Abstract
Introduction: Resurfacing hip arthroplasty is a successful option for the treatment of the young and active patient with hip arthritis. However, it is complicated by femoral neck fracture and avascular necrosis, which may result from devascularisation during surgery. Devascularisation maybe caused by thermal necrosis. Thermal necrosis of bone has been shown to occur in temperatures of 47°C and above. We investigated the temperatures generated during femoral head preparation to see if the temperatures reached were great enough to induce osteonecrosis.
Method: Eight patients with osteoarthritis underwent standard resurfacing hip arthroplasty through the posterior approach. From the first over-drilling of the femoral heads until the prosthesis was cemented in place the temperatures generated at the bone surface were recorded using an infra-red thermal imaging camera. Images were captured every 4 seconds as the operation was performed with no interference to the surgeon
Results: The maximum temperatures generated occurred during sleeve reaming at 88.4°C. Seven patients had a temperature recorded greater than 47°C. Removing the femoral caput with an oscillating saw had the highest mean temperature 62.2°C, followed by sleeve reaming (mean 48.7°C). Female patients had the lowest temperature rises and patients receiving the larger femoral prosthesis the greatest temperatures at the bone surface.
Conclusions: Heat generated during femoral head preparation exceeded 47°C in all but one case. Osteonecrosis secondary to thermal insult is likely to occur during femoral head preparation. Strategies need to be devised to decrease the temperatures generated during femoral head preparation.
Correspondence should be addressed to Mr Peter Howard, Editorial Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
