Incidence, associated risk factors and cumulative risk scores: a retrospective chart review of a single center’s experience with bone cement implantation syndrome in a low and middle income country, South Africa

Main Article Content

Celeste Houston
Kashvir Allopi



Background: Cemented arthroplasty is appropriate management for displaced neck of femur fractures. However, it is associated with Bone Cement Implantation Syndrome (BCIS), characterized by a drop in systemic blood pressure, hypoxia, unexpected loss of consciousness, and cardiovascular collapse. This study aimed to quantify the incidence of BCIS in a low and middle income country (LMIC), to compare whether similar risk factors exist as compared to high income countries. It also aimed to assess whether cumulative risk factors were associated with severe grades of BCIS.

Methods: A retrospective chart review analyzed consecutive adult patients undergoing cemented arthroplasty between January 2016 and July 2017 at Addington Hospital, KwaZulu-Natal, South Africa. The lowest blood pressure and oxygen saturation at defined points were compared to baseline readings, and patients were graded as grade 1, 2 or 3 BCIS. Records were analyzed for the presence of risk factors, of which 16 were identified and compared to the occurrence of BCIS. Factors deemed statistically significant were combined and a cumulative risk score was compared to the grades of BCIS.

Results: The total incidence of BCIS was 45.79%. The incidence of BCIS grade 1, 2 and 3 were 34.58%, 5.61%, and 5.61% respectively. Independent significant factors included ASA ≥3, hypertension, previous cerebral ischaemia, previous myocardial ischaemia, and renal failure. A statistically significant difference existed between various grades of BCIS and cumulative risk scores for each grade. The mean risk score for no BCIS, grade 1, 2 and 3 BCIS were 0.77 ± 0.75, 1.81 ± 1.15, 3.0 ± 0.63, and 3.5 ± 1.05 respectively.

Conclusions: This study reported the incidence of BCIS, risk factors associated with BCIS, and that cumulative risk factors increased the grade of BCIS. Grade 1 and grade 3 BCIS occurred more commonly in our institution than in the reported literature.