Bone Cement Implantation Syndrome in Cemented Hip Arthroplasty: Hypothetization of a New Therapeutic Approach and Proposition of a Treatment Algorithm

Author(s):

Leandro EN Santos*, Leonardo B Figueiredo, Lucas A Santos, Daniel S Baumfeld, Thiago L Lima, Marco AP Andrade and Robinson E Pires

Purpose: Management of bone cement implantation syndrome (BCIS) during or immediately after hip arthroplasty (HA) is difficult and often leads to mortality. We have reviewed the medical records of patients submitted to HA at our institution and propose a standard operating procedure (SOP) for the event of cardiogenic shock. Methods: SOP was based on the analysis of the medical records of patients who had been submitted to cemented (n = 250) or uncemented (n = 408) HA, three of whom died because of BCIS, and on the individual experiences of the surgical team, taking into consideration the pathophysiology of acute right ventricular failure. Results: The proposed SOP involves the use of extracorporeal membrane oxygenation (ECMO) as a complementary therapy to mechanical ventilation with the purpose of improving patient outcome and reducing the risk of death. Inclusion and exclusion criteria, along with recommendations for the use of ECMO, are presented. Conclusion: Although our hypothesis has yet to be fully validated, the proposed a SOP has been implemented in our hospital. Because of the rarity of BCIS, we hope that the SOP will be effectuated in other institutions to ascertain the effectiveness of ECMO in the treatment of BCIS.