Incidence of Bone Cement Implantation Syndrome Is Not Associated With Cement in a Modern Series of Patients Treated With Arthroplasty for Femoral Neck Fracture.

Abstract

Bone cement implantation syndrome (BCIS) has been characterized by hypotension and/or hypoxia during cementation of a prosthesis; however, the casual link between cement and the pathophysiology of BCIS is unclear. This study aimed to determine if there is an association between cement and the incidence of BCIS by comparing cemented versus noncemented hip arthroplasties in a modern series of patients who had a femoral neck fracture. A single-institution multisurgeon retrospective review of 428 patients who underwent either hemiarthroplasty (HA) or total hip arthroplasty (THA) for acute femoral neck fracture between May 2017 and December 2024 was performed. Data including American Society of Anesthesiologists classification, comorbidities, type of anesthesia, operative time, and use of cement for fixation were recorded. Intraoperative anesthesia records were manually reviewed for hypoxia and hypotension, and the grade of BCIS was calculated where applicable. Data were then analyzed using multivariate logistic regressions, analyses of variances, t-tests, and Chi-square analyses. Of the 428 patients, 301 (70%) had a cemented arthroplasty (211 HAs and 90 THAs), whereas the remaining 127 (30%) had cementless implants (18 HAs and 109 THAs). Of the patients who met the BCIS criteria, 219 (51%) were grade I and 83 (19%) were grade II. There were no patients who were grade III (cardiovascular collapse requiring cardiopulmonary resuscitation). Of the patients who met the BCIS criteria, there was no statistical association with cemented versus cementless fixation. In the multivariate analyses, only the type of anesthesia (spinal versus general) was associated with BCIS grade I or II (odds ratio = 2.37 [95% confidence interval: 1.55 to 3.61], P < 0.001). There were no other recorded variables that reached statistical significance. In this modern series of patients undergoing arthroplasty for femoral neck fracture, no association was found between intraoperative BCIS and the use of cement fixation. Prior assumptions regarding BCIS may need to be reconsidered given contemporary surgical and anesthetic techniques.