Intracardiac Leakage of Cement During Artificial Femoral Head Replacement: a Case Report and Review

Overview

Journal Int J Clin Exp Pathol

Specialty Pathology

Date 2024 Apr 5

PMID 38577698

Authors

Jin Li

Yanqing Zhang

Hongmei Zhang

Shanyun Jiang

Xindong Wu

Affiliations

Soon will be listed here.

Abstract

Bone cement leakage from the femoral medullary cavity is a rare complication following hip replacement. Currently, there are no reports of bone cement leakage into the heart. Here, we report an 81-year-old female patient with right femoral neck fracture. A thorough preoperative examination showed that bone cement had leaked into the heart during right femoral head replacement, leading to the death of the patient that night. Postoperative cardiac ultrasound showed that bone cement entered the vascular system through the femoral medullary cavity and subsequently entered the heart. Extreme deterioration in the patient's condition resulted in death that night. Unfortunately, the patient's family abandoned the idea of surgical removal of foreign bodies, leading to inevitable death. This case emphasizes the risk of clinical manifestations of cardiac embolism of bone cement after artificial femoral head replacement, suggesting that the risk of such embolism might be underestimated. We propose routine real-time C-arm X-ray guidance and injection of an appropriate amount of bone cement to prevent serious cardiopulmonary failure.

References

Zhang L, Wang J, Feng X, Tao Y, Yang J, Wang Y . A comparison of high viscosity bone cement and low viscosity bone cement vertebroplasty for severe osteoporotic vertebral compression fractures. Clin Neurol Neurosurg. 2014; 129:10-6. DOI: 10.1016/j.clineuro.2014.11.018. View

Prokop A, Hagele M, Pfeilsticker U, Koll S, Chmielnicki M . [Pericardial perforation 2.5 years after kyphoplasty. A rare complication after cement extravasation]. Unfallchirurg. 2012; 116(1):80-4. DOI: 10.1007/s00113-011-2136-1. View

Hatzantonis C, Czyz M, Pyzik R, Boszczyk B . Intracardiac bone cement embolism as a complication of vertebroplasty: management strategy. Eur Spine J. 2016; 26(12):3199-3205. DOI: 10.1007/s00586-016-4695-x. View

Baek I, Park H, Kim K, Jang T, Lee J . Paraplegia due to intradural cement leakage after vertebroplasty: a case report and literature review. BMC Musculoskelet Disord. 2021; 22(1):741. PMC: 8403441. DOI: 10.1186/s12891-021-04625-7. View

Caynak B, Onan B, Sagbas E, Duran C, Akpinar B . Cardiac tamponade and pulmonary embolism as a complication of percutaneous vertebroplasty. Ann Thorac Surg. 2008; 87(1):299-301. DOI: 10.1016/j.athoracsur.2008.05.074. View

Yin P, Hu J, Wang S, Sui G, Yuan G, Fan D . Bedside echocardiography for diagnosis of intracardiac cement embolism after percutaneous vertebroplasty: A case report. J Card Surg. 2021; 36(10):3929-3932. DOI: 10.1111/jocs.15830. View

Varnum C, Pedersen A, Rolfson O, Rogmark C, Furnes O, Hallan G . Impact of hip arthroplasty registers on orthopaedic practice and perspectives for the future. EFORT Open Rev. 2019; 4(6):368-376. PMC: 6549115. DOI: 10.1302/2058-5241.4.180091. View

Weingartner K, Stormann P, Schramm D, Wutzler S, Zacharowski K, Marzi I . Bone cement implantation syndrome in cemented hip hemiarthroplasty-a persistent risk. Eur J Trauma Emerg Surg. 2021; 48(2):721-729. PMC: 9001528. DOI: 10.1007/s00068-020-01587-8. View

Wu X, Shen Y, Chen Y, Zhang H, Jiang M . Comparison of clinical efficacy of artificial femoral head replacement and total hip replacement in the treatment of femoral neck fracture in the elderly. Minerva Surg. 2021; 76(5):484-485. DOI: 10.23736/S2724-5691.21.08868-7. View

10.

Ballas E, Nguyen V, Wolin E . Femoral Neck Fracture with Avascular Necrosis. J Nucl Med Technol. 2022; 51(1):78-79. DOI: 10.2967/jnmt.122.264354. View

11.

Kim H, Kim Y, Shin H, Kim I, Kim H, Park N . Intracardiac foreign body caused by cement leakage as a late complication of percutaneous vertebroplasty. Korean J Intern Med. 2013; 28(2):247-50. PMC: 3604617. DOI: 10.3904/kjim.2013.28.2.247. View

12.

Son K, Chung J, Sun K, Son H . Cardiac perforation and tricuspid regurgitation as a complication of percutaneous vertebroplasty. Eur J Cardiothorac Surg. 2008; 33(3):508-9. DOI: 10.1016/j.ejcts.2007.11.027. View

13.

Kim S, Seo J, Do K, Lee J, Song K, Lim T . Cardiac perforation caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJR Am J Roentgenol. 2005; 185(5):1245-7. DOI: 10.2214/AJR.04.1443. View

14.

Lim K, Yoon S, Jeon Y, Bahk J, Kim C, Lee J . An intraatrial thrombus and pulmonary thromboembolism as a late complication of percutaneous vertebroplasty. Anesth Analg. 2007; 104(4):924-6. DOI: 10.1213/01.ane.0000256974.84535.7a. View

15.

Hines C . Understanding Bone Cement Implantation Syndrome. AANA J. 2019; 86(6):433-441. View

16.

Weininger G, Sekar R, Elefteriades J . Intracardiac polymethylmethacrylate cement embolism. JTCVS Tech. 2022; 10:358-360. PMC: 8691793. DOI: 10.1016/j.xjtc.2021.09.001. View

17.

Grifka R, Tapio J, Lee K . Transcatheter retrieval of an embolized methylmethacrylate glue fragment adherent to the right atrium using bidirectional snares. Catheter Cardiovasc Interv. 2012; 81(4):648-50. DOI: 10.1002/ccd.24333. View

18.

Moon M, Jo K, Kim H . Cardiac perforation caused by bone cement embolism. Arch Cardiovasc Dis. 2013; 106(6-7):413-4. DOI: 10.1016/j.acvd.2011.11.010. View

19.

Lee V, Patel R, Meier P, Lawrence D, Roberts N . Conservative management of inferior vena cava cement spike after percutaneous vertebroplasty causes fatal cardiac tamponade. J Rheumatol. 2014; 41(1):141-2. DOI: 10.3899/jrheum.130570. View

20.

Pannirselvam V, Hee H . Asymptomatic cement embolism in the right atrium after vertebroplasty using high-viscosity cement: a case report. J Orthop Surg (Hong Kong). 2014; 22(2):244-7. DOI: 10.1177/230949901402200228. View