Distribution of Vascular Foramina Around the Femoral Head and Neck Junction: Relevance for Conservative Intracapsular Procedures of the Hip

Lavigne, Martin; Kalhor, Morteza; Beck, Martín; Ganz, Reinhold; Leunig, Michael

doi:10.1016/j.ocl.2005.02.002

Cited by 92 publications

(42 citation statements)

References 28 publications

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“…Evidence of osteonecrosis has been found in failed resurfacings by various authors [17–22]. Insult to the vascular supply of the remnant head might occur at various steps of the resurfacing procedure [27]. Using the posterior approach results in sacrifice of the deep branch of the medial circumflex femoral artery, the chief source of blood supply to the majority of the femoral head.…”

Section: Discussionmentioning

confidence: 99%

Femoral-head vascularity after hip surface arthroplasty

Kannan

Bal

Kumar

et al. 2010

J Orthopaed Traumatol

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BackgroundIatrogenic devascularization of the femoral head is as an area of concern following hip resurfacing arthroplasty, with probable implications on short-term failure and long-term survival of the implant.Materials and methodsWe assessed the vascularity of 25 resurfaced femoral heads in 20 patients by comparison with preoperative and postoperative Tc-99m methylene diphosphonate (MDP) bone scintigraphy images, the postoperative scans being done 9 months after the surgery.ResultsEight out of 25 hips (32%) showed <55% of their preoperative uptake at a mean of 9 months after surgery and were categorized as showing reduced vascularity.ConclusionOur study reveals reduction in vascularity of the femoral-head remnant as a frequent occurrence after hip resurfacing. Our study also highlights the role of bone scintigraphy as tool in assessing the vascularity of resurfaced femoral heads.

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Section: Discussionmentioning

confidence: 99%

Femoral-head vascularity after hip surface arthroplasty

Kannan

Bal

Kumar

et al. 2010

J Orthopaed Traumatol

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“…However, our excellent results in the uncomplicated cases have led us to be prudent before condemning The need of a wide postero-lateral surgical exposure to prepare the femoral epiphysis, with a circumferential capsular release, has been advocated as the possible origin of the critical interruption of blood supply that could lead to delayed avascular necrosis of the retained femoral head and lead to component loosening [14]. There are published reports of histological signs of avascular necrosis rate in about 92% in the retrieved cases revised for aseptic loosening or femoral neck fracture (12 of 13 cases revised) [15].…”

Section: Discussionmentioning

confidence: 99%

“…Although these discussions on the true impact of surgical exposure on the risk of developing a secondary necrosis have not resulted in an unambiguous conclusion, some authors have proposed the lateral approach as a possible alternative option, while other authors [14] recommend resurfacing procedures with a careful dissection of the capsule to preserve the retinacular vessels or suggest, even for resurfacing hip arthroplasty, other experimental approaches for intracapsular surgical procedures (digastric trochanteric osteotomy, with capsule exposure proximal to piriformis muscle) [16]. This last option should increase the surgeon's awareness of experimental minimally invasive surgical exposure which could increase the risk of neurovascular damage [1].…”

Section: Discussionmentioning

confidence: 99%

Hip resurfacing: why does it fail? Early results and critical analysis of our first 60 cases

Falez

Favetti

Casella

et al. 2007

International Orthopaedics (SICO

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Resurfacing replacement represents the most conservative solution available for total arthroplasty of the hip. However, despite the excellent results reported by highly experienced surgeons, a small but not insignificant body of literature has been published on the more controversial aspects of this approach, mainly those related to the biological and mechanical vulnerability of the retained epiphysis. We report here our evaluation of most of the variables inherent to this procedure (surgical exposure, implant design, technical steps). Based on our results, we conclude that the short-term outcome is strongly related to the surgical approach and the relationship between implant design and cementing technique. Even if posterior approaches are currently widely accepted for resurfacing replacement, the ability to preserve the medial circumflex artery has been questioned, and an alternative exposure has been proposed with good results (antero-lateral, lateral and digastric trochanteric osteotomy). Moreover, a minimally invasive posterior approach could increase the risks of vascular damage. Alternatively, inner implant geometry could affect the distribution of cement over the epiphysis when other variables (direct or indirect cementing technique, viscosity) are not properly selected.

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“…The location of cartilage defects is documented according to the clock-face notation for both the acetabulum 11 and femur. 12 …”

Section: Assessment Of Cartilage Defectsmentioning

confidence: 99%

Technique of Arthroscopically Assisted Transtrochanteric Drilling for Femoral Head Chondral Defects

Chandrasekaran

Lindner

Martin

et al. 2015

Arthroscopy Techniques

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Microfracture is a marrow-stimulation technique in which damaged cartilage is drilled or punched, perforating the subchondral bone and generating a blood clot within the defect that matures into fibrocartilage. Microfracture for the treatment of small cartilage defects of the hip has shown good results. Arthroscopic procedures are less invasive than open procedures and have a reduced incidence of complications such as infection or avascular necrosis of the femoral head. Furthermore, arthroscopic procedures allow for a shorter recovery time, resulting in not only lower overall treatment costs but also higher patient satisfaction. Medial and parafoveal cartilage defects of the femoral head can be challenging to effectively microfracture using standard arthroscopy portals because of the acute angles required for instrument manipulation. This report describes a technique for microfracturing these challenging areas of the femoral head using a 2.7-mm K-wire and drilling in a transtrochanteric direction using arthroscopic and imaging guidance to target the area of chondral damage.

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Distribution of Vascular Foramina Around the Femoral Head and Neck Junction: Relevance for Conservative Intracapsular Procedures of the Hip

Cited by 92 publications

References 28 publications

Femoral-head vascularity after hip surface arthroplasty

Femoral-head vascularity after hip surface arthroplasty

Hip resurfacing: why does it fail? Early results and critical analysis of our first 60 cases

Technique of Arthroscopically Assisted Transtrochanteric Drilling for Femoral Head Chondral Defects

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