Skip to main content
OpenTrials
Enrolling by Invitation

NCT Number: NCT06952257

Relationship Between Anesthetic Regimen and Bone Cement Implantation Syndrome (BCIS)

The annual incidence of geriatric hip fractures in the United States is 325,000 and is projected to rise given the aging population.1 The mainstay of treatment is cemented hip hemiarthroplasty. Bone cement implantation syndrome (BCIS) is a serious perioperative complication unique to cemented arthroplasty characterized by hypoxia, hypotension, cardiac arrhythmias, and in severe cases, cardiac arrest. BCIS is associated with significantly higher rates of unplanned intubation, vasopressor use, prolonged hospitalization, and 30-day mortality.

Given the rising incidence of hip fractures, the identification of readily modifiable risk factors for BCIS such as anesthetic regimen is crucial to reduce morbidity and mortality. However, a prospective study comparing the rate of BCIS development between general and neuraxial anesthesia is currently lacking. Additionally, no studies have examined how the anesthetic regimen affects histamine and complement levels. Therefore, this pilot study aims to investigate the effect of anesthetic regimen on BCIS development as well as on histamine and complement levels in patients undergoing cemented hemiarthroplasty for hip fracture. The investigators hypothesize that neuraxial anesthesia will be associated with lower rates of BCIS as well as lower histamine and complement levels compared to general anesthesia.

The primary objective of this pilot study is to compare the effect of general and neuraxial anesthesia on the incidence and severity of BCIS in patients undergoing cemented hemiarthroplasty for hip fracture.

Secondary objectives include examining postoperative outcomes associated with BCIS, such as cardiac arrhythmias, unplanned intubation, hypoxia necessitating supplemental oxygen, altered mental status, and in-hospital mortality.

Additional objectives include comparing histamine and complement levels between anesthetic regimens as well as between patients with and without BCIS

Enrolling by Invitation

Interested in participating?

Request Info

Key information

Conditions

Bone Cement Implantation Syndrome Femoral Fractures Fractures, Bone Hip Fractures Hip Injuries Leg Injuries Wounds and Injuries

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Dept of Orthopadic Surgery, Johns Hopkins Hospital, JHOC 5221, 601 N. Caroline St.

Baltimore, Maryland, 21287, United States

About this study

This study will be a prospective, randomized pilot study involving adult patients undergoing cemented hemiarthroplasty for hip fracture within the Johns Hopkins healthcare system. In total, 20-24 participants will be randomly assigned to receive either general anesthesia or neuraxial anesthesia with sedation. The use of general or neuraxial anesthesia in this study is consistent with the current standard of care for hip hemiarthroplasty. Randomization will be performed via computer-generated sequences and allocation concealment will be maintained. Blinding patients, anesthesiologists, and orthopedic surgeons to the anesthetic regimen is not possible, but the investigator(s) conducting the statistical analyses will be blinded to the anesthesic regimen.

Patients presenting to the Johns Hopkins system with a hip fracture will be screened for possible participation. If eligible for inclusion, informed consent will be obtained from the patient preoperatively. Patients will subsequently undergo a cemented hip hemiarthroplasty with an orthopedic surgeon under either general or neuraxial anesthesia. Intraoperative vital signs will be monitored in standard fashion and used to detect development of BCIS based upon previously established criteria.

Histamine and complement levels will be measured via blood samples collected at three timepoints: pre-operation, post-induction of anesthesia, and post-cementation. The collection of these labs is for research purposes only and is not part of routine care. Postoperative complications within 30-days of the index surgery will be identified via chart review. Thus, the study duration is 30 days for each patient and requires one visit (hospitalization with index surgery).

Patients that are randomly assigned to neuraxial anesthesia but require conversion to general anesthesia due to unsuccessful spinal or epidural will be considered a treatment failure. These patients will be analyzed per protocol.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients >18 years old that are indicated for cemented hemiarthroplasty for hip fracture.

Exclusion criteria

  • Patients with medical comorbidities that preclude randomization to an anesthetic regimen (e.g., severe aortic stenosis contraindicating general anesthesia or therapeutic anticoagulation contraindicating neuraxial anesthesia) or
  • a severe cognitive impairment that precludes the ability to provide informed consent.

Treatment and study plan

Administration of general anaesthesia

Procedure

The anaesthesia will be administered intravenously

Neuraxial Analgesia

Procedure

Will be administered as an epidural

Primary outcomes

  1. Number of Participants with Hypoxia

    Time frame: Intra-operatively, approximately 10 minutes

    Grade 1 BCIS, defined as moderate intraoperative hypoxia (<94%) or drop in systolic blood pressure of >20%) intraoperatively.

    Grade 2 BCIS, defined as severe hypoxia (<88%) or drop in systolic hypotension >40%.

    Grade 3 BCIS, defined as cardiovascular collapse requiring cardiopulmonary resuscitation.

Secondary outcomes

  1. Systolic and Diastolic Blood Pressure (mmHg)

    Time frame: Immediately before injection, int-operative up to 10 minutes

    Blood pressure will be monitored at two independent time points: (1) immediately before cement injection and (2) Intraoperative nadir after cement injection.

  2. Oxygen Saturation

    Time frame: Immediately before injection, intr-operative up to 10 minutes

    Oxygen saturation will be monitored at two independent time points: (1) immediately before cement injection and (2) Intraoperative nadir after cement injection.

Sponsors and collaborators

Lead sponsor

Johns Hopkins University

Other

Registry information

Official study title

Pilot Study: Relationship Between Anesthetic Regimen and Bone Cement Implantation Syndrome

Acronym: BCIS

Important dates

Study start
2027
Primary completion
2027
Study completion
2028
First posted
Apr 30, 2025
Registry last updated
Jul 21, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.