title: Retrograde cement arteriovenogram of nutrient vessels following hemiarthroplasty of the hip.
abstract: 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 postoperative radiographs to differentiate an extraosseous 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.
authors.affiliation: Department of Orthopaedics, Tan Tock Seng Hospital, Singapore. kaedetod@gmail.com
authors.forename: Lushun
authors.initials: L
authors.lastname: Wang
authors.forename: Antony Westwood
authors.initials: AW
authors.lastname: Gardner
authors.forename: Ernest Beng Kee
authors.initials: EB
authors.lastname: Kwek
authors.forename: Ganesan Rajamoney
authors.initials: GR
authors.lastname: Naidu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001843:Bone Cements / Q000009:adverse effects*; D002484:Cementation / Q000009:adverse effects* / Q000379:methods; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D005269:Femur / Q000098:blood supply / Q000000981:diagnostic imaging; D006615:Hip / Q000098:blood supply / Q000000981:diagnostic imaging; D006801:Humans; D011859:Radiography
chemical_list: D001843:Bone Cements