The use of bone cement induces an increase in serum astroglial S-100B protein in patients undergoing total knee arthroplasty.
Cerebral microemboli can occur during arthroplasty with the use of bone cement. Astroglial S-100B protein is a sensitive marker of cerebral damage. Therefore, we designed this study to determine the effect of bone cement on the brain by investigating serum levels of S-100B protein in patients undergoing bone surgery with or without bone cement. Fourteen patients undergoing knee arthroplasty (n = 7) or reamed intramedullary nailing for tibial fracture (n = 7) requiring a pneumatic tourniquet were enrolled in this study. Bone cement containing polymethyl methacrylate and methyl methacrylate was used for every patient undergoing knee arthroplasty. Serum samples were obtained from venous blood before the induction of general anesthesia, 15 min after deflation of a pneumatic tourniquet, and 3 days after the operation. The serum level of S-100B protein was significantly increased 15 min after a pneumatic tourniquet deflation in the knee arthroplasty group compared with the tibial fracture group (0.41 and 0.08 ng/mL, respectively; P < 0.05). In all patients studied, no neurological abnormalities were noted in the postoperative period. These results suggest that, in patients undergoing knee arthroplasty, bone cement may transiently induce astroglial injury, although it does not alter neurological outcome.


CONCLUSIONS
Serum S-100B protein was significantly increased 15 min after a pneumatic tourniquet deflation in patients undergoing knee arthroplasty with bone cement, but not in those undergoing reamed intramedullary nailing for tibial fracture without bone cement. These results suggest that bone cement may transiently induce astroglial injury.
Kinoshita
Hiroyuki
H
*Department of Anesthesia, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan; and †Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan.
Iranami
Hiroshi
H
Fujii
Keisuke
K
Yamazaki
Akinori
A
Shimogai
Manabu
M
Nakahata
Katsutoshi
K
Hironaka
Yasuo
Y
Hatano
Yoshio
Y
D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D001253:Astrocytes / Q000378:metabolism*; D001843:Bone Cements / Q000009:adverse effects*; D001923:Brain Chemistry / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000187:drug effects; D009483:Neuropsychological Tests; D019637:Orthopedic Procedures; D019904:Polymethyl Methacrylate / Q000009:adverse effects; D009418:S100 Proteins / Q000097:blood*; D013978:Tibial Fractures / Q000601:surgery
D001843:Bone Cements; D009418:S100 Proteins; D019904:Polymethyl Methacrylate