Cementation: a hazardous event during joint arthroplasty surgery

In their article on the cost to the NHS of time wasted during cement drying in joint arthroplasty surgery, Scrimshire and Holt suggest that the theatre team often stands relatively idle during this process.1 However, for the anaesthetist and the patient, cementation is potentially the most hazardous intraoperative event. Many surgeons recognise this and routinely warn us of the imminent implantation of the bone cement: we regard the smell of monomer as the “smell of danger.” The patient always needs to be prepared (fluid optimisation), cardiovascular support (pressor agents) is often needed, and sometimes the whole theatre team is involved in resuscitation.2 3

Although patients rarely come to grief, new techniques that avoid bone cement may be a safer way of providing high quality care, especially for very frail patients.4 When a cemented hip is indicated as the best treatment, we would regard the time spent waiting for the cement to dry as excellent use of both surgical and anaesthetic time.