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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 1,
35-39.
doi: 10.1302/0301-620X.88B1.16682 Copyright © 2006 by British Editorial Society of Bone and Joint Surgery Notching of the femoral neck during resurfacing arthroplasty of the hipA VASCULAR STUDYP. E. Beaulé, MD, FRCSC, Associate Professor1; P. A. Campbell, PhD, Adjunct Associate Professor2; R. Hoke, BS, Research Assistant2; and F. Dorey, PhD, Professor of Department of Paediatrics2
1 Ottawa Hospital, 501 Smyth Road, Suite 5004, Ottawa, Ontario, Canada K1H 8L6. Correspondence should be sent to Professor P. E. Beaulé; e-mail: pbeaule{at}ottawahospital.on.ca
During hip resurfacing arthroplasty, excessive valgus positioning or surgical technique can result in notching of the femoral neck. Although mechanical weakening and subsequent fracture of the femoral neck are well described, the potential damage to the retinacular vessels leading to an ischaemic event is relatively unknown. Using laser Doppler flowmetry, we measured the blood flow in 14 osteoarthritic femoral heads during routine total hip replacement surgery, before and after notching of the femoral neck. In ten hips there was a reduction in blood flow of more than 50% from the baseline value after simulated notching of the femoral neck. Our results suggest that femoral head vascularity in the osteoarthritic state is similar to the non-arthritic state, where damage to the extraosseous vessels can predispose to avascular necrosis. Surgeons who perform resurfacing arthroplasty of the hip should pay careful attention to these vessels by avoiding excessive dissection around the femoral neck and/or notching. This article has been cited by other articles:
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