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The Bone & Joint Journal

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The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 4 | Pages 437 - 444
1 Apr 2005
Little CP Graham AJ Carr AJ


The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 3 | Pages 320 - 323
1 Mar 2005
Little CP Ruiz AL Harding IJ McLardy-Smith P Gundle R Murray DW Athanasou NA

We present the histological findings of bone retrieved from beneath the femoral components of failed metal-on-metal hip resurfacing arthroplasties. Of a total of 377 patients who underwent resurfacing arthroplasty, 13 required revision; for fracture of the femoral neck in eight, loosening of a component in three and for other reasons in two. None of these cases had shown histological evidence of osteonecrosis in the femoral bone at the time of the initial implantation.

Bone from the remnant of the femoral head showed changes of osteonecrosis in all but one case at revision. In two cases of fracture which occurred within a week of implantation, the changes were compatible with early necrosis of the edge of the fracture. In the remaining six fractures, there were changes of established osteonecrosis. In all but one of the non-fracture cases, patchy osteonecrosis was seen.

We conclude that histological evidence of osteonecrosis is a common finding in failed resurfaced hips. Given that osteonecrosis is extensive in resurfaced femoral heads which fail by fracture, it is likely to play a role in the causation of these fractures.