Femoral neck arthroplasty after failed resurfacing: brief report.

Surface replacement of the hip was introduced as an alternative to conventional replacement. Unfortunately, its theoretical advantages have been overshadowed by the high incidence of early failure (Head 1981 ; Jolley, Salvati and Brown 1982; Bell et al. 1985). If failure necessitates removal of the prosthesis, we advocate preservation of the femoral neck stump for articulation. We report five such cases. Patients and Methods. Five patients, each of whom had a Wagner resurfacing arthroplasty, later required excisional arthroplasty for loosening : three were aseptic, and two septic. The acetabular and femoral components were removed but the femoral stump was left intact (Fig. 1), except in patient B who had an associated femoral neck fracture. In no case was any further acetabular bone stock resected. The femoral stump was placed in the acetabulum without any soft tissue interposition and the wounds closed primarily over suction drains. The patients were placed in traction for six weeks then allowed up taking as much weight as they would tolerate using walking aids. A shoe raise was used to compensate for leg length discrepancy. Results. These are summarised in Table I. Except for patient B who had a femoral neck fracture, they were very satisfactory. Discussion. In Girdlestone’s arthroplasty the entire femoral neck and the cartilage of the acetabulum are resected (Girdlestone 1943). In four of our five cases the femoral stump was not resected. Such relative lengthen-