Association of osteonecrosis and failure of hip resurfacing arthroplasty.
Osteonecrosis (ON) has been reported in femoral remnants removed after failure of hip resurfacing arthroplasty. Experimental and clinical studies have further described thermal effects of the cementation technique, damage of extraosseous blood vessels, and intraoperative hypoxemia as possible causative factors. We analyzed histologically a series of 123 retrieved specimens with a preoperative diagnosis other than ON to investigate the incidence and extent of advanced ON. ON was found in 88% of cases and associated with 60% (51 of a total of 85) of periprosthetic fractures. The fracture incidence correlated with the extent of ON. Collapse of necrotic tissue in three (2%) cases resulted in disconnection of the bone stock-femoral component. We observed smaller regions of superficial ON in the majority of the remaining femoral remnants with periprosthetic fractures and in hips that failed for reasons other than fracture.
Zustin
Jozef
J
Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany. j.zustin@uke.uni-hamburg.de
Sauter
Guido
G
Morlock
M Michael
MM
Rüther
Wolfgang
W
Amling
Michael
M
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005271:Femur Head Necrosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D005858:Germany / Q000453:epidemiology; D006622:Hip Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors