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Hemodynamic Effects of Bone Cement Implantation in Hip Arthroplasty: Insights from a Prospective Study in Eastern
Janki Sharan Bhadani1, Indrajeet Kumar2, Wasim Ahmed2
1Department of Orthopaedics, Paras HMRI Hospital, Patna 14, India.
Insights
Bone cement implantation syndrome (BCIS) can cause serious hemodynamic changes during hip arthroplasty. This study in eastern India found significant blood pressure drops and oxygen desaturation in patients, highlighting the need for careful monitoring.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Cardiovascular Physiology
Background:
- Bone cementation during hip arthroplasty can lead to potentially fatal bone cement implantation syndrome (BCIS).
- Existing research on BCIS predominantly originates from developed nations.
- Understanding BCIS in diverse populations, like eastern India, is crucial for global patient safety.
Purpose of the Study:
- To investigate the hemodynamic effects of bone cement during hip arthroplasty in the eastern Indian population.
- To compare these findings with existing international literature on BCIS.
- To identify key preventative measures for BCIS in this demographic.
Main Methods:
- A prospective study conducted by orthopedic surgeons and anesthesiologists.
- Inclusion of 72 patients (38 male, 34 female) aged 25-100 years undergoing hip arthroplasty.
- Perioperative monitoring of hemodynamic parameters including blood pressure and SpO2.
Main Results:
- Significant blood pressure drops were observed in 59.72% (10 mmHg), 30.56% (10-20 mmHg), and 9.72% (>20 mmHg) of patients.
- SpO2 decreased in 34 patients, with levels returning to normal within 10 minutes.
- Arrhythmias occurred in 16 patients, with two cardiac arrests and one fatality.
Conclusions:
- Bone cementation significantly impacts hemodynamics, necessitating vigilant monitoring during hip arthroplasty.
- Pre-operative evaluation and continuous perioperative monitoring are vital for managing high-risk patients.
- Implementing essential precautions during cemented arthroplasty can mitigate BCIS complications.
Introduction:
Bone cementation has various effects on hemodynamics including potentially fatal bone cement implantation syndrome (BCIS). Most of the studies on BCIS are from developed countries. We have studied the effect of bone cement on hemodynamics in hip arthroplasty in the eastern Indian population and compared it with the available literature.
Materials And Methods:
This prospective study was done by a team of orthopedic surgeons and anesthesiologists in a tertiary center in eastern India between March 2020 and December 2022.
Result:
Seventy-two patients (Male 38: and Female 34) of age between 25 and 100 years fulfilling the inclusion criteria were included. In 43 patients (43/72, 59.72%) systolic and diastolic blood pressure fell in the range of 10 mmHg, in 22 patients (22/72, 30.56%) fall in blood pressure was in the range of 10-20 mmHg, and more than 20 mmHg fall in blood pressure were seen in seven patients (7/72, 9.72%). SPO2 decreased from 97-100% to 94-96% in 28 patients and 90-93% in six patients, which began to rise after 5 min of cementing and returned to normal after 10 min. Arrhythmias were seen in 16 patients with multiple comorbidity. Two patients had a cardiac arrest and one patient died after 6 h in the intensive care unit.
Conclusion:
Pre-operative evaluation, perioperative monitoring of hemodynamic parameters during cementing especially in high-risk patients with multiple comorbidities, and taking essential precautions during cemented arthroplasty are the key to preventing complications like BCIS.
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