Bone cement implantation syndrome following cemented hip arthroplasty for traumatic and oncologic indications: A systematic review and meta-analysis of incidence, risk factors, and outcomes.

In 30 seconds

This systematic review and random-effects meta-analysis assessed the incidence, risk factors, and outcomes of bone cement implantation syndrome (BCIS) in cemented primary unilateral total hip or hemiarthroplasty, using the Donaldson severity criteria. Seventeen studies comprising 2560 cases were included. Pooled BCIS incidence was 29% in trauma settings and 60% in oncologic settings. Grade 1 was most frequently reported; Grades 2–3 were less common but associated with increased 30-day mortality. Advanced age, high ASA status, and oral anticoagulation were the most consistent risk factors, although evidence was generally limited and observational.

Key findings

• Pooled BCIS incidence was 29% in trauma settings and 60% in oncologic settings.
• Grade 1 BCIS was most frequently reported; Grades 2–3 were less common but associated with increased 30-day mortality.
• Advanced age, high ASA status, and oral anticoagulation were the most consistent risk factors, with generally limited evidence.
• Several prophylactic strategies were associated with reduced BCIS incidence in single-study analyses.

Why it matters

BCIS is a clinically important complication in cemented hip arthroplasty, and severe cases may carry substantial perioperative consequences. The pooled estimates and identified risk factors can inform awareness and perioperative assessment in trauma and oncologic settings. However, variation between institutions and limited evidence mean these findings should be interpreted cautiously, particularly outside the populations represented in the review.

What to keep in mind

Evidence for risk factors was generally limited and relied on observational data; pooled incidence estimates showed high heterogeneity. Only one included study addressed elective primary total hip arthroplasty for osteoarthritis.