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The Bone Cement Hypercoagulation Syndrome: Pathophysiology, Mortality, and Prevention.

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Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
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Bone cement used in hip replacements can cause fatal cardiorespiratory and vascular issues due to toxic substances and cell damage. This leads to blood clots and organ damage, especially in elderly patients.

Keywords:
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Area of Science:

  • Biomaterials Science
  • Orthopedic Surgery
  • Cardiovascular Physiology

Background:

  • Acrylic bone cement, introduced in the 1950s for hip prostheses, has been linked to perioperative cardiorespiratory and vascular complications.
  • Surgical procedures involving bone marrow damage and methyl methacrylate release trigger neurogenic stimulation and coagulation activation.

Purpose of the Study:

  • To elucidate the pathophysiologic mechanisms underlying fatal cardiorespiratory and vascular dysfunctions associated with bone cement implantation.
  • To identify the role of toxic substances and vasoactive compounds in cement-induced complications.

Main Methods:

  • Review of human and animal studies investigating the effects of bone cement.
  • Analysis of cell fragments and activated cells in pulmonary microcirculation.
  • Assessment of coagulation activation and vasoactive substance release.

Main Results:

  • Bone cement constituents cause cell destruction and activate coagulation, leading to pulmonary microcirculation sequestration.
  • A hypercoagulable state in pulmonary circulation can result in arterial thromboembolism and organ damage (brain, heart, kidneys).
  • Release of vasoactive substances contributes to hemodynamic imbalances and potentially fatal outcomes.

Conclusions:

  • The primary drivers of devastating outcomes are substantial coagulation activation and cell destruction from curing bone cement and released vasoactive substances.
  • Susceptible populations, like elderly patients with hip fractures, are at higher risk for these complications.
  • Understanding these mechanisms is crucial for mitigating risks associated with bone cement use in orthopedic surgery.