Retrograde cement arteriovenogram of nutrient vessels following hemiarthroplasty of the hip

Published online: Aug 27 2012

Lushun WANG, Antony WESTWOOD GARDNER, Ernest Beng KEE KWEK, Ganesan Rajamoney NAIDU

From Tan Tock Seng Hospital, Singapore


Retrograde cement extrusion into the nutrient vessels of the femur is a rare phenomenon in uncomplicated cemented hemiarthroplasty of the hip ; this is a report on three cases. Routine postoperative radiographs showed a continuous dense linear opacity arising from the posterior medial region of the femur. Computed tomography (CT) scans revealed no evidence of a cortical break in the femur and confirmed our suspicion of retrograde cement extrusion into the nutrient vessels of the femur. Post-operative recovery was uneventful with no complications of cement thromboembolism. Our findings in three cases suggest that cement retrograde extrusion into nutrient vessels following hemiarthroplasty is a benign complication of modern cementing techniques involving pressurisation. The site of cement extrusion into the nutrient foramina displays a constant topography. We recommend that a CT scan of the femur be done on detection of a radio-opaque density on post-operative radiographs to differentiate an extra-osseous breach from an intra-vascular extrusion of cement. The theoretical complications of cement embolism and thrombosis should be kept in mind and looked for clinically.