Case studies of femoral loosening and femoral head collapse in hip resurfacing

2013 ◽  
pp. 444-453
Author(s):  
P. Campbell ◽  
K. De Smet
Keyword(s):  
Femoral Head ◽  
Case Studies ◽  
Hip Resurfacing ◽  
Femoral Head Collapse ◽  
Femoral Loosening

A comparison of 2 cementing techniques in hip resurfacing using human femoral heads

2021 ◽  
pp. 112070002199706
Author(s):  
Sarah J Shiels ◽  
Martin Williams ◽  
Gordon C Bannister ◽  
Richard P Baker
Keyword(s):  
Femoral Head ◽  
Femoral Component ◽  
Bubble Formation ◽  
Young Male ◽  
Cement Mantle ◽  
Hip Resurfacing ◽  
Air Bubble ◽  
Low Viscosity ◽  
Femoral Heads ◽  
Group 2

Introduction: Hip resurfacing remains a valid option in young male patients. The creation of the optimum cement mantle aids fixation of the femoral component. If the cement mantle is too thick the prosthesis can remain proud leading to early failure or if it penetrates too far into the femoral head, it may cause osteonecrosis. Method: 18 of 96 femoral heads collected from patients undergoing total hip arthroplasty were matched for their surface porosity. They were randomly allocated into 2 different cementing groups. Group 1 had the traditional bolus of cement technique, while group 2 had a modified cementing technique (swirl) where the inside of the femoral component was lined with an even layer of low viscosity cement. Results: The traditional bolus technique had significantly greater cement mantle thickness in 3 of 4 zones of penetration ( p = 0.002), greater and larger air bubble formation (6 of 9 in bolus technique vs. 1 in 9 in swirl technique, p = 0.05) and more incomplete cement mantles compared with the swirl technique. There was no relationship to femoral head porosity. Conclusion: The swirl technique should be used to cement the femoral component in hip resurfacing. Long-term clinical studies would conform if this translates into increased survivorship of the femoral component.

Comparative repeatability of guide-pin axis positioning in computer-assisted and manual femoral head resurfacing arthroplasty

2007 ◽  
Vol 221 (7) ◽  
pp. 713-724 ◽  
Author(s):  
A Hodgson ◽  
N Helmy ◽  
B A Masri ◽  
N V Greidanus ◽  
K B Inkpen ◽  
...  
Keyword(s):  
Femoral Head ◽  
Computer Assisted Surgery ◽  
Hip Resurfacing ◽  
Computer Assisted ◽  
Comparable Amount ◽  
Hip Resurfacing Arthroplasty ◽  
Resurfacing Arthroplasty ◽  
Surgeon Experience ◽  
Position And Orientation ◽  
Version Measurement

The orientation of the femoral component in hip resurfacing arthroplasty affects the likelihood of loosening and fracture. Computer-assisted surgery has been shown to improve significantly the surgeon's ability to achieve a desired position and orientation; nevertheless, both bias and variability in positioning remain and can potentially be improved. The authors recently developed a computer-assisted surgical (CAS) technique to guide the placement of the pin used in femoral head resurfacing arthroplasty and showed that it produced significantly less variation than a typical manual technique in varus/valgus placement relative to a pre-operatively determined surgical plan while taking a comparable amount of time. In the present study, the repeatability of both the CAS and manual techniques is evaluated in order to estimate the relative contributions to overall variability of surgical technique (CAS versus manual), surgeon experience (novice versus experienced), and other sources of variability (e.g. across specimens and across surgeons). This will enable further improvements in the accuracy of CAS techniques. Three residents/fellows new to femoral head resurfacing and three experienced hip arthroplasty surgeons performed 20-30 repetitions of each of the CAS and manual techniques on at least one of four cadaveric femur specimens. The CAS system had markedly better repeatability (1.2°) in varus/valgus placement relative to the manual technique (2.8°), slightly worse repeatability in version (4.4° versus 3.2°), markedly better repeatability in mid-neck placement (0.7 mm versus 2.5 mm), no significant dependence on surgeon skill level (in contrast to the manual technique), and took significantly less time (50 s versus 123 s). Proposed improvements to the version measurement process showed potential for reducing the standard deviation by almost two thirds. This study supports the use of CAS for femoral head resurfacing as it is quicker than the manual technique, independent of surgeon experience, and demonstrates improved repeatability.

Prediction of Femoral Head Collapse in Osteonecrosis

2005 ◽  
Vol 128 (3) ◽  
pp. 467-470 ◽  
Author(s):  
K. Y. Volokh ◽  
H. Yoshida ◽  
A. Leali ◽  
J. F. Fetto ◽  
E. Y. S. Chao
Keyword(s):  
Femoral Head ◽  
Contact Problem ◽  
Contact Pressure ◽  
Cancellous Bone ◽  
Local Buckling ◽  
Young Modulus ◽  
Head Model ◽  
Element Mesh ◽  
Femoral Head Collapse ◽  
Cortical Shell

The femoral head deteriorates in osteonecrosis. As a consequence of that, the cortical shell of the femoral head can buckle into the cancellous bone supporting it. In order to examine the buckling scenario we performed numerical analysis of a realistic femoral head model. The analysis included a solution of the hip contact problem, which provided the contact pressure distribution, and subsequent buckling simulation based on the given contact pressure. The contact problem was solved iteratively by approximating the cartilage by a discrete set of unilateral linear springs. The buckling calculations were based on a finite element mesh with brick elements for the cancellous bone and shell elements for the cortical shell. Results of 144 simulations for a variety of geometrical, material, and loading parameters strengthen the buckling scenario. They, particularly, show that the normal cancellous bone serves as a strong supporting foundation for the cortical shell and prevents it from buckling. However, under the development of osteonecrosis the deteriorating cancellous bone is unable to prevent the cortical shell from buckling and the critical pressure decreases with the decreasing Young modulus of the cancellous bone. The local buckling of the cortical shell seems to be the driving force of the progressive fracturing of the femoral head leading to its entire collapse. The buckling analysis provides an additional criterion of the femoral head collapse, the critical contact pressure. The buckling scenario also suggests a new argument in speculating on the femoral head reinforcement. If the entire collapse of the femoral head starts with the buckling of the cortical shell then it is reasonable to place the reinforcement as close to the cortical shell as possible.

Femoral Head Vascularity and Hip Resurfacing

2008 ◽  
pp. 17-22
Author(s):  
Ahmad Bin Nasser ◽  
Paul E. Beaulé
Keyword(s):  
Femoral Head ◽  
Hip Resurfacing

Anatomic study on the blood supply to the femoral head following hip resurfacing using the posterior approach

2019 ◽  
Vol 29 (5) ◽  
pp. 558-563
Author(s):  
Mohammed Alsheri ◽  
Kamal Bali ◽  
Pamela Railton ◽  
Dragana Ponjevic ◽  
John Matyas ◽  
...  
Keyword(s):  
Femoral Head ◽  
Blood Vessels ◽  
Posterior Approach ◽  
Neck Region ◽  
Maximum Flow ◽  
Hip Resurfacing ◽  
Iliac Arteries ◽  
India Ink ◽  
The Common ◽  
Good Flow

Objectives: The aim of this study was to investigate femoral head perfusion following cadaveric hip resurfacing using the posterior approach. Methods: This cadaveric study involved injecting Higgins India ink into the common iliac arteries and evaluating the distribution of ink in the resurfaced heads using the modified Spalteholz technique. The study consisted of 2 parts. The 1st part involved utilisation of 22 cadaveric hips for establishing the injection and histological technique. The 2nd part of the study included 4 control cadaveric hips and 12 cadaveric hips with posterior approach hip resurfacing. Each specimen was divided into 15 zones (12 head zones and 3 neck zones) to evaluate detailed geographic distribution of dye-containing blood vessels. Results: All 4 controls had good flow of ink to all head zones and the neck region. In all the resurfaced heads, there was good flow to all the neck zones. 6 resurfaced specimens had no dye flow to any of the head zones. In the remaining 6, dye-stained vessels were seen variably in the anterior and middle zones but were consistently absent in the posterior zones of the head. Zones representing the antero-inferior parts of femoral head had the maximum flow of ink, followed by zones representing middle-inferior parts. Conclusions: Posterior approach for hip resurfacing arthroplasty results in vascular insult to the femoral head, with posterior zones more affected than the anterior zones. The persistence of the dye in the intraosseous blood vessels of the neck and in anteroinferior head may be a source of revascularisation of the femoral head after posterior approach hip resurfacing.

Correlation between continuation of glucocorticoid treatment and risk of femoral head collapse

2020 ◽  
Author(s):  
Zhongxin Zhu ◽  
Shaoguang Li ◽  
Huan Yu ◽  
Jiaxin Huang ◽  
Peijian Tong
Keyword(s):  
Femoral Head ◽  
Glucocorticoid Treatment ◽  
Femoral Head Collapse
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