Stress fracture of the pubis after total hip arthroplasty.

The occurrence of pain after total hip arthroplasty emphasizes the covert nature of acute stress fractures. In a 46-year-old woman, the lesion was not apparent on initial radiograms; cultures as well as gram stain of the joint fluid were also negative, and the initial ESR and white blood count were normal, effectively ruling out infection. An arthrogram, performed to demonstrate possible loosening, revealed stress fracture of the superior pubic ramus. Without evidence of active infection, it may therefore prove wise to postpone revision surgery for several weeks or until diagnosis of an occult fracture becomes radiologically apparent.