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Association of Osteonecrosis and Failure of Hip Resurfacing Arthroplasty

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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.

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Acknowledgments

We thank Michael Hahn, PhD, for assistance with processing the specimens. We also thank all cooperating orthopaedic surgeons who provided us with cases.

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Authors and Affiliations

  1. Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany

    Jozef Zustin MD & Guido Sauter MD

  2. Biomechanics Section, TUHH Hamburg University of Technology, Hamburg, Germany

    M. Michael Morlock MD

  3. Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Wolfgang Rüther MD

  4. Center for Biomechanics and Skeletal Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Michael Amling MD

  5. Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Michael Amling MD

Authors
  1. Jozef Zustin MD
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  2. Guido Sauter MD
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  3. M. Michael Morlock MD
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  4. Wolfgang Rüther MD
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  5. Michael Amling MD
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Corresponding author

Correspondence to Jozef Zustin MD.

Additional information

One or more of the authors received from DePuy Orthopaedics, Inc, Warsaw IN (MM, MA); Smith & Nephew, London, UK (MM, MA); Corin Group PLC, Cirencester, UK (MM, MA); Zimmer Inc, Warsaw, IN (MM, MA); and Biomet Inc, Warsaw, IN (MM, MA).

This work was performed at University Medical Center Hamburg-Eppendorf and TUHH University of Technology Hamburg-Harburg.

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Zustin, J., Sauter, G., Morlock, M.M. et al. Association of Osteonecrosis and Failure of Hip Resurfacing Arthroplasty. Clin Orthop Relat Res 468, 756–761 (2010). https://doi.org/10.1007/s11999-009-0979-3

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  • DOI: https://doi.org/10.1007/s11999-009-0979-3

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