The blood flow to the femoral head/neck junction during resurfacing arthroplasty

Amarasekera, Hiran; Costa, Matthew L.; Foguet, Pedro; Krikler, S. J.; Prakash, Udai; Griffin, Damian R.

doi:10.1302/0301-620x.90b4.20050

Cited by 49 publications

(28 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One explanation for narrowing of the neck might be a compromised blood supply. There is increasing evidence that the posterior approach (most frequently used for HRA) and preparation of the proximal femur can impair the blood supply to the femoral head [2,4,6,20]. Studies comparing neck narrowing after HRA with different approaches (eg, the posterior approach and the surgical hip dislocation) would be of interest, considering that progressive neck thinning might lead to later complications.…”

Section: Discussionmentioning

confidence: 99%

High Revision Rate at 5 Years after Hip Resurfacing with the Durom Implant

Naal

Pilz

Munzinger

et al. 2011

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background/rationale There is growing evidence that different resurfacing implants are associated with variable survival and revision rates. A registry analysis indicated the Durom resurfacing implant had high revision rates at 5 years, whereas three original studies reported low revision rates at short-term followups. Thus, the revision rates appear controversial. Questions/purposes We therefore assessed (1) the survivorship including differences between women and men at a mean of 5 years after resurfacing with the Durom implant, and (2) clinical scores and radiographic parameters. Patients and Methods We prospectively followed all 100 Durom hip resurfacings implanted in 91 patients (25 women and 66 men; mean age, 52 years) between 2003 and 2004. Survivorship analysis was performed with pending revision or revision for any reason as the endpoint. The minimum followup was 47 months (mean, 60 months; range, 47-72 months).Results At a mean of 5 years, 11 hips were revised for various reasons. Cumulative survival was 88.2% for all patients and 81.5% for women. The mean Oxford (OHS) and Harris hip (HHS) scores were 14.6 and 94.7, respectively. The mean UCLA activity level was 7.9. Sclerotic changes around the short femoral stem (pedestal sign) were detected in 40% of the hips. We observed considerable femoral neck thinning with component-to-neck ratios of 0.85 preoperatively and 0.82 at 5 years. Conclusions Our study highlights a high revision rate 5 years after hip resurfacing with the Durom implant. This observation underlines previous findings from registry data and suggests that revision rates increase with time.

show abstract

Section: Discussionmentioning

confidence: 99%

High Revision Rate at 5 Years after Hip Resurfacing with the Durom Implant

Naal

Pilz

Munzinger

et al. 2011

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Third, the use of general anesthesia or regional anesthesia may lead to differences in blood flow measurements. All patients in the study received general anesthesia, which did not deviate from previous LDF studies of the hip [1,5,22]. Only in the study by Nötzli et al [22] patients received either spinal or general anesthesia without differences in the amount of blood flow.…”

Section: Discussionmentioning

confidence: 91%

“…Concerns exist, however, about damage to the medial femoral circumflex artery (MFCA). This can occur during the surgical approach if performed through the posterior approach or damage to the superior retinacular vessels (RV), which can occur at the time of femoral head preparation regardless of the approach used [1,4,5,18,26,28].…”

Section: Introductionmentioning

confidence: 99%

Role of the Extraosseus Blood Supply in Osteoarthritic Femoral Heads?

Schoeniger

Espinosa

Sierra

et al. 2009

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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.

show abstract

“…The understanding of the anatomy of the extraosseous blood supply to the femoral head is of particular interest when conducting HRA because of its vulnerability during the procedure, especially with the most commonly used extended posterolateral approach (Gautier et al, 2000;Beaulé et al, 2006a;Beaulé et al, 2007a;Khan et al, 2007;Amarasekera et al, 2008). Several approaches have been investigated or modified in order to preserve an optimal oxygenation of the femoral head during and after the procedure.…”

Section: Neurovascular Injuriesmentioning

confidence: 99%

“…Several approaches have been investigated or modified in order to preserve an optimal oxygenation of the femoral head during and after the procedure. The direct lateral approach (Nork et al, 2005;Jacobs et al, 2008), the trochanteric flip approach according to Ganz et al (Ganz et al, 2001;Steffen et al, 2009a), and the modified posterolateral approach (Steffen et al, 2010) have all been shown to lead to less disruption of the blood flow and oxygenation of the femoral head in comparison to the extended posterolateral approach which was associated with a decrease of the blood flow, ranging from 40% to 70% (Beaulé et al, 2007a;Khan et al, 2007;Amarasekera et al, 2008). However, the consequences of the disruption of the medial femoral circumflex artery (Gautier et al, 2000;Kalhor et al, 2009), with the development of osteonecrosis, remains unproven (Freeman, 1978;Hananouchi et al, 2010) -possibly because of the variability in vascularization and/or the proposed presence of an intraosseous blood supply, which can be increased in osteoarthritic joints (Whiteside et al, 1983).…”

Section: Neurovascular Injuriesmentioning

confidence: 99%

Hip resurfacing arthroplasty: current status and future perspectives

Corten

Ganz²,

Simon³

et al. 2011

eCM

View full text Add to dashboard Cite

Hip resurfacing arthroplasty (HRA) is a concept of hip replacement that allows treating young active patients with a femoral bone preserving procedure. The proposed advantages of resuming an active lifestyle with increased frequency and duration of sports activities have been shown to be realistic. The 30-year cost-effectiveness in young male patients has been shown to be higher in resurfacing compared to conventional total hip replacement (THA). However, prognosticators of an inferior outcome have also been identified. The most important patient related factors are secondary osteoarthritis as the indication for surgery such as post-childhood hip disorders or AVN, female gender, smaller component sizes and older age (>65 years for males and >55 years for females). In addition, surgical technique (approach and cementing technique) and component design are also important determinant factors for the risk of failure. Moreover, concerns have surfaced with respect to high metal ion concentrations and metal ion hypersensitivities. In addition, the presumed ease of revising HRA has not reflected in improved or equal survivorship in comparison to a primary THA. This highlights the importance of identifying patient-, surgery-, and implant-related prognosticators for success or failure of HRA. Rather than vilifying the concept of hip resurfacing, detailed in depth analysis should be used to specify indications and improve implant design and surgical techniques.

show abstract

The blood flow to the femoral head/neck junction during resurfacing arthroplasty

Cited by 49 publications

References 28 publications

High Revision Rate at 5 Years after Hip Resurfacing with the Durom Implant

High Revision Rate at 5 Years after Hip Resurfacing with the Durom Implant

Role of the Extraosseus Blood Supply in Osteoarthritic Femoral Heads?

Hip resurfacing arthroplasty: current status and future perspectives

Contact Info

Product

Resources

About