Bone Cement Implantation Syndrome: Incidence and Associated Factors in a United States Setting

Background: The incidence of bone cement implantation syndrome (BCIS) following cemented hemiarthroplasty for the treatment of hip fracture in the United States (US) population is not previously described. We sought to describe the incidence and factors associated with BCIS as well as its impact on mortality.

Methods: In this retrospective observational study, electronic health records were examined for all relevant cases and BCIS was identified and graded according to accepted criteria. Demographic data was collected and an adjusted Cox proportional model was performed to determine the impact of severe BCIS on mortality.

Results: Following exclusions for documentation error and misclassification, 69 patients were included in the final analysis. BCIS, regardless of grade, was present in 24 (35%) patients, while severe BCIS (grades 2 and 3) was found in 7 (10%) of patients. Cox proportional hazard estimation adjusted for American Society of Anesthesiologists (ASA) grade, male sex, and age did not show severe BCIS to be independently associated with mortality, hazard ratio (CI) 1.96 (0.22-17.22).

Conclusion: The incidence of BCIS in a selected hip fracture population is comparable in the US to those found in European studies. This study did not establish the occurrence of BCIS with mortality. As cemented hemiarthroplasty is recommended for displaced hip fractures and its use escalates in the US, one can expect an increase in the absolute number of patients experiencing BCIS as well.