Cement (PMMA) Extrusion into Femoral Nutrient Vessels during Total Hip Arthroplasty: Case Series

Current concepts in cement Total Hip Arthroplasty advocates optimization of mechanical interlock of cement (PMMA) with trabecular bone. The Third generation cementing technique has been developed to achieve this with the use of cement gun retrograde cementing within the proximal femur and pressurization of the cement with wedge or surgeon’s thumb. The forces generated by cement compression during total hip replacement reach peak pressures that varied between 122 kPa and more than 1500 kPa. The high intramedullary pressures encountered can lead to extrusion of cement through the nutrient foramina in the femoral cortex and into the nutrient vessels, resulting in the retrograde arteriovenogram. This has been reported in the literature as a rare phenomenon. Published case reports [1,3-9] have highlighted the extrusion of cement into the nutrient vessels either as intravenous extrusion due to the appearance of valvular constriction or as extravascular extrusions of PMMA through a femoral vascular channel.