Occurrence, Risk Factors, and Outcomes of Bone Cement Implantation Syndrome after Hemi and Total Hip Arthroplasty in Cancer Patients
Eugenia Schwarzkopf, MD, Ridhi Sachdev, MD, Jessica Flynn, BSc, Venkat Boddapati, MD, Roger E. Padilla, MD, and Daniel E. Prince, MD, MPHHip
Background and Objectives:
Patients undergoing cement fixation for hip arthroplasty are at increased risk of developing bone cement implantation syndrome (BCIS). We sought to determine: What is the occurrence of BCIS in cancer patients after hip arthroplasty? What are the risk factors in cancer patients for the development of this syndrome? What is the outcome for cancer patients with BCIS?
Methods:
We identified 374 cancer patients who underwent cemented hip arthroplasty between 2010-2014. Patient characteristics, operative variables and outcomes were collected.
Results:
BCIS occurred in 279 (75%) patients. 353 (94%) patients had bone metastases and 179 (48%) patients had lung metastases at the time of surgery. Age greater than 60 (HR 2.09, p=0.02) and the presence of lung metastases (HR 1.77, p= 0.019) were associated with increased risk of BCIS. Increased perioperative use of vasopressors (HR 1.72, p= 0.023) and increased hospital stay beyond 10 days (HR 2.67, p=0.003) was associated with BCIS.
Conclusions:
BCIS is a frequent clinical event in cancer patients undergoing femoral cemented arthroplasty with increased risk for patients over age 60 and those with compromised lung function due to lung metastases and lung cancer. Patients who develop BCIS are more likely to require longer postoperative hospitalization. Careful preoperative assessment and intraoperative communication are crucial steps to reduce the consequences of BCIS.
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