The Effect of a Modified Posterior Approach on Blood flow to the Femoral Head during Hip Resurfacing

The deep branch of the medial femoral circumflex artery is vulnerable to injury during posterior approaches to the hip. We modified the posterior approach during hip resurfacing in 10 patients by dividing the short external rotators 2 cm from their insertion into the femur. The cefuroxime concentrations in bone samples from the femoral heads were compared with results for the extended posterolateral approach from previous published work. There was no difference between the concentration of cefuroxime in bone when using the modified posterior approach (mean 5.6 mg/kg; CI 3.6 – 7.8) compared to the extended posterolateral approach (mean 5.6 mg/kg; CI 3.5 - 7.8; p=0.95). The similarity in femoral head perfusion between approaches suggests that the blood supply may be impaired further by capsulotomy and capsulectomy rather than by damage to the deep branch of the MFCA alone.

[1]  D W Murray,et al.  The anterolateral approach leads to less disruption of the femoral head-neck blood supply than the posterior approach during hip resurfacing. , 2007, The Journal of bone and joint surgery. British volume.

[2]  H. Gill,et al.  The effect of hip resurfacing on oxygen concentration in the femoral head. , 2005, The Journal of bone and joint surgery. British volume.

[3]  R. Ganz,et al.  Anatomic considerations for the choice of surgical approach for hip resurfacing arthroplasty. , 2005, The Orthopedic clinics of North America.

[4]  R. Ganz,et al.  Distribution of vascular foramina around the femoral head and neck junction: relevance for conservative intracapsular procedures of the hip. , 2005, The Orthopedic clinics of North America.

[5]  A. Shimmin,et al.  Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. , 2005, The Journal of bone and joint surgery. British volume.

[6]  D W Murray,et al.  Osteonecrosis in retrieved femoral heads after failed resurfacing arthroplasty of the hip. , 2005, The Journal of bone and joint surgery. British volume.

[7]  P B Pynsent,et al.  Birmingham hip resurfacing arthroplasty. A minimum follow-up of five years. , 2005, The Journal of bone and joint surgery. British volume.

[8]  P. Waters,et al.  Effect of tendon transfers and extra-articular soft-tissue balancing on glenohumeral development in brachial plexus birth palsy. , 2005, The Journal of bone and joint surgery. American volume.

[9]  P. Beaulé.  A soft tissue-sparing approach to surface arthroplasty of the hip , 2004 .

[10]  P B Pynsent,et al.  Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. , 2004, The Journal of bone and joint surgery. British volume.

[11]  R. Ganz,et al.  Perfusion of the femoral head during surgical dislocation of the hip. Monitoring by laser Doppler flowmetry. , 2002, The Journal of bone and joint surgery. British volume.

[12]  G. Bannister,et al.  The penetration of ceftriaxone and cefamandole into bone, fat and haematoma and relevance of serum protein binding to their penetration into bone. , 2001, The Journal of antimicrobial chemotherapy.

[13]  R. Ganz,et al.  Anatomy of the medial femoral circumflex artery and its surgical implications. , 2000, The Journal of bone and joint surgery. British volume.

[14]  G. Bannister,et al.  A comparison of the penetration of cefuroxime and cephamandole into bone, fat and haematoma fluid in patients undergoing total hip replacement. , 1997, The Journal of antimicrobial chemotherapy.

[15]  J Schatzker,et al.  A study of implant failure in the Wagner resurfacing arthroplasty. , 1985, The Journal of bone and joint surgery. American volume.

[16]  R. G. Thompson,et al.  THE DISTRIBUTION AND ANASTOMOSES OF ARTERIES SUPPLYING THE HEAD AND NECK OF THE FEMUR. , 1965, The Journal of bone and joint surgery. British volume.

[17]  J. Kellgren,et al.  Radiological Assessment of Rheumatoid Arthritis * , 1957, Annals of the rheumatic diseases.

[18]  J. Trueta,et al.  The normal vascular anatomy of the femoral head in adult man. , 1953, The Journal of bone and joint surgery. British volume.

[19]  G. Bannister,et al.  The effect of surgical approach on blood flow to the femoral head during resurfacing. , 2007, The Journal of bone and joint surgery. British volume.

[20]  P. Campbell,et al.  Notching of the femoral neck during resurfacing arthroplasty of the hip: a vascular study. , 2006, The Journal of bone and joint surgery. British volume.