(Revised 10/2010 by Dr. David Lucas)
Femoral Head Resection
Femoral heads are resected and sent to Pathology for two main reasons: 1. Elective hip
replacement (total hip arthroplasty), and 2. Fracture (either pathological or not). Elective hip
replacement is usually done for degenerative joint disease and sometimes for avascular
necrosis. These specimens have a clean resection margin consistent with a saw cut. Femoral
heads resected for fracture have an irregular margin consistent with fracture that typically has
acute hemorrhage.
Procedure
Elective Hip Replacement:
1. Measure the specimen in 3 dimensions.
2. Describe the shape in terms of distortion and describe the outer surface, in particular the
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articular cartilage.
Bisect the femoral head in the coronal plane using the band saw or stryker saw.
Examine the cut surface paying particular attention to the thickness of the cartilage,
subchondral osteosclerosis or degenerative cysts, and any evidence of avascular
necrosis.
Femoral heads with degenerative joint disease are gross only specimens. Following
your gross description dictate the diagnosis as follows: Bone, right/left femoral head,
resection: Degenerative joint disease (gross diagnosis).
For tumors with avascular necrosis submit one section for decalcification from the
articular surface encompassing the area of necrosis.
Fracture
1.
For femoral heads removed for fracture, following coronial section on the band saw
carefully evaluate the fracture site for areas of hemorrhage or any fleshy tissues.
2. Submit one section for decalcification.
Description
Important observations and terminologies used for degenerative joint disease are listed below:
Shape distortion, cartilage sloughing, eburnation (polished bone), osteophytes, subchondral
sclerosis and subchondral cysts. Avascular necrosis of the femoral head is characterized by a
subchondral zone of yellow friable necrotic bone bordered by a hyperemic rim. The overlying
cartilage is typically viable appearing and often lifts away from the underlying necrotic bone.
(Revised 10/2010 by Dr. David Lucas)
Subchondral AVN
Normal
Eburnation
Degenerated
cartilage
Shape
distortion
Osteophytes
“bone spurs”
(Revised 10/2010 by Dr. David Lucas)
Full-thickness
sloughing
Subchondral scleosis
Cyst
Osteophyte
Loose body