The bone cement implantation syndrome (BCIS) occurs during or after placement of a cemented orthopedic implant. It occurs most often with a hip joint replacement but can occur with other joints as well.
Mechanism: massive release of microemboli consisting of bone marrow, cement and bone secondary to increased pressure on intramedullary contents
Clinical features - sudden onset of:
(1) hypoxia
(2) hypotension
(3) cardiac arrhythmias
(4) increased pulmonary vascular resistance
(5) cardiac arrest
(6) loss of consciousness
(7) sudden death
Other manifestations depend on the distribution of the microemboli:
(1) acute pancreatitis
(2) acute renal failue
(3) retinal micro-emboli
Risk factors:
(1) pathologic fractures or impending pathologic fractures
(2) COPD or pre-existing pulmonary hypertension
(3) cardiac disease
(4) ASA class III or IV
(5) warfarin therapy
(6) inter-trochanteric fracture
(7) long stem arthroplasty
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