THE USE OF A METALLIC FEMORAL HEAD

¹ WASHINGTON, D. C.

The steel femoral head has been well tolerated in the acetabulum and there has been no evidence of necrosis or protrusion except in the one case in which infection developed. Except in that case, that has been no occasion to remove the head of the prosthesis or to expose the new joint. Minimal discomfort has been present, and there has been no evidence of pain due to metal. There has been no bone neerosis due to pressure or traction and no loosening of the serews. In one case with broken serews, a supporting ledge of bone has developed under the lower border of the plate and the patient is bearing full weight without a cane.

Structural defects have led to fatigue fracture of one plate and of all serews in three cases. This indicates that the device should be strong and that proper technique should be observed in its application. It is possible to replace the plate and screws through a lateral approach to the femur without arthrotomy. A single long anterolateral incision is recommended, all muscle attachments being preserved. The head of the prosthesis or intervening washers should rest on bone if possible, although this is not mandatory if the device is sufficiently strong.

The minimum of postoperative care is required, active exercise is well tolerated, and full weight-bearing has been possible within three weeks. This device has furnished an effective means of arthroplasty or of reconstruction for non-union following fracture of the femoral neck.

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