13.06.14
Cement used in hip replacements linked with deaths
The use of cement in partial hip replacement surgery has been linked to 41 deaths in the UK, researchers from Imperial College London have warned in the online journal BMJ Open.
The report authors, who include the former chief medical officer for England, Professor Liam Donaldson, say that the risk is relatively rare. But they do state that the warning was first made in 2009, and most of the cases that have come to light have occurred since that date.
Based on an analysis of patient safety incidents in England and Wales, submitted between 2005 and 2012 to the National Reporting and Learning System (NRLS), the researchers found that all the cases involved sudden and severe deterioration among patients undergoing partial hip replacement, known as hemiarthroplasty, for fractured neck of femur (broken hip), and associated with the use of cement to help hold the artificial hip joint in place.
This sudden deterioration, referred to as bone cement implantation syndrome or BCIS for short caused either death; cardiac arrest; or periarrest – severe deterioration in the patient’s condition in each of the cases.
The researchers found that between 2005 and 2012, the NRLS received 62 reports of BCIS, equivalent to one incident for every 2,900 hemiarthroplasties performed for fractured neck of femur – indicating that it is a rare occurrence.
It also highlighted that in 2012, 22,000 people in the UK underwent partial hip replacement for a fractured neck of femur, although not all these involved the use of cement. However, in 41 of the cases reported to the NRLS the patient died, and in most (80%), this was on the operating table. In most cases (55 out of 62; 89%), these events occurred within minutes of the cement being inserted.
Professor Donaldson, who was the chief medical officer for England from 1998 to 2010, said: “Cement tends to be the main method for inserting hips in the UK. In other countries such as Canada it isn’t used at all.”
He added: “Patient death is caused by one of two things. Some chemical enters the blood and disturbs the heart rhythm. The other is that when the cement is pushed into the marrow of the bone it causes a fat embolism, a ball of fat enters the blood stream and that gets lodged in one of the main arteries. The death often comes almost immediately.”
In 2009, the now-defunct National Patient Safety Agency raised the alarm about the use of cement and associated patient harm during hemiarthroplasty and issued guidance to the NHS on how to minimise the risks.
But the researchers believe the fact that deaths are continuing to occur “clearly shows that the implementation of mitigation measures set out in the alert was suboptimal, or that their effectiveness is suboptimal, or both”.
Dr Paul Rutter, another of the researchers, said: “The risk is not enormous but it’s significant enough that we should try to understand and take account of it.
“Bone cement implantation syndrome happens and it’s killing people in the UK. It’s rare but it’s not extremely rare.”
A spokesman for NHS England said the NHS was working with patient safety groups and the royal colleges to tackle the problem.
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