BONE CEMENT IMPLANTATION SYNDROME (BCIS): A THROMBOELASTOGRAPHIC (TEG) STUDY OF THE EFFECT OF BONE CEMENT ON COAGULATION

Abstract

Bone cement implantation syndrome (BCIS) is a rare form of intraoperative pulmonary embolism (EP)that occurs during cementation. It can be explained by two main theories: the monomer mediated modeland the mechanic model. Our goal is to evaluate thromboelastographic changes in patients undergoingsurgery for femoral neck fractures. We recruited 32 patients with a femoral neck fracture. The averageage was 81.91 years (range 62-95). The patients were divided in two different groups: cemented hiparthroplasty (CC, 13 patients) and other surgical non-cemented techniques (SC, non-cemented hiparthroplasty, osteosynthesis). The coagulation was evaluated by TEG in the early pre-operatory (timeA) and post-operatory (time B), both on native blood and on blood added with Heparinase. We usedthe t-test to compare the differences between the two groups. The coagulation index CI was modified onhypercoagulability by surgery in both groups, but without statistical significance between the two groups(p>0.05). R parameter decreases between time A and time B in the same way in both groups (p>0.05).Parameter MA had no major variations between time A and B, without statistical significance (p>0.05).From our study it is evident that although the surgery would result in a change in the layout of the TEGtoward hypercoagulability, this is similar both in cemented and non-cemented surgical interventions forfemoral neck fractures in elderly patients. An altered coagulation does not appear to be the cause or afactor in determining the BCIS.