Scientific Exhibits   |    
Vascularity of the Arthritic Femoral Head and Hip Resurfacing
Paul E. Beaulé, MD, FRCSC; Pat Campbell, PhD; Zhen Lu, PhD; Katharina Leunig-Ganz, MD; Martin Beck, MD; Michael Leunig, MD; Reinhold Ganz, MD
View Disclosures and Other Information
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Los Angeles Orthopaedic Hospital Foundation. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Wright Medical Technology, Inc.). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Dec 01;88(suppl 4):85-96. doi: 10.2106/JBJS.F.00592
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


With the application of metal-on-metal bearings, hip resurfacing arthroplasty is being performed in a growing number of young adults worldwide. It is anticipated that the problems faced by the first generation of metal-on-polyethylene surface arthroplasties, primarily related to polyethylene wear debris-induced osteolysis1,2, have been overcome by the current generation of low-wearing metal-on-metal surface replacements3,4 (Fig. 1). Short-term clinical followup reports have been encouraging, with a 97% to 99% survival rate at four to five years5-8; however, femoral neck fractures and femoral loosening still pose a challenge5-8. In terms of surgical technique, femoral positioning in a valgus orientation9 and the avoidance of neck notching10 have been advocated. Currently, controversy surrounds the role of femoral head vascularity with regard to implant durability; some surgeons are concerned that the posterior surgical approach sacrifices the important extraosseous blood supply to the femoral head11-13 (Fig. 2), whereas others maintain that an adequate blood supply will be provided intraosseously14. Although femoral head viability may be maintained in part or in whole by an intraosseous blood supply, it is important to critically look at what level of evidence exists to support an intraosseous femoral head blood supply. Some of the evidence comes from retrieval analysis of failed metal-on-polyethylene resurfacing implants15-19 that were associated with a variable prevalence of ischemic failure (see Appendix). This varying prevalence of osteonecrosis-related failures could have been due to the different definitions or varying surgical approaches used as well as the orientation of the specimens during analysis in terms of the differentiation between generalized osteonecrosis and localized necrosis due to cement heat generation20,21. Another reason why these lesions could have been easily missed is that the bone adjacent to the cement interface had been resorbed by the granulation tissue resulting from the polyethylene wear debris1,2 and the micromotion resulting from implant loosening22. With the reduction of wear-related failures, the current generation of metal-on-metal hip resurfacings may bring to light other mechanisms of failure the same way that the elimination of "cement disease" led to the identification of polyethylene wear debris23,24. The purpose of the present report is to review some of the variables that may affect femoral head vascularity after hip resurfacing.
Figures in this Article

    First Page Preview

    View Large
    First page PDF preview
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    California - UCLA/OH Department of Orthopaedic Surgery
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    Massachusetts - The University of Massachusetts Medical School