An Experimental Study to Determine the Role of Inferior Vena Cava Filter in Preventing Bone Cement Implantation Syndrome

Inferior vena cava filters (IVCF) are frequently used for preventing pulmonary embolism (PE) following deep venous thromboembolism. The present study was designed to investigate whether IVCF could prevent or impede the occurrence of bone cement implantation syndrome (BCIS), since PE is considered as the central mechanism of BCIS. Fifteen sheep were divided into three groups: bone cement free (BCF) group, cement implantation (CI) group and IVCF group. In all the groups, an osteotomy proximal to the greater trochanter of left femur was carried out. In BCF group, the femoral canal was not reamed out or packed with any bone cement. In CI and IVCF groups, the left femoral canals were packed with bone cement, to simulate the cementing procedures carried out in hip replacement. An OptEase® filter was placed and released in inferior vena cava, prior to packing cement in the femoral canal in IVCF group, while the IVCF was not released in the CI group. The BCF group was considered as control. Systolic blood pressure (SBP), saturation of oxygen (SaO2) and partial pressure of carbon dioxide (PaCO2) declined significantly 10 min after the bone cement packing, in CI group, compared to those in BCF group. This was accompanied by a rise in the arterial pH. However, IVCF prevented those changes in the CI group. On ultrasonography, there were dotted echoes in right atrium in the CI group, after bone cement packing, while such echoes were hardly seen in the IVCF group. This study demonstrates that IVCF could prevent BCIS effectively, and, as a corollary, suggests that PE represents the leading cause of the constellation of BCIS symptoms.