Pubic Ramus Insufficiency Fractures Following Total Hip Arthroplasty
A Report of Six Cases
Cory G. Christiansen, MD; Rida A. Kassim, MD; John J. Callaghan, MD; J. Lawrence Marsh, MD; Andrew H. Schmidt, MD

Stress fractures are not uncommon in active individuals in their twenties and thirties, particularly athletes, runners, and military recruits 1. They represent fatigue fractures in which abnormal muscular stresses are applied to normal bone in a repetitive fashion, leading to increased forces on the bones. Insufficiency fractures, on the other hand, occur in patients who have underlying bone disease, resulting in fractures during activities of daily life.

Acute or subacute pain in the hip within the first few years following total hip arthroplasty is unusual when the replacement components are secure radiographically. The differential diagnosis includes subacute infection and periarticular bursitis or tendinitis. Pubic ramus insufficiency fractures also can be a cause of these symptoms and should be considered as part of the differential diagnosis. Isolated cases of pubic ramus insufficiency fracture have been reported following total hip arthroplasty with cement ( Table I ) 2-7. We present the cases of six patients with a pubic ramus insufficiency fracture following total hip arthroplasty in which a cementless acetabular component had been used. Our patients were notified that data concerning their cases would be submitted for publication.

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Cases of Pubic Ramus Stress Fractures Following Total Hip Arthroplasty

Case Reports

Case 1. A sixty-one-year-old woman with a medical history of hypertension, hypothyroidism, osteoporosis, and depression presented to our orthopaedic clinic with severe low-back pain that started after she got up from bed. The work-up revealed a sacral stress fracture, which was treated conservatively. One year later, she had another episode of localized low-back pain, and magnetic resonance imaging revealed a fracture of the fourth lumbar vertebra. Four years after the initial evaluation, she sustained a fall that resulted in a femoral neck fracture, which was treated by open reduction and internal fixation. The following year, osteonecrosis of the left femoral …

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