The anterolateral approach leads to less disruption of the femoral head-neck blood supply than the posterior approach during hip resurfacing 2007
R. Steffen, MRCS, Clinical Research Fellow1; K. O’Rourke, FRCS, Consultant Orthopaedic Surgeon2; H. S. Gill, DPhil, University Research Lecturer1; and D. W. Murray, FRCS, Consultant Orthopaedic Surgeon1
1 Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK. 2 Cappagh National Orthopaedic Hospital, Finglas Dublin 11, Ireland.In 12 patients, we measured the oxygen concentration in the femoral head-neck junction during hip resurfacing through the anterolateral approach. This was compared with previous measurements made for the posterior approach. For the anterolateral approach, the oxygen concentration was found to be highly dependent upon the position of the leg, which was adjusted during surgery to provide exposure to the acetabulum and femoral head. Gross external rotation of the hip gave a significant decrease in oxygenation of the femoral head. Straightening the limb led to recovery in oxygen concentration, indicating that the blood supply was maintained. The oxygen concentration at the end of the procedure was not significantly different from that at the start. The anterolateral approach appears to produce less disruption to the blood flow in the femoral head-neck junction than the posterior approach for patients undergoing hip resurfacing. This may be reflected subsequently in a lower incidence of fracture of the femoral neck and avascular necrosis.