Seven patients had a cardiac arrest during hip arthroplasty with a
cemented long-stem femoral component. Four patients died in the operating
room, and three patients were successfully resuscitated. When the three
survivors were eventually discharged from the hospital, they had no known
permanent cardiac, pulmonary, or neurological sequelae. Factors that were
common to all of the patients were advanced age, osteoporotic bone, a
previously undisturbed intramedullary canal, and use of a long-stem femoral
component and several batches of methylmethacrylate. Hip arthroplasty with
a long-stem femoral component is associated with substantial risk in these
patients. Excessive pressurization of cement should be avoided, and
invasive hemodynamic monitoring should be used when the described
conditions are present.