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Cement for hip replacement puts patients at risk of heart failure, death: Study

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More than 40 people in the U.K. have died due to the cement used in hip replacement surgery, and most of them died right on the operating table, according to a study conducted by a team of researchers at Imperial College London.  

The team of researchers, which included England's former chief medical officer Liam Donaldson, analyzed data submitted as patient safety incident reports to the National Health Service's (NHS) National Reporting and Learning System (NRLS), and discovered a total of 62 cases where patients undergoing hemiarthroplasty, better known as partial hip replacement, either died or were harmed after exposure to the cement used to help hold the artificial hip in place.

This amounts to around one case of what is called bone cement implantation syndrome (BCIS) for every 2,900 hip replacements, which means it is rare, but not so rare that doctors have to stop putting it into account when putting their patients under the knife.

Out of all the 62 cases of BCIS reported to the NRLS, 41 patients died, with 80% of deaths occurring within minutes of exposure to cement. Another 14 patients suffered from a heart attack but were revived, and the remaining underwent periarrest, a dangerously unstable condition that could lead to death, and recovered. Majority of these events also occurred shortly after the use of cement.

BCIS happens when the cement blocks proper circulation in the hip joint, which then lowers blood pressure and, in many cases, leads to cardiac arrest. In 2012, around 22,000 people underwent hip replacement surgery in the U.K., with most of them elderly who fractured their hipbone in a fall and were already suffering from age-related heart problems.

This is not the first warning against the use of cement in hip replacement surgeries. In 2009, the now defunct National Patient Safety Agency found 26 cases of death due to the cement used in hip surgeries and alerted the NHS to increase cautionary measures to prevent further harm to patients about to undergo the procedure. The Medicines and Healthcare Products Regulatory Agency also urged orthopedic surgeons to revise anesthetic and surgical procedures to minimize risk of BCIS.

However, most of the cases examined in the study occurred after 2009, suggesting that surgeons did not adequately heed the call to exercise prudence in the use of cement.

"The fact that deaths have continued clearly shows that the implementation of mitigation measures set out in the alert was suboptimal, or that their effectiveness is suboptimal, or both," according to the study (pdf).

Donaldson, who was the senior health adviser in England for 20 years, says the NHS needed to review the use of cement in hip replacement surgeries, noting that other countries seemed to have seen success in not using cement at all.

"We want to see this whole question about the use of cement opened up again and further research and evaluation of the risks," Donaldson says.

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