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British Journal of Anaesthesia Jan 2009Bone cement implantation syndrome (BCIS) is poorly understood. It is an important cause of intraoperative mortality and morbidity in patients undergoing cemented hip... (Review)
Review
Bone cement implantation syndrome (BCIS) is poorly understood. It is an important cause of intraoperative mortality and morbidity in patients undergoing cemented hip arthroplasty and may also be seen in the postoperative period in a milder form causing hypoxia and confusion. Hip arthroplasty is becoming more common in an ageing population. The older patient may have co-existing pathologies which can increase the likelihood of developing BCIS. This article reviews the definition, incidence, clinical features, risk factors, aetiology, pathophysiology, risk reduction, and management of BCIS. It is possible to identify high risk groups of patients in which avoidable morbidity and mortality may be minimized by surgical selection for uncemented arthroplasty. Invasive anaesthetic monitoring should be considered during cemented arthroplasty in high risk patients.
Topics: Arthroplasty, Replacement, Hip; Bone Cements; Cementation; Embolism; Humans; Hypotension; Hypoxia; Intraoperative Complications; Risk Factors; Syndrome
PubMed: 19059919
DOI: 10.1093/bja/aen328 -
The Malaysian Journal of Pathology Jun 2013Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance and cardiac arrest. It is...
Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance and cardiac arrest. It is a known cause of morbidity and mortality in patients undergoing cemented orthopaedic surgeries. The rarity of the condition as well as absence of a proper definition has contributed to under-reporting of cases. We report a 59-year-old woman who sustained fracture of the neck of her left femur and underwent an elective hybrid total hip replacement surgery. She collapsed during surgery and was revived only to succumb to death twelve hours later. Post mortem findings showed multiorgan disseminated microembolization of bone marrow and amorphous cement material.
Topics: Arthroplasty, Replacement, Hip; Bone Cements; Cementation; Embolism; Fatal Outcome; Female; Humans; Middle Aged; Postoperative Complications; Syndrome
PubMed: 23817399
DOI: No ID Found -
Clinical and Applied... 2023Since Charnley introduced acrylic cement to seal metallic hip prostheses in the 1950s, reports of perioperative fatal cardiorespiratory and vascular dysfunctions have... (Review)
Review
Since Charnley introduced acrylic cement to seal metallic hip prostheses in the 1950s, reports of perioperative fatal cardiorespiratory and vascular dysfunctions have been published. Studies on humans and animals have shown neurogenic stimulation and substantial local and systemic activation of coagulation are caused by surgical bone marrow damage and chemical cell destruction by toxic monomeric methyl methacrylate from the implanted cement and other tissue-released substances. Venous blood-borne cell fragments and conjugates of activated cells from the surgical site are sequestered and trapped in the pulmonary microcirculation. A substantial hypercoagulation occurs in the lung circulation. Hypercoagulable blood is passed over to the arterial side and may cause vessel obliteration and organ damage. This process may affect the brain, heart, and kidneys and, through the release of vasoactive substances, introduce hemodynamic imbalances that can lead to fatal outcomes in susceptible populations such as elderly patients with hip fractures. The main underlying pathophysiologic processes leading to these occasionally devastating outcomes are a substantial activation of coagulation and cell destruction caused by the toxic substance released by curing bone cement and several vasoactive substances.
Topics: Animals; Humans; Aged; Bone Cements; Blood Coagulation; Hip Prosthesis; Methylmethacrylate
PubMed: 37792504
DOI: 10.1177/10760296231198036 -
Journal of Musculoskeletal & Neuronal... Dec 2022Bisphosphonates represent an established treatment against bone resorption and osseous loss. Local application could help increase bone mineral density while minimizing... (Review)
Review
Bisphosphonates represent an established treatment against bone resorption and osseous loss. Local application could help increase bone mineral density while minimizing their systemic use side-effects. Bone cement, used on a large scale in orthopedic surgery and a historically successful drug carrier, could represent an effective scaffold. The aim of this review was to investigate the alterations produced on the cement's structure and properties by this mixture, as well as its antiosteoporotic and antitumor effect. After a thorough research of articles, title screening and duplicate removal we retained 51 papers. Two independent authors performed abstract and full-text reading, finally leaving 35 articles included in this review. In the current literature, acrylic and calcium phosphate bone cement have been used as carriers. A combination with nitrogen-containing bisphosphonates, e.g., zoledronic acid, provokes modifications in terms of setting time prolongation and mechanical strength decline within acceptable levels, on the condition that the drug's quantity stays beneath a certain plateau. Bisphosphonates in bone cement seem to have a powerful anti-osteoclastic and osteogenic local impact as well as a direct cytotoxic effect against several neoplastic lesions. Further investigation on the subject is required, with specifically designed studies focusing on this method's advantages and potential clinical applications.
Topics: Humans; Bone Cements; Diphosphonates; Zoledronic Acid; Bone Resorption; Orthopedic Procedures
PubMed: 36458394
DOI: No ID Found -
Joint Diseases and Related Surgery 2022Vertebral compression fractures are more common in the elderly, particularly in postmenopausal women. Most of these people are accompanied by osteoporosis, which can... (Review)
Review
Vertebral compression fractures are more common in the elderly, particularly in postmenopausal women. Most of these people are accompanied by osteoporosis, which can easily lead to spinal deformities and fractures. Once a fracture occurs, the patient would have severe pain response, limited spinal movement, and need to stay in bed for a long time, resulting in a significant decrease in their quality of life. Percutaneous vertebroplasty (PVP) is a minimally invasive spinal surgery that injects bone cement into the diseased vertebrae for therapeutic purposes. It can quickly relieve pain and stabilize the spine. It is widely used in the treatment of vertebral compression fractures and is currently an ideal treatment method. There are many materials of bone cement used in clinical treatment, and each material has unique characteristics. Many scholars would modify the bone cement according to the advantages and disadvantages to make it more suitable for clinical use. In this review, we discuss the clinical application and modification of bone cement.
Topics: Aged; Bone Cements; Female; Fractures, Compression; Humans; Pain; Quality of Life; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 35852210
DOI: 10.52312/jdrs.2022.628 -
Frontiers in Endocrinology 2023A large body of literature has demonstrated the significant efficacy of antibiotic bone cement in treating infected diabetic foot wounds, but there is less corresponding... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
A large body of literature has demonstrated the significant efficacy of antibiotic bone cement in treating infected diabetic foot wounds, but there is less corresponding evidence-based medical evidence. Therefore, this article provides a meta-analysis of the effectiveness of antibiotic bone cement in treating infected diabetic foot wounds to provide a reference basis for clinical treatment.
METHODS
PubMed, Embase, Cochrane library, Scoup, China Knowledge Network (CNKI), Wanfang database, and the ClinicalTrials.gov were searched, and the search time was from the establishment of the database to October 2022, and two investigators independently. Two investigators independently screened eligible studies, evaluated the quality of the literature using the Cochrane Evaluation Manual, and performed statistical analysis of the data using RevMan 5.3 software.
RESULTS
A total of nine randomized controlled studies (n=532) were included and, compared with the control group, antibiotic bone cement treatment reduced the time to wound healing (MD=-7.30 95% CI [-10.38, -4.23]), length of hospital stay (MD=-6.32, 95% CI [-10.15, -2.48]), time to bacterial conversion of the wound (MD=-5.15, 95% CI [-7.15,-2.19]), and the number of procedures (MD=-2.35, 95% CI [-3.68, -1.02]).
CONCLUSION
Antibiotic bone cement has significant advantages over traditional treatment of diabetic foot wound infection and is worthy of clinical promotion and application.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO identifier, CDR 362293.
Topics: Humans; Bone Cements; Anti-Bacterial Agents; Diabetic Foot; Diabetes Mellitus; Wound Infection; Wound Healing
PubMed: 37008902
DOI: 10.3389/fendo.2023.1134318 -
Anatolian Journal of Cardiology Mar 2022
Topics: Bone Cements; Heart Injuries; Humans
PubMed: 35346920
DOI: 10.5152/AnatolJCardiol.2021.1404 -
Biomedical Journal 2013Vertebral compression fracture is the most common complication of osteoporosis. It may result in persistent severe pain and limited mobility, and significantly impacts... (Review)
Review
Vertebral compression fracture is the most common complication of osteoporosis. It may result in persistent severe pain and limited mobility, and significantly impacts the quality of life. Vertebroplasty involves a percutaneous injection of bone cement into the collapsed vertebrae by fluorescent guide. The most commonly used bone cement in percutaneous vertebroplasty is based on the polymerization of methylmethacrylate monomers to polymethylmethacrylate (PMMA) polymers. However, information on the properties of bone cement is mostly published in the biomaterial sciences literature, a source with which the clinical community is generally unfamiliar. This review focuses on the chemistry of bone cement polymerization and the physical properties of PMMA. The effects of altering the portions and contents of monomer liquid and polymer powders on the setting time, polymerization temperature, and compressive strength of the cement are also discussed. This information will allow spine surgeons to manipulate bone cement characteristics for specific clinical applications and improve safety.
Topics: Bone Cements; Fractures, Compression; Humans; Polymerization; Polymethyl Methacrylate; Spinal Fractures; Vertebroplasty
PubMed: 23989310
DOI: 10.4103/2319-4170.112750 -
Orthopaedic Surgery Dec 2021To investigate the biomechanical and elution properties of meropenem-loaded bone cement.
OBJECTIVE
To investigate the biomechanical and elution properties of meropenem-loaded bone cement.
METHODS
Bone cement (Palacos LV) with 5% (2 g/4 0g), 10% (4 g/40 g), and 15% (6 g/40 g) meropenem; 5% (2 g/40 g) and 10% (4 g/40 g) vancomycin; and blank bone cement were prepared in a total of six groups named A2, A4, A6, B2, B4, and A0 (antibiotic-free). 36 cylinder specimens (6-mm diameter and 12-mm height) of all six groups were molded for a compression test. After the compression test, because of mechanical properties below the ISO standard requirements, groups B2, B4 were not subjected to a bending test. So a total of 24 rectangular strip specimens (10-mm width, 75-mm length, and 3.3-mm thickness) for groups A2, A4, A6 and A0 were molded for the bending test. Between-group differences of compressive strength, bending strength and bending modulus were analyzed. The meropenem standard was prepared as a series of standard solutions to calculate the standard curve. At a constant temperature of 37 °C, separately, meropenem-loaded bone cement cylinder specimens (12 mm in diameter and 17 mm in length) of A2, A4 and A6 were serially immersed in saline solution without stirring. The eluent drug concentration at 24, 48, 72 h and 6, 12, 24 days was measured and the drug concentration-time curve of meropenem was constructed.
RESULTS
With the exception of groups B2 and B4, all cements compressive strength values were well above the minimum requirement of the ISO 5833 standard (70 MPa). The compressive strength and bending strength values of group A4 were higher than those of group A0 (P < 0.05), but no difference was found between the A0, A2 and A6 groups (P > 0.05). There were no intergroup differences of bending modulus between the A0, A2, A4 and A6 groups (P > 0.05). A standard curve of meropenem was obtained and a regression equation was constructed: Y = 15.0265 X + 13.5218, r = 1.00. At 37 °C, the release of meropenem was rapid during the first 48 h for all A2, A4, A6 samples, and subsequent release continued to decrease.
CONCLUSION
When adding up to 15% (6 g/40 g) meropenem to the bone cement, the biomechanical properties were not reduced, and bone cement with 10% (4 g/40 g) meropenem had the best performance. At a constant temperature of 37°C, meropenem can be released from bone cement for up to 24 days.
Topics: Anti-Bacterial Agents; Biomechanical Phenomena; Bone Cements; Compressive Strength; Humans; Materials Testing; Meropenem; Polymethyl Methacrylate; Powders; Vancomycin
PubMed: 34734478
DOI: 10.1111/os.13139 -
World Neurosurgery Aug 2023Percutaneous vertebroplasty and percutaneous kyphoplasty are effective methods to treat acute osteoporotic vertebral compression fractures that can quickly provide... (Review)
Review
Percutaneous vertebroplasty and percutaneous kyphoplasty are effective methods to treat acute osteoporotic vertebral compression fractures that can quickly provide patients with pain relief, prevent further height loss of the vertebral body, and help correct kyphosis. Many clinical studies have investigated the characteristics of bone cement. Bone cement is a biomaterial injected into the vertebral body that must have good biocompatibility and biosafety. The optimization of the characteristics of bone cement has become of great interest. Bone cement can be mainly divided into 3 types: polymethyl methacrylate, calcium phosphate cement, and calcium sulfate cement. Each type of cement has its own advantages and disadvantages. In the past 10 years, the performance of bone cement has been greatly improved via different methods. The aim of our review is to provide an overview of the current progress in the types of modified bone cement and summarize the key clinical findings.
Topics: Humans; Bone Cements; Fractures, Compression; Spinal Fractures; Spine; Vertebroplasty; Osteoporotic Fractures; Kyphoplasty; Treatment Outcome; Retrospective Studies
PubMed: 37087028
DOI: 10.1016/j.wneu.2023.04.048