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Erschienen in:
01.06.2011 | Symposium: Update on Hard-on-Hard Bearings in Hip Arthroplasty
Avoiding Short-term Femoral Neck Fracture With Imageless Computer Navigation for Hip Resurfacing
Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 6/2011
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Background
Femoral neck fracture in hip resurfacing has been attributed to technical error during femoral head preparation. In the absence of fracture, several radiographic findings have been speculated to increase the risk of femoral component failure.
Questions/purposes
We examined whether (1) the use of navigation to reduce technical errors during femoral head preparation reduces the incidence of femoral neck fractures in the short-term followup period; and (2) alignment of the femoral component with the use of computer navigation reduces the incidence of femoral neck thinning, femoral stem radiolucencies, and stem migration.
Methods
We retrospectively reviewed the first 100 Birmingham Hip Resurfacings performed in 94 prospectively followed patients between October 2005 and November 2007. We examined all radiographs on last followup. Eighty-six patients of the 94 patients had a minimum followup of 2 years (mean, 2.5 years; range, 2–4.1 years).
Results
There were no cases of femoral neck notching, varus femoral component alignment, or femoral neck fractures in the series. Neck thinning of greater than 10% was observed in three patients and perimetaphyseal stem lucencies were noted in 10 patients. In three patients, the metaphyseal stem showed varus migration relative to the postoperative stem-shaft angle at latest followup. There was one revision to a total hip arthroplasty for deep sepsis. The overall survivorship at 4 years was 99%.
Conclusions
The use of imageless computer navigation to reduce technical errors in hip resurfacing may reduce the incidence of femoral neck fracture in the short-term. However, neck thinning, stem radiolucencies, and stem migration remain radiographic sequelae of hip resurfacing despite the use of navigation for placement of the femoral component.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.