Increased post-operative ischemia in the femoral head found by microdialysis by the posterior surgical approach: a randomized clinical trial comparing surgical approaches in hip resurfacing arthroplasty

Abstract

HRA in the posterior approach results in increased post-operative ischemia in the femoral head and neck although during surgery, no difference in the blood flow was found. Still, the antero-lateral approach also causes considerable ischemia and other possible explanations, such as damage to the retinacular vessels during surgery or altered microcirculation because of heating from the cementation process, needs to be investigated.

Microdialysis for the Assessment of Intervertebral Disc and Vertebral Cancellous Bone Metabolism in a Large Porcine Model

“…For vertebral cancellous bone, ischemic conditions have not previously been shown. However, these findings are consistent with previous microdialysis results of ischemia in bone demonstrated in the femoral head of both humans and pigs (12)(13)(14). Altogether, the findings from the present study confirms previous findings of ischemia in bone and the intervertebral disc.…”

“…Glycerol is liberated as a result of cell membrane damage. As previously demonstrated, the trauma of drilling in bone tissue results in initially elevated glycerol concentrations (12)(13)(14). The lowest mean glycerol concentrations were found in the intervertebral disc, which may be explained by a lower number of cells in this compartment.…”

“…The cell changes its metabolism from oxidative phosphorylation to anaerobic glycolysis to generate energy and preserve homeostasis. Accordingly, a reduction of oxygen supply will decrease the production of pyruvate with a following increase in lactate, resulting in an increase in the lactate/pyruvate (L/P) ratio (14,19). A L/P ratio above 25 is considered to signify ischemia (20).…”

“…Microdialysis as a method is, among others, advantaged by dynamic and simultaneous in vivo sampling from multiple compartments of the unbound water-soluble molecules from the interstitial space of the investigated tissue (9,10). For the particular cases of bone tissue and the intervertebral disc, microdialysis has only been applied for the assessment of metabolism in the femoral head of humans and pigs, and in a cadaver study, respectively (11)(12)(13)(14). To date, microdialysis sampling from vertebral cancellous bone and the intervertebral disc has been limited to antimicrobials in a porcine model (15,16).…”

Use of near‐infrared systems for investigations of hemodynamics in human in vivo bone tissue: A systematic review

“…Twenty‐one studies were identified using near infrared spectroscopy (NIRS) and 10 studies were identified using photoplethysmography (PPG) non‐invasively on in vivo bone tissue . Fifty‐seven studies were identified using laser Doppler flowmetry (LDF) in vivo of which 56 were intra‐operative. Only one study using LDF attempted to measure bone non‐invasively .…”