Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 3,
320-323.
doi: 10.1302/0301-620X.87B3.15330
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
Osteonecrosis in retrieved femoral heads after failed resurfacing arthroplasty of the hip
C. P. Little, FRCS (Tr & Orth), Clinical Lecturer1;
A. L. Ruiz, FRCS (Tr & Orth), Consultant Orthopaedic Surgeon2;
I. J. Harding, FRCS (Tr & Orth), Specialist Registrar3;
P. McLardy-Smith, MA, FRCS, Consultant Orthopaedic Surgeon3;
R. Gundle, D Phil, FRCS(Orth), Consultant Orthopaedic Surgeon3;
D. W. Murray, MD, FRCS(Orth), Professor of Orthopaedic Surgery1; and
N. A. Athanasou, FRCPath, Professor of Musculoskeletal Pathology1
1 Nuffield Department of Orthopaedic Surgery
2 Department of Orthopaedics, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire HP21 8AL, UK.
3 Adult Hip and Knee Reconstruction Service Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK.
Correspondence should be sent to Mr C. P. Little; e-mail: chris.little{at}doctors.org.uk
We present the histological findings of bone retrieved from beneath the femoral components of failed metal-on-metal hip resurfacing arthroplasties. Of a total of 377 patients who underwent resurfacing arthroplasty, 13 required revision; for fracture of the femoral neck in eight, loosening of a component in three and for other reasons in two. None of these cases had shown histological evidence of osteonecrosis in the femoral bone at the time of the initial implantation.
Bone from the remnant of the femoral head showed changes of osteonecrosis in all but one case at revision. In two cases of fracture which occurred within a week of implantation, the changes were compatible with early necrosis of the edge of the fracture. In the remaining six fractures, there were changes of established osteonecrosis. In all but one of the non-fracture cases, patchy osteonecrosis was seen.
We conclude that histological evidence of osteonecrosis is a common finding in failed resurfaced hips. Given that osteonecrosis is extensive in resurfaced femoral heads which fail by fracture, it is likely to play a role in the causation of these fractures.
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