Abstract
Hip Resurfacing is now an established treatment option for young active patients with osteoarthritis. However, there is slow uptake of hip resurfacing by some surgeons, with concern regarding failure from femoral neck fracture, a small but significant risk. Femoral neck fracture may follow notching of the neck, which occurs upon preparing the femoral head after inserting the femoral head/neck guide-wire. The placement of the femoral head/neck guide-wire is a concern for even experienced surgeons routinely, and in difficult cases of femoral head/neck deformity this is especially so.
For the first time a preliminary series of Durom hip resurfacings, based on the successful Metasul bearing, were implanted using a computer image guidance system. The aim of computer navigation is to optimally place the femoral prosthesis in the correct degree of valgus with good underlying bone coverage, without notching the femoral neck or over-sizing the femoral component. Preoperative CT scanning was not required. A standard posterior approach to the hip was utilised, and a navigation reference frame was applied to the proximal femur. Then using an image intensifier and the computer navigation system, a guide-wire was passed quickly and easily into the femoral head/neck with a navigated drill guide. The femoral head was then prepared safely for the femoral component of the resurfacing, with minimal risk of femoral neck fracture.
Computer navigation systems have an important role to play in hip resurfacing with respect to femoral head/neck preparation, as demonstrated from our preliminary study. This series shows the use of computer navigation in hip resurfacing to be both SAFE and SIMPLE with a quick learning curve. It was shown to be FASTER and MORE ACCURATE in the process of guide-wire placement in the femoral head/neck as compared to conventional jigs. Crucially, femoral neck fractures may even be potentially ELIMINATED using this technique.
In the future, hip resurfacing in conjunction with computer navigation systems may allow;
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- SAFER hip resurfacing, with reduced rates of femoral neck fractures
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- Improved TRAINING to include junior surgeons in hip resurfacing
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- Surgeons to operate INDEPENDENTLY initially
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- Surgeons to operate on DIFFICULT cases subsequently
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- The development of MINIMALLY INVASIVE hip resurfacing
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- The development of SPECIALIST centres for teaching and difficult cases
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
