Intraoperative Complications and Anesthetic Management During Bone Cement Application in Total Knee Replacement: A Comparative Cross-Sectional Study

Abstract

Background: Total knee replacement (TKR) is a common orthopedic procedure, but bone cement application can cause serious intraoperative complications, particularly Bone Cement Implantation Syndrome (BCIS), with uncertainty regarding the optimal anesthesia technique. Objective: This study aimed to compare the incidence and severity of intraoperative complications—specifically BCIS, hypotension, tachycardia, and desaturation—between general and regional anesthesia during bone cement application in TKR, evaluating their impact on patient safety and postoperative recovery. Methods: A descriptive cross-sectional study was conducted with 120 patients undergoing elective TKR at a tertiary care hospital. All adults receiving bone cement during TKR were eligible; patients without intraoperative complications or who declined consent were excluded. Data were collected via perioperative records, intraoperative monitoring, anesthesia charts, and validated pain scales. The primary outcomes were the incidence and grade of BCIS, hemodynamic instability, and anesthesia recovery time. Ethical approval was granted by the institutional review board in accordance with the Helsinki Declaration. Statistical analysis used SPSS 27.0, employing chi-square and t-tests, with p < 0.05 considered significant. Results: BCIS was observed in 18.3% of patients (Grade 1: 10%, Grade 2: 6.7%, Grade 3: 1.7%), with higher rates in the general anesthesia group (p < 0.05). General anesthesia was also associated with significantly increased hypotension (30% vs. 11.7%), tachycardia (20% vs. 10%), and desaturation (13.3% vs. 3.3%) compared to regional anesthesia, as well as prolonged recovery time (45.2 ± 10.3 vs. 30.5 ± 8.7 minutes) and higher postoperative pain scores (6.2 ± 1.5 vs. 4.8 ± 1.2; all p < 0.05). Conclusion: Regional anesthesia significantly reduces the risk and severity of intraoperative complications during cemented TKR, improves recovery, and lowers postoperative pain, supporting its use as the preferred technique to enhance safety and patient outcomes in orthopedic surgery.