cadera / hip - Active Congress.......

MIÉRCOLES / WEDNESDAY
116
CAUSE AND PREVENTION
OF NECK FRACTURES IN
HIP RESURFACING
P. Beaulé
Head Adult Reconstruction
Division of Orthopaedic Surgery
University of Ottawa, Canada
The reintroduction of hip resurfacing has
been fostered by the introduction of metal
on metal bearing. Early results have been
promising both in the short and medium term,
however although relatively low at 1-2%, the
occurrence of a femoral neck fracture represents
a signifi cant disadvantage to a stem
type total hip replacement.
The occurrence of a femoral neck fracture is
multifactorial in its etiology where a certain
threshold of the bony structural integrity must
be reached for it to occur. Some of these factors
include damage to the vascular supply
to the femoral head by surgical approach,
damage to the retinacular vessels, and over
cement penetration leading to thermal necrosis
of the bone.
There are also patient factors such osteoporosis
which may permit over cement
penetration as well as presence of femoral
head cysts. Finally, some guidelines will be
provided to minimize those risks in respect
to femoral component positioning i.e. relative
valgus and choice of surgical exposure i.e.
preserving femoral head vascularity.
RECOMMENDED READING:
ORTHOPEDIC CLINICS OF NORTH AMER-
ICA: APRIL 2005 VOL 36 NO. 2 entitled Surface
Arthroplasty of the Hip Revisited edited
by Leunig and Beaulé.
Notching of the Femoral Neck During Hip
Resurfacing. A vascular study.
PE Beaulé, P Campbell, R Hoke and F. Dorey
JBJS 88B Vol 1, pp 35-39, 2006.
Femoral Head Blood Flow during Hip Resurfacing.
PE Beaulé, P Campbell, Paul Shim
Clin Orthop and Rel Res (E Pub Sept 28
2006)
Vascularity of the Arthritic Femoral Head and
Its Implications for hip resurfacing.
PE Beaulé, P Campbell, Z Lu, Ganz K, Beck
M, Leunig M and Ganz R.
JBJS Am Suppl December 2006
SURFACE ARTHROPLASTY
OF THE HIP: RESULTS OF
MULTICENTER TRIALS
V. M Goldberg, M.D
Department of Orthopaedics
Case Western Reserve University
University Hospitals of Cleveland
Cleveland, Ohio, USA
Hip resurfacing arthroplasty using metal on
metal surfaces has become another option
for the young patient with significant hip
arthritis. Surface replacement arthroplasty
(SRA) provides enhancement to the lifestyle
of young active patients while conserving
bone to make future revisions easier. There
are a number of additional advantages to this
procedure. They include: an increased range
of motion because of the large diameter femoral
head, a more wear resistant couple compared
to traditional surfaces, and a signifi cant
reduction of hip dislocation because of the
large femoral head diameter. A large femoral
head approximating normal hip anatomy may
provide patients an opportunity for enhanced
kinematics with improved function.
The original designs used in resurfacing hip
replacements were generally not successful