Endogenous cannabinoids are candidates for lipid mediators of bone cement implantation syndrome

Shock. 2004 Jan;21(1):8-12. doi: 10.1097/01.SHK.0000094766.36694.49.


Acute hypotension, hypoxemia, cardiac arrhythmias, cardiac arrest, (or a combination of these), and sudden death are well-recognized complications of the cemented hip arthroplasty procedure. Collectively, these are known as the bone cement implantation syndrome (BCIS). The endogenous cannabinoids, anandamide (ANA) and 2-arachidonylglycerol (2-AG), are reported to be strong vasodilators and play a role in the hypotension associated with hemorrhagic and septic shock. In the present study, a potential role for the endogenous cannabinoids in influencing hemodynamic variables in BCIS was investigated. Thirty-five patients (35 hips) entered a prospective, randomized clinical trial. The patients were divided into two groups. Group 1 comprised 16 patients who had the component inserted using a conventional cementing technique, whereas group 2 consisted of 19 patients who had the femoral component inserted without cement. Blood samples were taken at six consecutive time points: before anesthesia, after reaming the femur, 2 min after insertion of stems with or without cement into the femur, and 10 min, 20, and 30 min after stem insertion. In group 1 (with cement), the mean levels of ANA and 2-AG significantly increased after stem insertion. In a comparison of each group after stem insertion, mean ANA and 2-AG levels in group 1 also significantly differed from those in group 2. By contrast, in group 2 (without cement) neither ANA nor 2-AG levels exhibited a significant increase or change at any point in time. In conclusion, we have shown for the first time that endogenous cannabinoids are candidates for lipid mediators of BCIS.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Arachidonic Acids / metabolism
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Blood Pressure
  • Bone Cements / therapeutic use*
  • Cannabinoids / metabolism*
  • Endocannabinoids
  • Female
  • Glycerides / metabolism
  • Heart Diseases / etiology*
  • Humans
  • Hypotension
  • Lipid Metabolism*
  • Male
  • Models, Biological
  • Polyunsaturated Alkamides
  • Prospective Studies
  • Prosthesis Failure
  • Shock / etiology
  • Syndrome
  • Time Factors
  • Vasodilator Agents / pharmacology


  • Arachidonic Acids
  • Bone Cements
  • Cannabinoids
  • Endocannabinoids
  • Glycerides
  • Polyunsaturated Alkamides
  • Vasodilator Agents
  • glyceryl 2-arachidonate
  • anandamide