Femoral neck fracture following surface replacement hip arthroplasty has been reported by a number of authors. In 1982, Cook et proposed the use of a fibula strut bone graft in surface replacement hip arthroplasty as a means of reducing the rate of femoral neck fracture. Using finite element analysis, Cook et ai' reported markedly abnormal stress distribution in the femoral neck following surface replacement arthroplasty; stresses in the lateral femoral neck were found to be re-directed transversely across the femoral neck. The authors postulated that this abnormal stress pattern might be responsible for the femoral neck fractures following surface replacement. The authors further reported that stresses could be made physiologic (parallel to the femoral neck) through the use of a fibula strut bone graft placed in the femoral neck. This paper reports our long-term experience in two patients who underwent surface replacement hip arthroplasty with an adjunct autogenous fibula strut bone graft.

 

Case 1. A 41-year-old man who had undergone open reduction with internal fixation of a right femoral neck fracture 13 years prior presented to the Veterans Administration Hospital of New Orleans in 1981, complaining of progressively debilitating right hip pain. A thorough work-up including a hip aspiration and serum laboratory tests ruled out infectious, metabolic, and endocrine disorders. Roentgenograms showed collapse of subchondral bone which was consistent with avascular necrosis (the patient had a history of heavy alcohol abuse).
 
The patient und.-rwent a cemented THARIES (total hip articular replacement by internal eccentric shells) resurfacing arthroplasty with an autogenous fibula strut bone graft (Figure 1). Postoperatively, the...

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