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Bone Cement Implantation Syndrome — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaBone Cement Implantation SyndromeFRCA Final

A 78-year-old woman (ASA III) undergoes emergency hip hemiarthroplasty under spinal anaesthesia. Intra-operatively during cement insertion she develops sudden hypotension (BP 55/30), desaturation (SpO2 78%), and bradycardia (HR 38). What is the most likely diagnosis?

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Correct answer: C — Bone cement implantation syndrome

Bone cement implantation syndrome (BCIS) occurs during cemented arthroplasty when pressurisation of methylmethacrylate cement forces fat, marrow, cement monomer, and air into the venous circulation. It typically presents during or shortly after cement insertion/prosthesis impaction with sudden hypotension, hypoxia, and cardiac arrest. Severity is graded 1-3. Risk factors include: cemented long-stem prosthesis, intertrochanteric fractures, and pre-existing cardiopulmonary disease. Management is supportive with 100% O2, vasopressors, fluid resuscitation, and CPR if needed. Preventive measures include medullary lavage and venting.

Reference: Donaldson AJ – 2009 – BCIS; AAGBI – 2015 – Cement implantation syndrome; RCOA – 2023 – Orthopaedic module