title: Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty.
abstract: Cement extrusion into the pelvis with subsequent palsy of the obturator and femoral nerves is a rare entity after hip replacement surgery. Cemented fixation of the acetabular cup has been considered as a safe and reliable standard procedure with very good long term results. We present a case of fifty year old female patient after hip arthroplasty procedure which suffered an obturator and femoral nerve palsy caused by extrusion of bone cement into the pelvis. Postoperative X-rays and CT-scan of the pelvis demonstrated a huge mass consisted of bone cement in close proximity of femoral and obturator nerves. The surgery charts reported shallow and weak bony substance in postero-superior aspect of the acetabulum. This weak bony acetabular substance may have caused extrusion of bone cement during press-fitting of the polyethylene cup into the acetabulum, and the following damage of the both nerves produced by polymerization of bone cement. The bone cement fragment has been surgically removed 3 weeks after arthroplasty. The female patient underwent intensive postoperative physical therapy and electro stimulation which resulted in full recovery of the patient to daily routine and almost normal electromyography results.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany.
authors.forename: Pawel
authors.initials: P
authors.lastname: Zwolak
authors.forename: Peer
authors.initials: P
authors.lastname: Eysel
authors.forename: Joern
authors.initials: J
authors.lastname: William-Patrick Michael