SHM Converge Scientific Abstract ePoster Gallery-Take My Breath Away

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This case describes a 66-year-old woman who developed unexplained postoperative hypoxia, tachycardia, and hypotension after a cemented right total hip arthroplasty for femoral neck fracture. During cement placement, she had transient hypoxia and hypotension. In the recovery room, bedside ultrasound showed an underfilled, hyperdynamic left ventricle without right heart strain, and lung ultrasound did not show pulmonary edema, effusion, or pneumothorax. She remained hypoxic despite fluids, blood transfusion, and albumin. Chest x-ray and CT pulmonary angiogram were negative for acute cardiopulmonary disease or pulmonary embolism. Mild troponin elevation was attributed to demand ischemia.<br /><br />The final diagnosis was bone cement implantation syndrome (BCIS), a diagnosis of exclusion that commonly occurs during cementation, prosthesis insertion, joint reduction, or tourniquet deflation. BCIS typically presents with hypoxia and hypotension, and in severe cases can cause arrhythmias, loss of consciousness, or cardiac arrest. Reported incidence in cemented arthroplasty is around 25-30%, with higher rates in cemented hip hemiarthroplasty and in patients with cancer. Risk factors include older age, male sex, severe cardiopulmonary disease, high ASA score, pulmonary hypertension, diuretic or warfarin use, osteoporosis, and malignancy.<br /><br />The presumed mechanism involves embolic release of medullary contents during cementation and/or inflammatory mediator release. BCIS is usually time-limited and often improves within 24 hours. Treatment is supportive: 100% oxygen, IV fluids, vasopressors if needed, and close hemodynamic monitoring.<br /><br />In this patient, oxygen needs and tachycardia gradually improved over several days, and she eventually had normal ambulatory oxygen saturation. The key takeaway is that BCIS should be considered in postoperative orthopedic patients with unexplained hypoxia and hypotension after cemented procedures.

Asset Subtitle

Saloni K. Maharaj

Meta Tag

Author List Saloni K. Maharaj

Category Clinical Vignettes

Concept Bone Cement Implantation Syndrome

Concept Postoperative Hypoxia

Concept Hypoxia

Concept Diagnosis of Exclusion

Concept Supportive Care

Distinguished Non-Finalist

Presenter Organization Stanford University School of Medicine

Presenting Author Saloni K. Maharaj

Track Adult

Keywords

bone cement implantation syndrome

BCIS

postoperative hypoxia

hypotension

tachycardia

cemented total hip arthroplasty

femoral neck fracture

orthopedic surgery

pulmonary embolism exclusion

supportive treatment

Bone Cement Implantation Syndrome

Postoperative Hypoxia

Hypoxia

Diagnosis of Exclusion

Supportive Care