Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 12/2013

01-12-2013 | Hip Arthroplasty

Increased post-operative ischemia in the femoral head found by microdialysis by the posterior surgical approach: a randomized clinical trial comparing surgical approaches in hip resurfacing arthroplasty

Authors: Nina Dyrberg Lorenzen, Maiken Stilling, Michael Ulrich-Vinther, Niels Trolle-Andersen, Thomas Prynø, Kjeld Søballe, Hanne Birke-Sørensen

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2013

Login to get access

Abstract

Background

Hip resurfacing arthroplasty (HRA) is associated with osteonecrosis of the femoral head and femoral neck fracture, which may be caused by a decrease in the perfusion of the bone initiated at surgery. Several studies have demonstrated a decreased blood flow during surgery depending on the choice of surgical approach. We investigated the effect of the surgical approach on the blood flow and metabolism in the femoral head and neck in HRA by Laser Doppler flowmetry (LDF) and microdialysis.

Materials and methods

We conducted a randomized clinical trial on 38 patients, allocated to HRA by either the posterior (Post) or the antero-lateral (AntLat) surgical approach. LDF was performed during surgery and microdialysis after surgery to assess the concentration of the following metabolic markers: glucose, lactate, pyruvate and glycerol.

Results

At 44–50 h after surgery, the mean lactate/pyruvate (L/P) and lactate/glucose (L/G) ratio was higher in the Post group compared to the AntLat group; L/P 195.3 (SEM 123) in Post and 128.5 (108.0) in AntLat; L/G 16.9 (6.5) in Post and 8.9 (3.7) in AntLat (p L/P = 0.02 and p L/G = 0.03). There was no difference in the LDF measurements (p = 0.74).

Interpretation

HRA in the posterior approach results in increased post-operative ischemia in the femoral head and neck although during surgery, no difference in the blood flow was found. Still, the antero-lateral approach also causes considerable ischemia and other possible explanations, such as damage to the retinacular vessels during surgery or altered microcirculation because of heating from the cementation process, needs to be investigated.
Literature
1.
Springer BD, Connelly SE, Odum SM, Fehring TK, Griffin WL, Mason JB et al (2009) Cementless femoral components in young patients. review and meta-analysis of total hip arthroplasty and hip resurfacing. J Arthroplasty 24(6 SUPPL):2–8PubMedCrossRef
2.
Beaule PE, Campbell P, Lu Z, Leunig-Ganz K, Beck M, Leunig M et al (2006) Vascularity of the arthritic femoral head and hip resurfacing. J Bone Joint Surg Am 88(Suppl 4):85–96PubMedCrossRef
3.
Gautier E, Ganz K, Krugel N, Gill T, Ganz R (2000) Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 82(5):679–683PubMedCrossRef
4.
Kalhor M, Beck M, Huff TW, Ganz R (2009) Capsular and pericapsular contributions to acetabular and femoral head perfusion. J Bone Joint Surg Am 91(2):409–418PubMedCrossRef
5.
Schoeniger R, Espinosa N, Sierra RJ, Leunig M, Ganz R (2009) Role of the extraosseus blood supply in osteoarthritic femoral heads? Clin Orthop Relat Res 467(9):2235–2240PubMedCrossRef
6.
Boraiah S, Dyke JP, Hettrich C, Parker RJ, Miller A, Helfet D et al (2009) Assessment of vascularity of the femoral head using gadolinium (Gd-DTPA)-enhanced magnetic resonance imaging: a cadaver study. J Bone Joint Surg Br 91(1):131–137PubMed
7.
Beaule PE, Campbell PA, Hoke R, Dorey F (2006) Notching of the femoral neck during resurfacing arthroplasty of the hip: a vascular study. J Bone Joint Surg Br 88(1):35–39PubMedCrossRef
8.
Notzli HP, Siebenrock KA, Hempfing A, Ramseier LE, Ganz R (2002) Perfusion of the femoral head during surgical dislocation of the hip. Monitoring by laser Doppler flowmetry. J Bone Joint Surg Br 84(2):300–304PubMedCrossRef
9.
Amarasekera HW, Costa ML, Foguet P, Krikler SJ, Prakash U, Griffin DR (2008) The blood flow to the femoral head/neck junction during resurfacing arthroplasty: a comparison of two approaches using Laser Doppler flowmetry. J Bone Joint Surg Br 90(4):442–445PubMed
10.
Steffen R, O’Rourke K, Gill HS, Murray DW (2007) The anterolateral approach leads to less disruption of the femoral head-neck blood supply than the posterior approach during hip resurfacing. J Bone Joint Surg Br 89(10):1293–1298PubMed
11.
Steffen RT, Fern D, Norton M, Murray DW, Gill HS (2009) Femoral oxygenation during hip resurfacing through the trochanteric flip approach. Clin Orthop Relat Res 467(4):934–939PubMedCrossRef
12.
Khan A, Yates P, Lovering A, Bannister GC, Spencer RF (2007) The effect of surgical approach on blood flow to the femoral head during resurfacing. J Bone Joint Surg Br 89(1):21–25PubMed
13.
Keller AK, Jorgensen TM, Ravlo K, Nielsen TK, Olsen LH, Stolle LB (2009) Microdialysis for detection of renal ischemia after experimental renal transplantation. J Urol 182(4 Suppl):1854–1859PubMedCrossRef
14.
Setala L, Papp A, Romppanen EL, Mustonen P, Berg L, Harma M (2006) Microdialysis detects postoperative perfusion failure in microvascular flaps. J Reconstr Microsurg 22(2):87–96PubMedCrossRef
15.
Birke-Sorensen H, Andersen NT (2010) Metabolic markers obtained by microdialysis can detect secondary intestinal ischemia: an experimental study of ischemia in porcine intestinal segments. World J Surg 34(5):923–932PubMedCrossRef
16.
Bogehoj M, Emmeluth C, Overgaard S (2007) Blood flow and microdialysis in the human femoral head. Acta Orthop 78(1):56–62PubMedCrossRef
17.
Stolle LB, Arpi M, Jorgensen PH, Riegels-Nielsen P, Keller J (2003) In situ gentamicin concentrations in cortical bone: an experimental study using microdialysis in bone. Acta Orthop Scand 74(5):611–616PubMedCrossRef
18.
Stolle LB, Plock N, Joukhadar C, Arpi M, Emmertsen KJ, Buerger C et al (2008) Pharmacokinetics of linezolid in bone tissue investigated by in vivo microdialysis. Scand J Infect Dis 40(1):24–29PubMedCrossRef
19.
Thorsen K, Kristoffersson AO, Lerner UH, Lorentzon RP (1996) In situ microdialysis in bone tissue. Stimulation of prostaglandin E2 release by weight-bearing mechanical loading. J Clin Invest 98(11):2446–2449PubMedCrossRef
20.
Schintler MV, Traunmuller F, Metzler J, Kreuzwirt G, Spendel S, Mauric O et al (2009) High fosfomycin concentrations in bone and peripheral soft tissue in diabetic patients presenting with bacterial foot infection. J Antimicrob Chemother 64(3):574–578PubMedCrossRef
21.
Bogehoj MF, Emmeluth C, Overgaard S (2011) Microdialysis in the femoral head of the minipig and in a blood cloth of human blood. Acta Orthop 82(2):241–245PubMedCrossRef
22.
Ullmark G, Sundgren K, Milbrink J, Nilsson O, Sorensen J (2009) Osteonecrosis following resurfacing arthroplasty. Acta Orthop 80(6):670–674PubMedCrossRef
23.
Forrest N, Welch A, Murray AD, Schweiger L, Hutchison J, Ashcroft GP (2006) Femoral head viability after Birmingham resurfacing hip arthroplasty: assessment with use of [18F] fluoride positron emission tomography. J Bone Joint Surg Am 88(Suppl 3):84–89PubMedCrossRef
24.
Ullmark G, Sundgren K, Milbrink J, Nilsson O (2011) Femoral head viability following resurfacing arthroplasty. A clinical positron emission tomography study. Hip Int 21(1):66–70PubMedCrossRef
25.
Sugamoto K, Ochi T, Takahashi Y, Tamura T, Matsuoka T (1998) Hemodynamic measurement in the femoral head using laser Doppler. Clin Orthop Relat Res 353:138–147PubMedCrossRef
26.
Beck M, Siebenrock KA, Affolter B, Notzli H, Parvizi J, Ganz R (2004) Increased intraarticular pressure reduces blood flow to the femoral head. Clin Orthop Relat Res 424:149–152PubMedCrossRef
27.
Ungerstedt U (1991) Microdialysis–principles and applications for studies in animals and man. J Intern Med 230(4):365–373PubMedCrossRef
28.
Rooyackers O, Thorell A, Nygren J, Ljungqvist O (2004) Microdialysis methods for measuring human metabolism. Curr Opin Clin Nutr Metab Care 7(5):515–521PubMedCrossRef
29.
Ungerstedt U, Rostami E (2004) Microdialysis in neurointensive care. Curr Pharm Des 10(18):2145–2152PubMedCrossRef
30.
Lundberg G, Wahlberg E, Swedenborg J, Sundberg CJ, Ungerstedt U, Olofsson P (2000) Continuous assessment of local metabolism by microdialysis in critical limb ischaemia. Eur J Vasc Endovasc Surg 19(6):605–613PubMedCrossRef
31.
Beaule PE, Campbell P, Shim P (2007) Femoral head blood flow during hip resurfacing. Clin Orthop Relat Res 456:148–152PubMedCrossRef
32.
Korth U, Merkel G, Fernandez FF, Jandewerth O, Dogan G, Koch T et al (2000) Tourniquet-induced changes of energy metabolism in human skeletal muscle monitored by microdialysis. Anesthesiology 93(6):1407–1412PubMedCrossRef
33.
Beaule PE, Matar WY, Poitras P, Smit K, May O (2009) 2008 Otto Aufranc Award: component design and technique affect cement penetration in hip resurfacing. Clin Orthop Relat Res 467(1):84–93PubMedCrossRef
34.
Little JP, Gray HA, Murray DW, Beard DJ, Gill HS (2008) Thermal effects of cement mantle thickness for hip resurfacing. J Arthroplasty 23(3):454–458PubMedCrossRef
35.
Australian National Joint Replacement Registry. Australian National Joint Replacement Registry. Annual Report 2010. 2011
36.
The National Joint Registry for England and Wales. The National Joint registry for England and Wales. Annual report 2010. 2011. 24-9-2011
37.
Danish Hip Arthroplasty Registry. Danish Hip Arthroplasty Registry. Annual Report 2010. 2012. 9-10-2011
Metadata
Title
Increased post-operative ischemia in the femoral head found by microdialysis by the posterior surgical approach: a randomized clinical trial comparing surgical approaches in hip resurfacing arthroplasty
Authors
Nina Dyrberg Lorenzen
Maiken Stilling
Michael Ulrich-Vinther
Niels Trolle-Andersen
Thomas Prynø
Kjeld Søballe
Hanne Birke-Sørensen
Publication date
01-12-2013
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 12/2013
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-013-1851-1

Other articles of this Issue 12/2013

Archives of Orthopaedic and Trauma Surgery 12/2013 Go to the issue

Erratum

Erratum to: The utility of clinical features for distinguishing subchondral insufficiency fracture from osteonecrosis of the femoral head

Trauma Surgery

Non surgically managed anteromedial coronoid fractures in posteromedial rotatory instability: three cases with 2 years follow-up

Arthroscopy and Sports Medicine

In vivo evaluation of the kinematics of the long head of the biceps tendon within the pulley: A 3 T MRI motion analysis

Trauma Surgery

Feasibility study on the potential of a spiral blade in osteoporotic distal femur fracture fixation

Erratum

Erratum to: Clinical and radiographical results after double flip button stabilization of acute grade III and IV acromioclavicular joint separations

Orthopaedic Surgery

Comparison between posterior lumbar interbody fusion and posterolateral fusion with transpedicular screw fixation for isthmic spondylolithesis: a meta-analysis