Femoral Head Vascularity. Impact and Implications for Hip Resurfacing Arthroplasty

Summary: The blood supply to the resurfaced femoral head has been implicated in the early failure of implants. The extraosseous supply to the femoral head is threatened both during the approach and the preparation of the femoral head to receive an implant. The presence or degree of intraosseous supply is under debate as is its ability to compensate for any damage of the supply. Evidence of a decrease in the femoral head blood flow has been demonstrated due to the approach, positioning of the limb, and after preparation of the femoral head for hip resurfacing. Histologic studies have shown evidence of osteonecrosis around failed implants, and identified as a cause of femoral neck fracture after hip resurfacing. It is with this in mind that a thorough understanding of the femoral blood flow anatomy and it implications for long-term success is needed to achieve the best results in resurfacing of the arthritic femoral head. This article describes the key considerations of the vascularity of the arthritic femoral head undergoing resurfacing arthoplasty and the latest research evidence of its influence on resurfacing outcomes.