JOA - 2026-05-13 - Journal Article
Incidence of Bone Cement Implantation Syndrome Is Not Associated With Cement in a Modern Series of Patients Treated with Arthroplasty for Femoral Neck Fracture.
Engh CA, Temple J, Novicoff W, Browne JA
Topics
Key Takeaway
In 428 femoral neck fracture arthroplasties, BCIS grade I or II occurred in 70% of patients but was not associated with cement use; spinal anesthesia was the only independent predictor (OR 2.37, 95% CI 1.55–3.61).
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Summary
This single-institution retrospective study asked whether cement fixation is independently associated with intraoperative BCIS in patients undergoing HA or THA for acute femoral neck fracture. Anesthesia records were manually reviewed for hypotension and hypoxia in 428 patients (301 cemented, 127 cementless); BCIS grade was assigned per established criteria. Cement use showed no statistical association with BCIS on multivariate analysis, while spinal anesthesia was the sole independent predictor (OR 2.37, p<0.001).
Key Limitation
The retrospective, non-randomized design means cemented and cementless groups differ substantially in procedure type (HA vs. THA), making it impossible to fully isolate the effect of cement from the confounding influence of procedure type and associated patient selection.
Original Abstract
INTRODUCTION
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 non-cemented hip arthroplasties in a modern series of patients who had a femoral neck fracture.
METHODS
A single-institution multi-surgeon retrospective review of 428 patients who underwent either hemi-arthroplasty (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 (ASA) classification, co-morbidities, 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 (ANOVA), t-tests, and Chi-square analyses. Of the 428 patients, 301 (70%) had a cemented arthroplasty (211 HA and 90 THA), whereas the remaining 127 (30%) had cementless implants (18 HA and 109 THA). Of patients who met BCIS criteria, 219 (51%) were grade I and 83 (19%) were grade II.
RESULTS
There were no patients who were grade III (cardiovascular collapse requiring cardiopulmonary resuscitation). Of patients who met 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 (OR) = 2.37 (95% confidence interval (CI): 1.55 to 3.61), P < 0.001). There were no other recorded variables that reached statistical significance.
CONCLUSION
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.