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The cause of fracture of the femoral neck after hip resurfacing is poorly understood. In order to evaluate the role of avascular necrosis we compared 19 femoral heads retrieved at revision for fracture of the femoral neck and 13 retrieved for other reasons. We developed a new technique of assessing avascular necrosis in the femoral head by determining the percentage of empty osteocyte lacunae present. Femoral heads retrieved as controls at total hip replacement for osteoarthritis and avascular necrosis had 9% (sd 4; n = 13) and 85% (sd 5; n = 10, p < 0.001) empty lacunae, respectively. In the fracture group the percentage of empty lacunae was 71% (sd 22); in the other group it was 21% (sd 13). The differences between the groups were highly significant (p < 0.001). We conclude that fracture after resurfacing of the hip is associated with a significantly greater percentage of empty osteocyte lacunae within the trabecular bone. This indicates established avascular necrosis and suggests that damage to the blood supply at the time of surgery is a potent risk factor for fracture of the femoral neck after hip resurfacing.

Type

Journal article

Journal

The Journal of bone and joint surgery. British volume

Publication Date

06/2010

Volume

92

Pages

787 - 793

Addresses

Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.

Keywords

Osteocytes, Humans, Femur Head Necrosis, Femoral Neck Fractures, Prosthesis Failure, Observer Variation, Arthroplasty, Replacement, Hip, Postoperative Period, Reproducibility of Results, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Young Adult