Late onset femoral stress fracture associated with extruded cement following hip arthroplasty: a case report

The presented case demonstrates a femoral stress fracture in association with a cortical defect occupied by extruded polymethylmethacrylate, occurring approximately two years after a cemented total hip arthroplasty (THA). Although more emphasis is currently being placed on cementless arthroplasty, there is a large population of patients with cemented arthroplasties, and a number of surgeons continue to use pressurized cementing techniques. The diagnosis of stress fracture should be considered in addition to diagnoses of infection and loosening in patients with painful THAs and extruded femoral cement. Once the diagnosis of stress fracture is established, the authors advocate cement excision to the level of the endosteal cortex and bone grafting. The history of recent abrupt onset of pain and the bone scan with focal uptake have been found to be most helpful in establishing the diagnosis.