Pulmonary embolism with coexistent incidental pulmonary cement embolism post vertebroplasty

Pulmonary cement embolism is frequently observed but not a contributing factor for death in patients with cemented total hip and knee arthroplasty: a postmortem study

Purpose

Bone cement is frequently used for implant fixation in orthopaedic surgery. The occurrence of pulmonary cement embolism (PCE) in hip and knee arthroplasty has been described previously, but the exact extent and frequency have not been adequately studied. A postmortem cohort provides a unique opportunity for a more detailed analysis of this phenomenon.

Methods

Through retrospective analysis of whole-body computed tomography (CT) scans and autopsy protocols, we identified 67 cases with previous cemented total hip or knee arthroplasties. A grading system originally developed for PCE after cemented spine procedures was used. Findings were compared with two control groups: 35 individuals with previous cementless total joint arthroplasty as well as 25 individuals without evidence of prostheses.

Results

PCE was detected in 46.3% of the cases: grade 1 (31.3%), grade 2 (10.5%), and grade 3 (4.5%). No statistically significant difference was found between hip and knee arthroplasties in terms of PCE frequency. Importantly, none of the autopsy reports listed PCE as a cause of death or a contributing factor for the patients’ death. In the two control groups, only one case per group was classified as grade 1 PCE, while the remaining cases did not show any evidence of PCE.

Conclusion

The presented data reveal a high frequency of PCE in hip and knee arthroplasties, which is almost identical to previous findings in patients with cement-augmented interventions in the spine. This way, our results underline the relevance of PCE after arthroplasty, suggesting an adaptation of surgical methods to minimize this complication.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00264-022-05381-6.

Cement pulmonary embolism after percutaneous kyphoplasty: An unusual culprit for non-thrombotic pulmonary embolism

Non-thrombotic pulmonary embolism can occur from rare but diverse etiology and is not well understood. Increasing prevalence of osteoporosis in the aging population has contributed to increased utilization of percutaneous vertebral augmentation procedures of vertebroplasty and its recent modification, kyphoplasty. Though these procedures are relatively well tolerated, there is risk of potentially fatal complication of bone cement embolization to distant vasculature. We report a case of symptomatic pulmonary cement emboli developed 2 day's post kyphoplasty and its successful treatment with novel anticoagulant for 6 months. We also summarize evidence to assist clinicians and radiologists for early identification, treatment, and prevention of cement pulmonary emboli.