The effect of surgical approach on the histology of the femoral head following resurfacing of the hip
Analysis of retrieval specimens
- H. W. Amarasekera, MS, FRCS(Ed), Orthopaedic PhD Fellow1
, - P. C. Campbell, PhD, Adj. Professor2 ,
- N. Parsons, PhD, Statistician3 ,
- J. Achten, MSc, PhD, Senior Research Fellow1,
- J. Masters, BSc, MBBS, Academic Foundation Doctor4 ,
- D. R. Griffin, MA(Cantab), MPhil(Cantab), FRCS(Tr & Orth), Professor of Trauma and Orthopaedic Surgery1 and
- M. L. Costa, PhD, FRCS(Tr & Orth), Professor of Trauma and Orthopaedic Surgery5
Correspondence should be sent to H. W. Amarasekera; e-mail: hiran.amarasekera@warwick.ac.uk
Author contributions: H. W. Amarasekera: Project design, Collecting, preparing and analysis of specimens, Data collection and analysis, Manuscript writing
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P. C. Campbell: Project design and supervision, Data analysis, Manuscript assistance
N. Parsons: Data analysis, Writing manuscript
J. Achten: Project design, Manuscript writing
J. Masters: Data collection, Cell count analysis
D. R. Griffin: Supervision, Project design, Collection of specimens, Manuscript writing
M. L. Costa: Project design, Collection of specimens, Analysis, Manuscript writing
Abstract
Objectives We aimed to determine the effect of surgical approach on the histology of the femoral head following resurfacing of the hip.
Methods We performed a histological assessment of the bone under the femoral component taken from retrieval specimens of patients having revision surgery following resurfacing of the hip. We compared the number of empty lacunae in specimens from patients who had originally had a posterior surgical approach with the number in patients having alternative surgical approaches.
Results We found a statistically significant increase in the percentage of empty lacunae in retrieval specimens from patients who had the posterior approach compared with other surgical approaches (p < 0.001).
Conclusions This indicates that the vascular compromise that occurs during the posterior surgical approach does have long-term effects on the bone of the femoral head, even if it does not cause overt avascular necrosis.
Cite this article: Bone Joint Res 2013;2:200–5.
Article focus
We studied the long-term effects of surgical approach on vascularity of femoral head using retrieval specimens from failed hip resurfacings
We used a nuclei-counting method to compare the vascularity of femoral heads between posterior and anterior type approaches, such as the trochanteric flip and anterolateral approaches
The research question we aimed to answer by this study is: “Does the posterior surgical approach have any long-term effects on vascularity of the femoral head compared with other anterior-type approaches?”
Key messages
There is a statistically significant increase in the percentage of empty lacunae in retrieval specimens from patients who had the posterior approach compared with other surgical approaches
The posterior surgical approach does have long-term effects on the bone of the femoral head, even if it does not cause overt avascular necrosis
Strengths and limitations
