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.
