Key result
Resection of 50% of the femoral head-neck junction significantly reduced peak load (p=0.0025), while 30% resection decreased energy to fracture without altering load-bearing capacity.
Why the study?
Does resection of 10%, 30%, or 50% of the femoral head-neck junction alter the load-bearing capacity and energy to fracture compared to intact femoral necks in cadaveric specimens?
Does resection of 10%, 30%, or 50% of the femoral head-neck junction alter the load-bearing capacity and energy to fracture compared to intact femoral necks in cadaveric specimens?
p-value: p=0.0015 for energy to fracture; 0.0025 for peak load
Resection of up to 30% of the anterolateral quadrant of the femoral head-neck junction is the greatest feasible amount without significantly altering peak load-bearing capacity, though it decreases energy to fracture.
May limit safe resection to ≤30% during hip preservation surgery; leaves open clinical fracture risk from reduced energy absorption.
BACKGROUND: In patients with symptomatic hip impingement, surgical resection of the femoral head-neck junction may improve the range of motion and relieve pain. A risk of this procedure is fracture. We evaluated the amount of resection of the anterolateral aspect of the femoral head-neck junction that can be done safely. METHODS: Cadaveric proximal femoral specimens (fifteen matched pairs) were divided into three groups: 10%, 30%, or 50% of the diameter of one femoral neck was removed, and the contralateral femoral neck was left intact to serve as the control. A compressive load was applied directly to the femoral head. Peak load, stiffness, and energy to fracture were compared among the groups. RESULTS: The energy to fracture differed significantly (p = 0.0015) among the 10%, 30%, and 50% resection groups. The peak load after the 50% resection was significantly less (p = 0.0025) than that after the 10% or 30% resection. With the numbers available, there was no significant difference in peak load between the 10% and 30% resections. CONCLUSIONS: Resection of up to 30% of the anterolateral quadrant of the head-neck junction did not significantly alter the load-bearing capacity of the proximal part of the femur. However, a 30% resection significantly decreased the amount of energy required to produce a fracture. Thirty percent should be considered to be the greatest feasible amount of resection because of the change in the pattern of the femoral head-neck response to axial loads that we observed.
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Mardones et al. (2006) studied Symptomatic hip impingement (n=30). Resection of 10%, 30%, or 50% of the anterolateral aspect of the femoral head-neck junction vs. Intact contralateral femoral neck was evaluated on Peak load, stiffness, and energy to fracture (p=0.0015 for energy to fracture; 0.0025 for peak load). Resection of 50% of the femoral head-neck junction significantly reduced peak load (p=0.0025), while 30% resection decreased energy to fracture without altering load-bearing capacity.
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