DOI: https://doi.org/10.36347/sjmcr.2025.v13i03.042

Pages: 503-507

Background: Bone Cement Implantation Syndrome (BCIS) is a potentially fatal complication associated with cemented orthopedic procedures, primarily hip arthroplasty. It is characterized by acute respiratory and cardiovascular instability, often occurring intraoperatively or immediately after cementation. However, delayed-onset BCIS remains a rare and under-recognized entity. Case Presentation: We report the case of a 75-year-old male with a history of well-controlled chronic obstructive pulmonary disease (COPD) who underwent cemented hemiarthroplasty for a right femoral neck fracture. The preoperative assessment classified him as ASA II, with no significant cardiopulmonary compromise. Surgery was uneventful under spinal anesthesia, with stable intraoperative hemodynamics. However, one hour postoperatively, the patient developed respiratory distress, profound hypoxia (SpO₂ 85%), and hemodynamic instability (BP 87/66 mmHg, HR 119 bpm). Despite initial resuscitative measures, he deteriorated further, necessitating intensive care unit (ICU) admission, invasive monitoring, mechanical ventilation, and vasopressor support. Transthoracic echocardiography revealed acute right ventricular (RV) failure, a hallmark of severe BCIS. Over the following days, intensive supportive management led to gradual clinical improvement, and the patient was successfully extubated on day six. He was discharged from the ICU on day eight and later recovered without further complications. Conclusion: This case underscores the importance of heightened awareness of BCIS, particularly its delayed presentation. A multidisciplinary approach, prompt diagnosis, and aggressive supportive management are crucial in improving survival in high-risk patients undergoing cemented arthroplasty.