What happens to femoral neck bone mineral density after hip resurfacing surgery?

Abstract

The major advantage of hip resurfacing is the decreased amount of bone resection compared with a standard total hip replacement. Fracture of the femoral neck is the most common early complication and poor bone quality is a major risk factor. We undertook a prospective consecutive case control study examining the effect of bone mineral density changes in patients undergoing hip resurfacing surgery. A total of 423 patients were recruited with a mean age of 54 years (24 to 87). Recruitment for this study was dependent on pre-operative bilateral femoral bone mineral density results not being osteoporotic. The operated and non-operated hips were assessed. Bone mineral density studies were repeated over a two-year period. The results showed no significant deterioration in the bone mineral density in the superolateral region in the femoral neck, during that period. These findings were in the presence of a markedly increased level of physical activity, as measured by the short-form 36 health survey physical function score.

Metal-On-Metal Hip Resurfacing in Patients Aged 65 Or Older

“…In both studies a comparison was made with a group of younger patients who had also been treated with resurfacing but without comparison to the current standard of care. Older women are usually regarded 10,9,8,7 for pain, walking, function, and activity, respectively.…”

“…The conservative nature and stability of hip resurfacing arthroplasty (HRA) make it a viable alternative to conventional total hip arthroplasty (THA) in young and active patients (1,2) because of the preservation of bone mineral density over time in the proximal femur (3)(4)(5)(6)(7) and because of the prospect of potentially easy and successful revision surgery should this be necessary (8)(9)(10)(11). Conventional THA is extremely successful in older patients with hip arthritis and remains the treatment 'gold standard' for this group of patients (12)(13)(14).…”

Hip Resurfacing

“…However, a femoral neck fracture is the most common complication, which makes poor bone quality a major risk factor. 10 In fact, the femoral neck loses bone mineral density (BMD) in the perioperative phase (fi rst 3 months) of healing, which poses a major risk for individuals who already have poor bone quality. 11 , 12 In 2012, Matharu et al reported the prevalence of femoral neck fractures after HRA in a group of 3076 individuals.…”

Radiographic assessment of primary hip arthroplasty

“…21,101 As for the femur, existent anatomy and preoperative BMD probably affect the extent of the phenomenon. 104,105 Spontaneous narrowing of the femoral neck (>10% of femoral neck diameter) is a phenomenon of unknown origin that may be seen in 27.6% cases at 5 years 106 (Figure 5a). This usually occurs as a spontaneous acute event (not necessarily traumatic) and is thought to result from postsurgical avascular necrosis (AVN) of the femoral head and/or neck.…”