Bone mineral density measurements and the development of patient selection criteria for patients requiring hip resurfacing surgery

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There is concern about femoral neck fractures for patients in the early post operative period following hip resurfacing surgery. Although patient selection is multifactorial bone quality plays an important role in fracture risk. Reduced bone mineral mass induces an increased fracture risk on the superior side of the femoral neck before and after hip resurfacing. Close scrutiny to bone quality other than the use of visual inspection of radiographs (Singh Index) to estimate the mechanical quality of the bone has not been closely analysed. A change in bone mass across the femoral neck can be influenced by disease (Osteoarthritis) or a change in load pattern (pain and disuse). If hip resurfacing is the technique of choice, the major difficulty is to distinguish clearly which patient will have a positive outcome without the complication of femoral neck fracture. Bone mineral density (BMD) measurement is a well known technique for the diagnoses of poor bone mass (Osteoporosis). To date there has been no published data analyzing the effect of bone mineral density examination in patient selection criteria for hip resurfacing surgery. This is the first attempt to introduce a practical tool for surgeons to assess bone quality prior to hip resurfacing surgery. A prospective longitudinal outcome analysis of 423 consecutive hip resurfacing procedures was conducted to test the validity of the introduction of BMD in conjunction with unique selection criteria. There were 339 patients under 65 years of age (264 males and 75 females). There were 84 patients 65 years and over (61 males and 23 females). Bone mineral density examination was introduced preoperatively, 6 months, 12 months and 24 months postoperatively to test for bone mass quality. The short form (SF-36), WOMAC health questionnaire, TEGNER activity score and body mass index (BMI) were used to analysis the patient’s outcomes, activity and general health preoperatively, 6 months, 12 months, 24 months and 36 months postoperatively. The results concluded that this was the first time BMD measurements were successfully introduced as a selection tool for patient requiring hip resurfacing surgery. There were no femoral neck fractures after its introduction. I propose BMD examination is part of a multifactorial approach in the selection of patient for hip resurfacing surgery and it is the one determining factor that will ensure the bone is strong enough to cope with this load sharing device.
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