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.
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.