Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur
Background: Patients with bone metastases in the femur (BMf) may experience pathological fractures requiring surgery with cemented endoprostheses (EPR). At cementation and prosthesis insertion, patients are at risk of experiencing hypoxia, hypotension, cardiac failure and potentially death, known as...
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Elsevier
2025-06-01
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| Series: | Journal of Bone Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2212137425000181 |
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| author | Thea Hovgaard Ladegaard Jakob Stensballe Michael Mørk Petersen Michala Skovlund Sørensen |
| author_facet | Thea Hovgaard Ladegaard Jakob Stensballe Michael Mørk Petersen Michala Skovlund Sørensen |
| author_sort | Thea Hovgaard Ladegaard |
| collection | DOAJ |
| description | Background: Patients with bone metastases in the femur (BMf) may experience pathological fractures requiring surgery with cemented endoprostheses (EPR). At cementation and prosthesis insertion, patients are at risk of experiencing hypoxia, hypotension, cardiac failure and potentially death, known as bone cement implantation syndrome (BCIS). We aimed to 1) investigate the incidence and grade of BCIS in patients with BMf treated with cemented EPR, and 2) examine if the incidence or extent of BCIS has decreased after a change of a combined anesthesiologic and surgical protocol. Methods: We retrospectively assessed patients with BMf operated with cemented EPR in two periods 2017 – 2018 (early cohort) and 2019 – 2020 (late cohort) and stratified before and after the intervention. Results: Comparing the early and late cohorts, 26/86 (32 %) vs. 30/80 (35 %) experienced BCIS, but mild BCIS (grade 0 + 1) was seen in 79 % vs. 86 %, and severe BCIS (grade 2 + 3) in 21 % vs. 14 %. In the late cohort the per-operative use of vasopressors was higher (86 % vs. 59 %, p < 0.001), we found fewer pulmonary embolisms (PE) (p = 0.024), and a trend toward a reduced length of stay (LOS). 30-day survival was lower for patients with grade 0 + 1 compared to grade 2 + 3 (p = 0.03). Conclusions: BCIS occurs in more than 1/3 of patients operated for BMf with cemented EPR. An increased multidisciplinary focus on BCIS may reduce the complications of BCIS, such as PE and LOS. |
| format | Article |
| id | doaj-art-cc0a2bb4e38444bb892a1b75e27716e8 |
| institution | Kabale University |
| issn | 2212-1374 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Bone Oncology |
| spelling | doaj-art-cc0a2bb4e38444bb892a1b75e27716e82025-08-20T03:47:01ZengElsevierJournal of Bone Oncology2212-13742025-06-015210067710.1016/j.jbo.2025.100677Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femurThea Hovgaard Ladegaard0Jakob Stensballe1Michael Mørk Petersen2Michala Skovlund Sørensen3Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark; Corresponding author at: Thea Hovgaard Ladegaard, Rigshospitalet, Inge Lehmanns vej 6, 2100 København Ø, Denmark.Department of Anesthesiology, Surgery and Trauma Center, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark; Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 33.5, Section A, Copenhagen, DenmarkMusculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 33.5, Section A, Copenhagen, DenmarkMusculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 33.5, Section A, Copenhagen, DenmarkBackground: Patients with bone metastases in the femur (BMf) may experience pathological fractures requiring surgery with cemented endoprostheses (EPR). At cementation and prosthesis insertion, patients are at risk of experiencing hypoxia, hypotension, cardiac failure and potentially death, known as bone cement implantation syndrome (BCIS). We aimed to 1) investigate the incidence and grade of BCIS in patients with BMf treated with cemented EPR, and 2) examine if the incidence or extent of BCIS has decreased after a change of a combined anesthesiologic and surgical protocol. Methods: We retrospectively assessed patients with BMf operated with cemented EPR in two periods 2017 – 2018 (early cohort) and 2019 – 2020 (late cohort) and stratified before and after the intervention. Results: Comparing the early and late cohorts, 26/86 (32 %) vs. 30/80 (35 %) experienced BCIS, but mild BCIS (grade 0 + 1) was seen in 79 % vs. 86 %, and severe BCIS (grade 2 + 3) in 21 % vs. 14 %. In the late cohort the per-operative use of vasopressors was higher (86 % vs. 59 %, p < 0.001), we found fewer pulmonary embolisms (PE) (p = 0.024), and a trend toward a reduced length of stay (LOS). 30-day survival was lower for patients with grade 0 + 1 compared to grade 2 + 3 (p = 0.03). Conclusions: BCIS occurs in more than 1/3 of patients operated for BMf with cemented EPR. An increased multidisciplinary focus on BCIS may reduce the complications of BCIS, such as PE and LOS.http://www.sciencedirect.com/science/article/pii/S2212137425000181Bone metastasesBone cement implantation syndromeBCISEndoprosthetic reconstructionPathological fracturesCementation |
| spellingShingle | Thea Hovgaard Ladegaard Jakob Stensballe Michael Mørk Petersen Michala Skovlund Sørensen Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur Journal of Bone Oncology Bone metastases Bone cement implantation syndrome BCIS Endoprosthetic reconstruction Pathological fractures Cementation |
| title | Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur |
| title_full | Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur |
| title_fullStr | Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur |
| title_full_unstemmed | Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur |
| title_short | Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur |
| title_sort | bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur |
| topic | Bone metastases Bone cement implantation syndrome BCIS Endoprosthetic reconstruction Pathological fractures Cementation |
| url | http://www.sciencedirect.com/science/article/pii/S2212137425000181 |
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