Patient (MC) was a 59 year old female presenting with bilateral hip Osteoarthritis. She underwent right-sided cemented Stanmore THR. The hip joint was exposed through the posterior approach. The femoral cavity was prepared, cleaned using pulse lavage and brushing, dried and a size 12.5 mm cement restrictor placed (cement plug JRI) two centimetres distal to the tip of the femoral component. After three to four minutes of polymerisation standard viscosity cement (Refobacin, Biomet) was introduced into the femoral cavity using 4th generation cementing techniques. A retrograde technique was employed with a suction catheter placed distally in the initial cementation period and a proximal cement pressurisation adapter for the cement gun was used. It was apparent that the gun (Stryker UK cement gun) nozzle, abutted the endosteum closely. No untoward intra-operative events were noted and the patient returned to the ward with no adverse features in the post-operative course. A check X-ray of the procedure taken two days post- operatively demonstrated significant cement extrusion from the posterior-medial aspect of the femoral diaphysis approximately 2 cms (26.6 mm) proximal from the stem tip and 17mm extrusion into the soft tissues. ( & AP and lateral of proximal femur, measurements took account of radiographic magnification). The patient had no adverse pain on mobilisation. A CT scan was requested which showed cement extrusion outside the femur cortex (). Given no report of pain on mobilisation and the absence of a definitive fracture line, cement extravasation was attributable to pressurisation through the nutrient foramen. Three months later the patient attended for contra-lateral surgery and underwent an identical procedure as the first hip. A similar, but not identical x-ray appearance was noted, () with 8.5 mm cement extrusion out into the soft tissues and 4 cms (41mm) cement extrusion from the tip of the prosthesis. The patient was happy with the post-operative result and continued to make an uneventful and full recovery.