The effect of hip resurfacing on oxygen concentration in the femoral head

Abstract

We inserted an electrode up the femoral neck into the femoral head of ten patients undergoing a metal-on-metal hip resurfacing arthroplasty through a posterior surgical approach and measured the oxygen concentration during the operation. In every patient the blood flow was compromised during surgery, but the extent varied. In three patients, the oxygen concentration was zero at the end of the procedure. The surgical approach caused a mean 60% drop (p < 0.005) in oxygen concentration while component insertion led to a further 20% drop (p < 0.04). The oxygen concentration did not improve significantly on wound closure. This study demonstrates that during hip resurfacing arthroplasty, patients experience some compromise to their femoral head blood supply and some have complete disruption.

Association of Osteonecrosis and Failure of Hip Resurfacing Arthroplasty

“…ON reportedly occurs predominantly in early-and midterm hip failures and may relate to impaired blood supply to the femoral head [2,15,18] or heat injury [7,8] at the time of surgery. We therefore analyzed the incidence, extent, and morphologic features of ON in a large series of retrieval specimens.…”

“…Furthermore, ON was described mostly in failures attributable to fractures [14,16,17] and was suggested as a cause of the fracture [3,5,16]. Several causes of ON, particularly those related to surgical techniques, such as the effects of cementation [1,[7][8][9] or intraoperative extraosseous vascular injury [2,4,15,18,21], have been discussed.…”

Resultados preliminares da artroplastia do quadril metal-metal de superfície: análise dos primeiros 40 casos com seguimento médio de 3 anos

“…For both patients requiring prosthesis replacement, no bone necrosis was found on the tissue removed from femoral nail and from the neck, after anatomicopathological analysis, evidencing that the technique caused no damages to femoral head flow (20,21) . It was our own decision to use the anterolateral access port, based on surgeons' experience, but it is scientifically validated as less favorable to femoral neck flow injury (22) . The follow-up period on this series was short, with an insufficient number to be able to provide final conclusions, but it was proven to be a good treatment alternative, with success and complication rates consistent to those of the largest reference centers.…”

Letter to the Editor: Association of Osteonecrosis and Failure of Hip Resurfacing Arthroplasty

“…Osteonecrosis may be caused by insult to the vascular supply [1,11] or by thermal damage [6,8]. However, postoperative radionuclide imaging studies have revealed no evidence of reduction in vascularity [5,10].…”