk of experiencing hypoxia, hypotension, cardiac failure and potentially death, known as bone cement implantation syndrome (BCIS). We aimed to 1) investigate the incidence and grade of BCIS in patients with BMf treated with cemented EPR, and 2) examine if the incidence or extent of BCIS has decreased after a change of a combined anesthesiologic and surgical protocol.</div></div><div><h3>Methods</h3><div>We retrospectively assessed patients with BMf operated with cemented EPR in two periods 2017 – 2018 (early cohort) and 2019 – 2020 (late cohort) and stratified before and after the intervention.</div></div><div><h3>Results</h3><div>Comparing the early and late cohorts, 26/86 (32 %) vs. 30/80 (35 %) experienced BCIS, but mild BCIS (grade 0 + 1) was seen in 79 % vs. 86 %, and severe BCIS (grade 2 + 3) in 21 % vs. 14 %. In the late cohort the per-operative use of vasopressors was higher (86 % vs. 59 %, p < 0.001), we found fewer pulmonary embolisms (PE) (p = 0.024), and a trend toward a reduced length of stay (LOS). 30-day survival was lower for patients with grade 0 + 1 compared to grade 2 + 3 (p = 0.03).</div></div><div><h3>Conclusions</h3><div>BCIS occurs in more than 1/3 of patients operated for BMf with cemented EPR. An increased multidisciplinary focus on BCIS may reduce the complications of BCIS, such as PE and LOS.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"52 ","pages":"Article 100677"},"PeriodicalIF":3.4000,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Bone Oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2212137425000181","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Patients with bone metastases in the femur (BMf) may experience pathological fractures requiring surgery with cemented endoprostheses (EPR). At cementation and prosthesis insertion, patients are at risk of experiencing hypoxia, hypotension, cardiac failure and potentially death, known as bone cement implantation syndrome (BCIS). We aimed to 1) investigate the incidence and grade of BCIS in patients with BMf treated with cemented EPR, and 2) examine if the incidence or extent of BCIS has decreased after a change of a combined anesthesiologic and surgical protocol.

Methods

We retrospectively assessed patients with BMf operated with cemented EPR in two periods 2017 – 2018 (early cohort) and 2019 – 2020 (late cohort) and stratified before and after the intervention.

Results

Comparing the early and late cohorts, 26/86 (32 %) vs. 30/80 (35 %) experienced BCIS, but mild BCIS (grade 0 + 1) was seen in 79 % vs. 86 %, and severe BCIS (grade 2 + 3) in 21 % vs. 14 %. In the late cohort the per-operative use of vasopressors was higher (86 % vs. 59 %, p < 0.001), we found fewer pulmonary embolisms (PE) (p = 0.024), and a trend toward a reduced length of stay (LOS). 30-day survival was lower for patients with grade 0 + 1 compared to grade 2 + 3 (p = 0.03).

Conclusions

BCIS occurs in more than 1/3 of patients operated for BMf with cemented EPR. An increased multidisciplinary focus on BCIS may reduce the complications of BCIS, such as PE and LOS.

查看原文本刊更多论文

骨水泥植入综合征与骨水泥内假体治疗股骨转移性骨病的关系

背景：股骨骨转移（BMf）患者可能经历病理性骨折，需要手术治疗骨水泥内假体（EPR）。在骨水泥植入和假体植入时，患者面临缺氧、低血压、心力衰竭和潜在死亡的风险，即骨水泥植入综合征（BCIS）。我们的目的是1)调查骨水泥EPR治疗的BMf患者BCIS的发生率和分级，2)检查改变麻醉和手术联合方案后BCIS的发生率或程度是否降低。方法回顾性评估2017 - 2018年（早期队列）和2019 - 2020年（晚期队列）两个时期BMf行骨水泥EPR手术的患者，并对干预前后进行分层。结果比较早期和晚期队列，26/86（32%）比30/80（35%）经历过BCIS，但轻度BCIS（0 + 1级）的比例为79%比86%，严重BCIS（2 + 3级）的比例为21%比14%。在晚期队列中，术前使用血管加压药物的比例更高(86% vs. 59%, p <；0.001)，我们发现肺栓塞（PE）减少（p = 0.024），住院时间（LOS）也有缩短的趋势。0 + 1级患者的30天生存率低于2 + 3级患者（p = 0.03）。结论超过1/3的BMf合并骨水泥EPR患者发生bcis。对BCIS多学科关注的增加可能会减少BCIS的并发症，如PE和LOS。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Bone Oncology ONCOLOGY-

CiteScore

7.20

自引率

2.90%

发文量

审稿时长

34 days

期刊介绍： The Journal of Bone Oncology is a peer-reviewed international journal aimed at presenting basic, translational and clinical high-quality research related to bone and cancer. As the first journal dedicated to cancer induced bone diseases, JBO welcomes original research articles, review articles, editorials and opinion pieces. Case reports will only be considered in exceptional circumstances and only when accompanied by a comprehensive review of the subject. The areas covered by the journal include: Bone metastases (pathophysiology, epidemiology, diagnostics, clinical features, prevention, treatment) Preclinical models of metastasis Bone microenvironment in cancer (stem cell, bone cell and cancer interactions) Bone targeted therapy (pharmacology, therapeutic targets, drug development, clinical trials, side-effects, outcome research, health economics) Cancer treatment induced bone loss (epidemiology, pathophysiology, prevention and management) Bone imaging (clinical and animal, skeletal interventional radiology) Bone biomarkers (clinical and translational applications) Radiotherapy and radio-isotopes Skeletal complications Bone pain (mechanisms and management) Orthopaedic cancer surgery Primary bone tumours Clinical guidelines Multidisciplinary care Keywords: bisphosphonate, bone, breast cancer, cancer, CTIBL, denosumab, metastasis, myeloma, osteoblast, osteoclast, osteooncology, osteo-oncology, prostate cancer, skeleton, tumour.