A 68-year-old woman undergoes cemented total knee replacement. Which complication is most directly related to the use of bone cement (polymethylmethacrylate — PMMA) during implant insertion?

• A Bone cement implantation syndrome (hypotension, hypoxia, and cardiac arrest during cement pressurization) ✓
• B Deep vein thrombosis
• C Periprosthetic joint infection
• D Patellar maltracking

Explanation

Bone Cement Implantation Syndrome (BCIS) is a well-recognized complication occurring at the time of cement pressurization and implant insertion — characterized by hypoxia, hypotension, dysrhythmias, and potentially cardiac arrest. It results from fat and marrow emboli, air emboli, and release of cement monomer (methylmethacrylate) into the circulation when the medullary canal is pressurized. It is most dangerous in elderly patients with pre-existing cardiopulmonary disease undergoing cemented hip hemiarthroplasty. Prevention includes thorough pulse lavage before cementing, avoiding over-pressurization, and adequate oxygenation. DVT is a general postoperative complication, not specific to cement use.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.