Bone Cement Implantation Syndrome

Instructor: Amy Lipsett

Amy works as a nurse educator for a university health care organization. She has a bachelor's of science in nursing and a master's degree in health care administration.

Bone cement implantation syndrome is a rare but potentially fatal complication from the cement used during certain orthopedic surgeries. In this lesson, a broad overview of bone cement implantation syndrome will be presented.

A Medical Emergency

Imagine that you are a critical care registered nurse (RN) and that you are receiving handoff communication, or verbal report on the status of a patient that you will be assuming care of, from the recovery room RN. You are told that the patient, Mrs. Smith, is a 75 year old female who went into shock during her surgery for a total hip replacement. The recovery room RN reports that the surgical team believes that bone cement implantation syndrome has caused Mrs. Smith to go into shock. You do not remember much from college about this syndrome other than the fact that it is rare, so you decide to do a little research before Mrs. Smith arrives to the intensive care unit (ICU).


Bone cement implantation syndrome is a rare but potentially fatal complication that can occur when a patient reacts to medical cement that is used during certain orthopedic surgeries.

These orthopedic surgeries include:

  • total hip replacement
  • total knee replacement
  • total shoulder replacement
  • total elbow replacement

In these surgeries, the doctor uses bone cement as a space filler to create a tight space between the remaining bone and the new prosthesis. When a patient like Mrs. Smith is exposed to bone cement, she is at risk for bone cement implantation syndrome.

Signs and Symptoms

Bone cement implantation syndrome is a sudden, catastrophic emergency that occurs while the patient is in the operating room, usually within minutes of placing the bone cement into the patient. Signs and symptoms of this emergency include:

  • hypoxia (low oxygen level)
  • hyotension (low blood pressure)
  • cardiac arrhythmia (irregular heart beat)
  • increased pulmonary vascular resistance (resistance of blood flow through pulmonary circulation)
  • unexpected loss of consciousness
  • cardiac arrest (heart beat stops)
  • any combination of the above


When a patient is believed to have bone cement implantation syndrome, a fast-acting doctor and surgical team are crucial for survival. Aggressive treatment is necessary in order to stabilize the patient as soon as possible. The surgical procedure is usually stopped while the anesthesiologist and medical team provide life-saving treatment. This treatment includes:

  • intubation to protect the patient's airway and to increase oxygenation
  • medication to increase blood pressure
  • medication or defibrillator shock to stabilize the patient's heart rhythm
  • CPR to circulate blood and medication for cardiac arrest until the patient's heart rhythm returns

All of these efforts may prove to be futile. If the patient can not be stabilized, bone cement implantation syndrome will cause death. If the patient is stabilized, usually the surgeon quickly finishes the surgery before the patient is transferred to the ICU. If the surgeon is unable to finish the surgery, the patient's surgical wound is left opened and packed with a sterile dressing. The surgeon will plan to finish the surgery once the patient is stable enough to return to the operating room.

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