Role of the Extraosseus Blood Supply in Osteoarthritic Femoral Heads?

Abstract

Blood perfusion to the femoral head might be endangered during the surgical approach or the preparation of the femoral head or both in hip resurfacing arthroplasty. The contribution of the intramedullary blood supply to the femoral head in osteoarthritis is questionable. Therefore, the contribution of the extraosseous blood supply to osteoarthritic femoral heads was measured intraoperatively to question if there is measurable blood flow between the epiphysis and metaphysis in osteoarthritic hips in case of extraosseus vessel damage. At defined points during surgery we acquired the epiphyseal and metaphyseal femoral head perfusion by high-energy laser Doppler flowmetry. Complete femoral neck osteotomy sparing the retinacular vessels to simulate intraosseous blood disruption showed unchanged epiphyseal blood flow compared to initial measurement after capsulotomy. The pulsatile signal disappeared after transection of the retinacular vessels. Based on these acute measurements, we conclude intramedullary blood vessels to the femoral head do not provide measurable blood supply to the epiphysis once the medial femoral circumflex artery or the retinacular vessels have been damaged. We recommend the use of a safe surgical approach for hip resurfacing and careful implantation of the femoral component to respect blood supply to the femoral head and neck region in hip resurfacing arthroplasty.

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 .…”

“…The proximal femur and hip joint represented one of the biggest areas of interest for research involving LDF in bone tissue, with 19 studies found investigating a range of clinical applications including osteonecrosis (either idiopathic, steroid induced, or following neck of femur fracture), approaches to hip resurfacing arthroplasty or total hip replacement following arthritis, femur‐acetabular impingement, hip joint debridement, and congenital developmental problems . Specifically most studies took measurements from the femoral head and neck, but others also looked at intra‐trochanteric regions, the greater trochanter, proximal femoral shaft, medial calcar, or acetabulum …”

“…The sensitivity of probes to movement also means stable probe placements during surgical operations is important and some studies reported holding probes by hand or using bespoke probe holders . Some study designs involved having to move probes in between measurements to facilitate surgery, which can introduce measurement error given the small sampling volume and potential for measuring a different vascular bed when probes are repositioned . In addition, as these LDF studies were intra‐operative the effects of anesthesia, blood loss during surgery and direct impact of surgery cannot be discounted as sources of error .…”

Anatomia vascolare

“…Vascular contribution to the femoral head is basically due to the arteria circumflexa femoris medialis (MFCA) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], coming from the ramus profundus: the postero-superior and postero-inferior retinacular vessels run along the intertrochanteric ridge, penetrating the capsule and continuing under the synovia to the bone-cartilage junction. The rounded ligament arteria and the circumflexa lateralis also contribute to the vascularization of the proximal femural epiphysis but their contribution is much lesser [1,2,4,12].…”

“…La circolazione intraossea -ricordata da Trueta e Harrison -è stata postulata teoricamente come in grado di nutrire la testa femorale, ma i dati flussimetrici odierni contraddicono questa osservazione [4,18,21]. L'arteria femorale profonda è il ramo più grande dell'arteria femorale e rifornisce la maggior parte della muscolatura della coscia; origina -all'interno del triangolo femorale -dalla faccia laterale dell'arteria femorale, a circa 3,5 centimetri inferiormente al legamento inguinale.…”