Embolism After Injection of a Calcium Sulfate Bone Graft Substitute: A Case Report

JBJS Case Connect. 2022 Sep 22;12(3). doi: 10.2106/JBJS.CC.22.00338. eCollection 2022 Jul 1.


Case: A 66-year-old man presented with new left hip pain after total hip arthroplasty 21 years earlier. Computed tomography imaging revealed massive osteolysis involving the ileum behind the well-fixed acetabular component. The patient was indicated for head and liner exchange with grafting of the osteolytic lesion. Surgery was complicated by cardiopulmonary arrest after injection of a bone graft substitute into the lesion. Despite resuscitation attempts, the patient died.

Conclusion: Embolism is a rare complication of bone graft substitute injection for pelvic osteolysis. This material can extravasate from bone and deposit in the pulmonary and cerebral microcirculation.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Bone Substitutes*
  • Calcium Sulfate
  • Embolism* / complications
  • Embolism* / surgery
  • Hip Prosthesis* / adverse effects
  • Humans
  • Male
  • Osteolysis* / etiology
  • Reoperation / adverse effects


  • Bone Substitutes
  • Calcium Sulfate