Bone Cement Emboli after Arthroplasty: Is It Possible? A Case Report and Literature Review
-
Seyyed-Morteza Kazemi
,
Sohrab Keyhani
,
Mohammadreza Miniator Sajjadi
,
Ramin Etemadi
,
Seyyed-Mohsen Hosseininejad
,
Hoda Nouri
Abstract
Background: Polymethylmethacrylate (PMMA) has been extensively used as bone cement in orthopedic procedures. Pulmonary cement embolisms (PCEs) are supposed to originate from cement extravasation into the basivertebral veins before draining into the inferior vena cava and eventually becoming lodged in the pulmonary capillaries. Few cases of bone cement embolism have been reported. This study reported a case of pulmonary embolism (PE) after thoracolumbar fixation and kyphoplasty and reviewed the current literature.
Case Report: We presented an 81-year-old woman who had undergone thoracolumbar vertebroplasty three months before admission and became symptomatic due to PE after total knee arthroplasty (TKA).
Conclusion: This case illustrates that clinicians must be aware of the probable occurrence of respiratory distress syndrome in patients with a history of vertebroplasty.
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2. Yoo KY, Jeong SW, Yoon W, Lee J. Acute respiratory distress syndrome associated with pulmonary cement embolism
following percutaneous vertebroplasty with polymethylmethacrylate. Spine (Phila Pa 1976). 2004;29(14):E294-E297. doi: 10.1097/01.brs.0000131211.87594.b0. [PubMed: 15247590].
3. Colonna DM, Kilgus D, Brown W, Challa V, Stump DA, Moody DM. Acute brain fat embolization occurring after total hip arthroplasty in the absence of a patent foramen ovale. Anesthesiology. 2002;96(4):1027-9. doi: 10.1097/00000542-200204000-00036. [PubMed: 11964616].
4. Zarei M, Rostami M, Khan F. Does spine surgery in patients with a history of bariatric gastrectomy increase the risk of delayed pulmonary embolism?. J Orthop Spine Trauma. 2022;7(4):154-6. doi: 10.18502/jost.v7i4.8864.
5. Ioannis P, Andreas B, Panagiotis K. Calcium phosphate cement leakage during balloon kyphoplasty causing incomplete paraplegia: Case report and review of the literature. J Orthop Spine Trauma. 2016;2(3):e8894. doi: 10.5812/jost.8894.
6. Bengtson A, Larsson M, Gammer W, Heideman M.
Anaphylatoxin release in association with methylmethacrylate fixation of hip prostheses. J Bone Joint Surg Am. 1987;69(1):46-9. [PubMed: 3805070].
7. Robbins RA, Russ WD, Rasmussen JK, Clayton MM. Activation of the complement system in the adult respiratory distress syndrome. Am Rev Respir Dis. 1987;135(3):651-8. doi: 10.1164/arrd.1987.135.3.651. [PubMed: 3826891].
8. Gershater R, St Louis EL. Lumbar epidural venography. Review of 1,200 cases. Radiology. 1979;131(2):409-21. doi: 10.1148/131.2.409. [PubMed: 441331].
9. Drigalla D, Stone CK, Juergens AL. Delayed symptomatic pulmonary embolism secondary to bone cement after percutaneous vertebroplasty. J Emerg Med. 2021;60(3):e45-e47. doi: 10.1016/j.jemermed.2020.10.045. [PubMed: 33419654].
10. Dahl OE, Garvik LJ, Lyberg T. Toxic effects of methylmethacrylate monomer on leukocytes and endothelial cells in vitro. Acta Orthop Scand. 1994;65(2):147-53. doi: 10.3109/17453679408995423. [PubMed: 8197846].
11. Kristensen SD, Knuuti J, Saraste A, Anker S, Botker HE, Hert SD, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: Cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35(35):2383-431. doi: 10.1093/eurheartj/ehu282. [PubMed: 25086026].
12. Nooh A, Abduljabbar FH, Abduljabbar AH, Jarzem P. Pulmonary artery cement embolism after a vertebroplasty. Case Rep Orthop. 2015;2015:582769. doi: 10.1155/2015/582769. [PubMed: 26221556]. [PubMed Central: PMC4499392].
13. Krebs J, Aebli N, Goss BG, Wilson K, Williams R, Ferguson SJ. Cardiovascular changes after pulmonary cement embolism: An experimental study in sheep. AJNR Am J Neuroradiol. 2007;28(6):1046-50. doi: 10.3174/ajnr.A0499. [PubMed: 17569954]. [PubMed Central: PMC8134139].
14. Jaffer AK, Brotman DJ, Chukwumerije N. When patients on warfarin need surgery. Cleve Clin J Med. 2003;70(11):973-84. doi: 10.3949/ccjm.70.11.973. [PubMed: 14650471].
15. O'Donnell M, Kearon C. Perioperative management of oral anticoagulation. Cardiol Clin. 2008;26(2):299-309. doi: 10.1016/j.ccl.2007.12.012. [PubMed: 18407002].
16. Waler AR, Sanchez KJ, Parikh AA, Okorie ON. A case of pulmonary cement embolism managed through symptomatic treatment. Case Rep Crit Care. 2020;2020:2425973. doi: 10.1155/2020/2425973. [PubMed: 32566322]. [PubMed Central: PMC7293736].
17. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. doi: 10.1093/eurheartj/ehz405. [PubMed: 31504429].
2. Yoo KY, Jeong SW, Yoon W, Lee J. Acute respiratory distress syndrome associated with pulmonary cement embolism
following percutaneous vertebroplasty with polymethylmethacrylate. Spine (Phila Pa 1976). 2004;29(14):E294-E297. doi: 10.1097/01.brs.0000131211.87594.b0. [PubMed: 15247590].
3. Colonna DM, Kilgus D, Brown W, Challa V, Stump DA, Moody DM. Acute brain fat embolization occurring after total hip arthroplasty in the absence of a patent foramen ovale. Anesthesiology. 2002;96(4):1027-9. doi: 10.1097/00000542-200204000-00036. [PubMed: 11964616].
4. Zarei M, Rostami M, Khan F. Does spine surgery in patients with a history of bariatric gastrectomy increase the risk of delayed pulmonary embolism?. J Orthop Spine Trauma. 2022;7(4):154-6. doi: 10.18502/jost.v7i4.8864.
5. Ioannis P, Andreas B, Panagiotis K. Calcium phosphate cement leakage during balloon kyphoplasty causing incomplete paraplegia: Case report and review of the literature. J Orthop Spine Trauma. 2016;2(3):e8894. doi: 10.5812/jost.8894.
6. Bengtson A, Larsson M, Gammer W, Heideman M.
Anaphylatoxin release in association with methylmethacrylate fixation of hip prostheses. J Bone Joint Surg Am. 1987;69(1):46-9. [PubMed: 3805070].
7. Robbins RA, Russ WD, Rasmussen JK, Clayton MM. Activation of the complement system in the adult respiratory distress syndrome. Am Rev Respir Dis. 1987;135(3):651-8. doi: 10.1164/arrd.1987.135.3.651. [PubMed: 3826891].
8. Gershater R, St Louis EL. Lumbar epidural venography. Review of 1,200 cases. Radiology. 1979;131(2):409-21. doi: 10.1148/131.2.409. [PubMed: 441331].
9. Drigalla D, Stone CK, Juergens AL. Delayed symptomatic pulmonary embolism secondary to bone cement after percutaneous vertebroplasty. J Emerg Med. 2021;60(3):e45-e47. doi: 10.1016/j.jemermed.2020.10.045. [PubMed: 33419654].
10. Dahl OE, Garvik LJ, Lyberg T. Toxic effects of methylmethacrylate monomer on leukocytes and endothelial cells in vitro. Acta Orthop Scand. 1994;65(2):147-53. doi: 10.3109/17453679408995423. [PubMed: 8197846].
11. Kristensen SD, Knuuti J, Saraste A, Anker S, Botker HE, Hert SD, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: Cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35(35):2383-431. doi: 10.1093/eurheartj/ehu282. [PubMed: 25086026].
12. Nooh A, Abduljabbar FH, Abduljabbar AH, Jarzem P. Pulmonary artery cement embolism after a vertebroplasty. Case Rep Orthop. 2015;2015:582769. doi: 10.1155/2015/582769. [PubMed: 26221556]. [PubMed Central: PMC4499392].
13. Krebs J, Aebli N, Goss BG, Wilson K, Williams R, Ferguson SJ. Cardiovascular changes after pulmonary cement embolism: An experimental study in sheep. AJNR Am J Neuroradiol. 2007;28(6):1046-50. doi: 10.3174/ajnr.A0499. [PubMed: 17569954]. [PubMed Central: PMC8134139].
14. Jaffer AK, Brotman DJ, Chukwumerije N. When patients on warfarin need surgery. Cleve Clin J Med. 2003;70(11):973-84. doi: 10.3949/ccjm.70.11.973. [PubMed: 14650471].
15. O'Donnell M, Kearon C. Perioperative management of oral anticoagulation. Cardiol Clin. 2008;26(2):299-309. doi: 10.1016/j.ccl.2007.12.012. [PubMed: 18407002].
16. Waler AR, Sanchez KJ, Parikh AA, Okorie ON. A case of pulmonary cement embolism managed through symptomatic treatment. Case Rep Crit Care. 2020;2020:2425973. doi: 10.1155/2020/2425973. [PubMed: 32566322]. [PubMed Central: PMC7293736].
17. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. doi: 10.1093/eurheartj/ehz405. [PubMed: 31504429].
| Files | ||
| Issue | Vol 9, No 2 (2023) | |
| Section | Case Report | |
| DOI | https://doi.org/10.18502/jost.v9i2.12629 | |
| Keywords | ||
| Bone Cements Polymethylmethacrylate Pulmonary Embolism Knee Replacement Arthroplasty Vertebroplasty | ||
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How to Cite
1.
Kazemi S-M, Keyhani S, Sajjadi M, Etemadi R, Hosseininejad S-M, Nouri H. Bone Cement Emboli after Arthroplasty: Is It Possible? A Case Report and Literature Review. J Orthop Spine Trauma. 2023;9(2):100-2.
