Avascular Necrosis Of Femoral Head Research Articles

Osseoscopy-assisted core decompression and debridement in the treatment of avascular necrosis of the femoral head.

Core decompression of the femoral head is a standard surgical procedure used in the early stages of the femoral head avascular necrosis (AVN) (Steinberg I to III). This study aimed to determine whether the advantages of osseoscopy-assisted core decompression using a standard arthroscopic set up in the early stages of AVN of the femoral head. Twelve hips of 12 patients who underwent osseoscopy-assisted core decompression and debridement with the diagnosis of AVN of the femoral head were reviewed between 2019 and 2021. The etiology was idiopathic in 2 patients; ten had a history of steroid use. The preoperative and postoperative first month Harris Hip Score (HHS) and visual analogue scale (VAS) were recorded. Standard X-rays, computerized tomography, and magnetic resonance imaging (MRI) were noted at preoperatively and sixth month follow-ups. In a 1-year follow-up, X-rays and MRIs were reviewed. All patients significantly improved in the VAS and HHS after the osseoscopy-assisted core decompression (P = .002). Two of the 12 patients with an initial stage of Steinberg IIC and IIB and one with Steinberg IA had a progressive femoral collapse and, therefore, had a total hip replacement at the end of the follow-up. Nine patients (75%) had satisfactory functional and radiological results in 1-year of follow-up. However, 3 patients (25%) culminated in total hip arthroplasty in a 1-year follow-up. Using an arthroscopic set up during osseoscopy-assisted core decompression surgery of the femoral head AVN has the benefits of direct visualization and accurate debridement of the involved area. The osseoscopy-assisted core decompression technique avoids excessive debridement of the healthy bone tissue adjacent to the necrotic area.

Designing and synthesis of injectable hydrogel based on carboxymethyl cellulose/carboxymethyl chitosan containing QK peptide for femoral head osteonecrosis healing

Femoral head necrosis is a debilitating disorder that typically caused by impaired blood supply to the hip joint. In this study, a novel injectable hydrogel based on Oxidized Carboxymethyl Cellulose (OCMC)-Carboxymethyl Chitosan (CMCS) polymers containing an angiogenesis stimulator peptide (QK) with a non-toxic crosslinking interaction (Schiff based reaction) was synthesized to enhance angiogenesis following femoral head necrosis in an animal model. The physicochemical features of fabricated injectable hydrogel were analyzed by FTIR, swelling and degradation rate, rheometry, and peptide release. Also, the safety and efficacy were evaluated following an in vitro hydrogel injection study and an avascular necrosis (AVN) animal model. According to the results, the hydrogel exhibited an appropriate swelling ratio and water uptake (>90 %, 24 h) as well as a suitable degradation rate over 21 days accompanied by a continuous peptide release. Also, data showed that hydrogels containing QK peptide boosted the proliferation, differentiation, angiogenesis, and osteogenic potential of both Bone Marrow mesenchymal Stem Cells (BM-MSCs) and human umbilical vein endothelial cells (HUVECs) (****p < 0.0001 and ***p < 0.001, respectively). Furthermore, molecular and histological evaluations significantly demonstrated the overexpression of Runx2, Osteocalcin, Collagen I, VEGF and CD34 genes (**p < 0.01 and ***p < 0.001, respectively), and also femoral head necrosis was effectively prohibited, and more blood vessels were detected in defect area by OCMC-CMCS hydrogel containing QK peptide (bone trabeculae >9000, ***p < 0.001). In conclusion, the findings demonstrate that OCMC-CMCS-QK injectable hydrogel could be considered as an impressive therapeutic construct for femoral head AVN healing.

Femoral Neck Shaft Angle Measurement for Differentiating Femoral Head Stress Fracture from Avascular Necrosis

Objective: The study aimed to evaluate whether the measurement of Femoral Neck Shaft Angle (FNSA) can be helpful in differentiating femoral head Stress Fracture (SF) from Avascular Necrosis (AVN). Methods: From September 2019 to April 2022, sixty-four patients [median age 32.0 years, interquartile range (IQR) 23.0–39.0 years] who underwent both hip radiograph and Magnetic Resonance Imaging (MRI) and diagnosed as femoral head SF or AVN were included in our retrospective study. Patients were divided into as having either femoral head SF (n = 34) or AVN (n = 30). The FNSA was measured in anteroposterior hip radiography. Continuous values were compared using the Mann-Whitney U test. The assessment of the predictive value of FNSA for femoral head SF was performed by Receiver Operating Characteristic (ROC) analysis. Results: The FNSA was significantly higher in patients with SF (median 133.5°, IQR 128.0–136.7°) than those with AVN (median 127.5°, IQR 124.0–132.0°) (p = 0.001). In addition, the FNSA was significantly higher in SF femurs (median 134.8°, IQR 129.2–137.4°) than in contralateral normal femurs (median 127.1°, IQR 124.3–132.5°) in patients with unilateral femoral head SF (n = 30) (p &lt; 0.001). In ROC analysis, the sensitivity, specificity, and Area Under the Curve (AUC) for predicting the femoral head SF were 77.3%, 63.3%, and 0.785 (95% confidence interval: 0.666–0.905), respectively, at a cutoff of 130.2°. Conclusion: Increased FNSA was associated with femoral head SF; thus, measurement of FNSA could be helpful for differentiating femoral head SF from AVN.

Randomised control trial on management of early avascular necrosis of femoral head by core decompression with bisphosphonate therapy versus core decompression in tertiary care hospital in central India

Background This study outlines a randomised control trial to assess the efficacy of Core Decompression with and without Bisphosphonate Therapy in managing early Avascular Necrosis of the femoral head. Avascular Necrosis, a debilitating condition, necessitates exploration of interventions to mitigate progression. The trial is conducted at Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, focusing on clinical, radiographic, and patient-reported outcomes. Methods Skeletally mature participants diagnosed with stage 1 or 2 Avascular Necrosis of the femoral head will be randomly assigned to either Core Decompression with Bisphosphonate Therapy or Core Decompression Alone. Data collection from July 2022 to September 2024 will involve preoperative assessments, intraoperative details, postoperative care records, and followup evaluations at six weeks, three months, six months, and nine months. Statistical analyses will encompass primary outcomes assessed by Harris Hip Score, secondary outcomes including pain reduction and radiographic changes, and subgroup analyses. Expected Outcome Anticipated outcomes involve insights into the comparative effectiveness of the two interventions. Primary analyses will reveal variations in Harris Hip Score changes over time, while secondary analyses will shed light on pain reduction, radiographic changes, and potential complications. Subgroup analyses may discern nuances based on etiological factors. The results aim to inform clinical practice, guiding the optimal management of early Avascular Necrosis of the femoral head.

Comparison of epoprostenol and viscum album efficiencies in the treatment of avascular necrosis of the femoral head: An experimental animal study.

The aim of our study is to compare the efficacy of epoprostenol and viscum album in the treatment of femoral head avascular necrosis with an experimental study. Our hypothesis is that viscum album, which has similar properties to epoprostenol on the vascular system, is as effective as epoprostenol in the treatment of avascular necrosis. Avascular necrosis was created on the femoral heads of 45 New Zealand type rabbits by surgical vascular deprivation method. The rabbits were divided into 3 groups. Group 1 was designed as a control group, in group 2 Ilomedin (epoprostenol analogue) was administrated to subjects and in group 3, Helixor (viscum album extract) was administrated. At the end of the study, there were nine subjects in each group. Osteocyte necrosis, bone marrow necrosis, new bone formation and cartilage degeneration were evaluated microscopically. The extent of bone necrosis and repair and involvement of epiphysis, the bone marrow cellularity ratio and trabecular bone volume were investigated. Subchondral necrosis was seen in more animals in the control group (p=0.03). Osteoblastic and osteoclastic activity were more prominent in the Ilomedin group (p=0.25 and 0.07, respectively). It was seen that the cartilages of the subjects in the Helixor and Ilomedin groups were less damaged. In the Ilomedin group, more animals were seen in the chronic phase of the repair process than in the other groups (p=0.07). Bone marrow cellularity was higher in treatment groups (22% and 20,6% for Ilomedin and Helixor, respectively, p=0,04). Trabecular volume was found to be increased in damaged femoral heads in the treatment groups, the highest increased observed in the Helixor group (p=0.01). Viscum album seems to be effective in decreasing the extention of necrosis and protecting the articular cartilage, and epoprostenol in increasing repair and regeneration.

Ayurveda in the Management of Avascular Necrosis of Femoral Head - A Case Report

Avascular necrosis (AVN) is defined as cellular death of bone components due to interruption of the blood supply. The bone structures then collapse, resulting in pain, loss of joint function and long-term joint damage. Treatment goals for AVN are to improve the joint, stop the bone damage, and ease pain. In modern science treatment includes NSAIDS, core decompression, bone grafting and total joint arthroplasty which have their own complications, high cost and prognosis is also very poor. In Ayurveda it can be correlated to the Asthi-Majja gatha vata. In this Raktavaha Srotorodha also occur which results in Asthi Dhatu Kshaya. Aim of study is to introduce an alternative therapeutic modality through Ayurveda which help to reduce pain, improve quality of life and prevent further damage of bone which is cost effective as well. The present case report is a single case study of a 32year old female patient who was diagnosed with Stage Ⅱ Avascular Necrosis of bilateral femoral head done at Government Ayurveda College Panchakarma Hospital, Poojappura, Thiruvananthapuram. She was treated with selected Panchakarma treatments and specific Samana oushadhis. There was significant improvement in the symptoms which was assessed using relevant tools like VAS score for pain, goniometer for range of movement and Oxford Hip score for assessment of function and pain in hip. The present case study documents that Panchakarma procedures and Samana oushadhis can be effective in AVN and improve the quality of life of patient.

Adipose Derived Stem Cells in Orthopaedics: History and Current Applications

Context: Some studies have shown promising results with adipose-derived stem cell treatments for orthopaedic problems as a nonsurgical treatment option or an augmentation of surgical treatment. Purpose: Review of the history and background, preparation methods, and current applications of adipose-derived stem cells in orthopedics. Provide critical appraisal of the available evidence for the use of Adipose Derived Stem Cells. Results: Most of the studies utilizing adipose-derived stem cells are case series or meta-analyses with a small number of studies, therefore presenting a risk of selection bias. In cases of femoral head avascular necrosis and meniscal repair, no systematic review or meta-analysis has been published and available evidence is derived from smaller studies. Almost every review article concluded that large, multicenter, randomized control trials are needed to establish the value of adipose-derived stem cells in orthopaedics. Conclusion: There is a need in orthopaedics for treatment modalities that increase biological healing potential for some pathologies and adipose derived stem cells represent a potential modality for such a purpose. However, there is a lack of high quality and robust evidence regarding the efficacy and safety of this treatment modality in orthopaedic applications. The use of adipose derived stem cells in orthopaedics requires additional studies of higher quality before they can be considered an appropriate treatment option. Strength of Recommendation: Level C for use of Adipose-derived stem cells in orthopaedics.

Fabricating patient-specific 3D printed drill guides to treat femoral head avascular necrosis

BackgroundFemoral head avascular necrosis (AVN), or death of femoral head tissue due to a lack of blood supply, is a leading cause of total hip replacement for non-geriatric patients. Core decompression (CD) is an effective treatment to re-establish blood flow for patients with AVN. Techniques aimed at improving its efficacy are an area of active research. We propose the use of 3D printed drill guides to accurately guide therapeutic devices for CD.MethodsUsing femur sawbones, image processing software, and 3D modeling software, we created a custom-built device with pre-determined drill trajectories and tested the feasibility of the 3D printed drill guides for CD. A fellowship trained orthopedic surgeon used the drill guide to position an 8 ga, 230 mm long decompression device in the three synthetic femurs. CT scans were taken of the sawbones with the drill guide and decompression device. CT scans were processed in the 3D modeling software. Descriptive statistics measuring the angular and needle-tip deviation were compared to the original virtually planned model.ResultsCompared to the original 3D model, the trials had a mean displacement of 1.440 ± 1.03 mm and a mean angle deviation of 1.093 ± 0.749º.ConclusionsThe drill guides were demonstrated to accurately guide the decompression device along its predetermined drill trajectory. Accuracy was assessed by comparing values to literature-reported values and considered AVN lesion size. This study demonstrates the potential use of 3D printing technology to improve the efficacy of CD techniques.

The efficacy of gradual reduction using two-stage traction for developmental dysplasia of the hip in southern China.

This study aimed to report the preliminary outcome of gradual reduction (GR) utilizing two-stage traction (TST) compared with traditional traction (TT) in the treatment of developmental dysplasia of the hip (DDH) and to evaluate whether the prognosis of the TST is better than that of TT. The following information on children diagnosed with DDH who underwent treatment with GR using two-stage traction or traditional traction between June 2016 and August 2017 was collected: sex, age, weight, acetabular index (AI), International Hip Dysplasia Institute (IHDI) classification, femoral head ossification, traction time, reduction quality, and labrum shape in arthrography. The AI, IHDI classification, second operation rate, and incidence of femoral head avascular necrosis (AVN) were analyzed after the final comprehensive 1-year follow-up. In this study, 27 cases (31 hips: 18 left and 13 right) were enrolled, with 18 hips (16 cases) assigned to the TT group and 13 hips (11 cases) assigned to the TST group, with the corresponding average age at diagnosis of 5.56 ± 1.66 and 4.06 ± 1 months (p < 0.001). For both TT and TST groups, the average age at operation was 6.01 ± 1.67 and 65 ± 0.86 months (p = 0.435), the distribution of affected left and right sides was 10/8 and 8/5 hips (p = 1), and the average initial AI was 37.11 ± 3.26 and 36.77 ± 4.34 (p = 0.804), respectively. IHDI classification III/IV was observed in 15/3 and 11/2 hips, respectively (p = 1). Femoral head ossification was present in 6/18 hips in the TT group and 2/13 hips in the TT group (p = 0.412). The total traction time was 13.22 ± 2.6 days for the TT group and 49.23 ± 25.77 days for the TST group (p < 0.001). After GR, IHDI classification III/IV was observed in 9/9 and 12/1 hips, respectively (p = 0.02). AVN was present in 5/18 hips in the TT group and 0/13 hips in the TST group (p = 0.048), while the need for a second operation was approved in 5/18 hips in the TT group and 1/13 hips in the TST group (p = 0.359) at the final follow-up. Two-stage traction can significantly decrease the ratios of IHDI classifications III and IV and the incidence of AVN compared to traditional traction; also, it significantly reduces the total traction time.

MRI spectrum of avascular necrosis of femoral head in patients treated for COVID-19.

This prospective observational study aimed to investigate the occurrence of avascular necrosis (AVN) of the femoral head in COVID-19 patients through MRI scans. The study examined the patterns of AVN in 110 individuals who had undergone conventional COVID-19 therapy and reported hip discomfort. This study highlights the importance of considering AVN as a potential complication of COVID-19 therapy, particularly in younger patients who experience hip discomfort. Individuals who had corticosteroid treatment for COVID-19 and experienced hip discomfort during 6 months between January 2022 and August 2022 were included in this study, and an MRI scan was done to observe changes in the hip joint. The results were classified using the Ficat and Arlet classification system. The analysis revealed that AVN was not present in 91.81% of cases. However, Stage I AVN was detected in 4.54% of cases, Stage II AVN in 2.72% of cases, and Stage III AVN in 1.1% of cases. No cases of Stage IV AVN were observed. The study concludes that AVN occurred in 6% of individuals who underwent conventional therapy for COVID-19 and experienced hip discomfort. In these settings (post COVID-19), normal MRI results were more typical, and mild AVN (Stage I) was a frequent finding in MRI scans that were positive.

Using Computed Tomography-Based Three-dimensional Modeling and Computer Navigation for Minimally Invasive Core Decompression and Adjuvant Orthobiologic Therapy of Femoral Head Avascular Necrosis

Avascular necrosis of the femoral head is a debilitating condition that can lead to femoral head collapse. Core decompression with adjuvant cellular therapies, such as bone marrow aspirate concentrate, delays disease progression and improves outcomes. However, inconsistent results in the literature may be due to limitations in surgical technique and difficulty in targeting the necrotic lesions. Here, we present a surgical technique utilizing computed tomography-based three-dimensional modeling and instrument tracking to guide the therapy to the center of the lesion. This method minimizes the number of attempts to reach the lesion and confirms the three-dimensional positioning of the instrumentation within the lesion. Our technique may improve the outcomes of core decompression and adjuvant therapy and prevent or delay hip collapse in patients with femoral head avascular necrosis.

Single-Center Experience of Surgical Treatment of Subjects with Late-Presenting Developmental Dysplasia of the Hip

Aim: This study aimed to delineate the single-center experience surrounding the long-term consequences of surgical reconstruction in subjects with late-presenting DDH (developmental dysplasia of the hip). Methods: We analyzed 23 hips of 21 subjects aged &amp;gt;6 years who underwent surgical interventions, such as pelvic osteotomy, open reduction, femoral shortening, and derotation, for developmental hip dysplasia. Results: After a median follow-up of 23.34 (8–120) months, there were no noteworthy alterations in the Harris score and anteversion. Nevertheless, significant improvements were observed in SHARP, CE angle, and depth and width index over the follow-up duration. Using Sever’s radiological criteria, 87.1% of subjects achieved excellent and good results. Assessment of femoral head avascular necrosis, based on Bucholz and Ogden’s classification, produced the subsequent findings: 52% of hips were Type I; 13% were Type II; 22% were Type III; and 13% were categorized as Type IV. Conclusion: Despite achieving favorable postoperative radiological outcomes, there's a noticeable decline in clinical success in these subjects, especially as their age increases. Additionally, they face an elevated risk of avascular necrosis. The juxtaposition of a 75% radiological success rate with a 50% clinical success rate accentuates this contrast. Crucially, the success rate of surgical corrections in late-presenting DDH is tied to the age of the patient, with the success rate decreasing as age progresses.

Open reduction after failed closed reduction following failed Pavlik harness treatment in developmental dysplasia of the hip: One- or two-stage?

The current published evidence for the treatment of developmental dysplasia of the hip (DDH) with failed closed reduction (CR) following failed Pavlik harness (PH) treatment is still limited. This study aimed to determine whether an one-stage open reduction (OR) would lead to a similar outcome to a two-stage OR in these patients. Meanwhile, the occurrence of femoral head avascular necrosis (AVN) and further surgery (pelvic osteotomy, PO) within the follow-up period was investigated. A consecutive series of DDH patients who failed CR following failed PH treatment and received OR finally between January 2008 and December 2020 were studied. The patients were divided into two groups. One group of which received OR immediately after failed CR (one-stage OR group, Group A), and the other received a delayed OR (two-stage OR group, Group B). The McKay's criteria, acetabular index (AI) and the degree of dislocation of the hips were evaluated for the final outcomes. At the last follow-up, 54 (84.4%) of the 64 hips in Group A and 26 (83.9%) of 31 hips in Group B were in excellent or good condition. Comparison between the two groups revealed that there were no differences in terms of McKay grading (P = 0.950), AI (P = 0.783), incidence of AVN (P = 0.745), and also incidence of PO (P = 1.000). However, a significant lower mean AI was found in Group A, when the OR was performed in Group B (31.06 ± 4.45° vs. 33.87 ± 4.12°, P = 0.004). Both of the one- and two-stage OR may acheive favorable outcomes. Moreover, one-stage OR is of without the general anesthesia risk associated with two-stage OR. We therefore advocate that an OR should be performed in appropriate DDH patients during the same session once a failed CR is detected.

A Case Report on Avascular Necrosis of Right Femoral Head in a 20-years Old Male

Avascular necrosis of the femoral head is a condition which causes cellular destruction of bone material due to interruption of blood supply. Necrosis is caused by inadequate blood supply, resulting in bone tissue destruction with collapsing of that segment. The disease usually occurs in young adults, and femoral head is one of the commonest sites. Avascular necrosis may be traumatic or non-traumatic and causes major musculoskeletal disability. Initially patients remain asymptomatic. In untreated cases the disease progresses and causes joint destruction, requiring surgical intervention and in later stages need total hip replacement. Plain X-ray, isotope bone scan and magnetic resonance imaging (MRI) play important role in making the diagnosis. MRI is highly accurate method for the diagnosis of avascular necrosis of the femoral head.

Autological bone marrow concentrate for the treatment of early stages of femoral head avascular necrosis (literature review)

Relevance. In the treatment of the early stages of the femoral head osteonecrosis core decompression is widely used, which reduces intraosseous pressure and increases blood flow to the femoral head. To increase the efficiency of the core decompression the use of various bioadjuvants, including concentrate of autologous bone marrow cells is needed, the appropriateness of which is actively discussed.Purpose of the systematic review: evaluation of the effectiveness of autologous bone marrow cells in core decompression in the treatment of the early stages of the femoral head osteonecrosis according to the literature.Material and methods. Articles with clinical data in full text in English or Russian available in the Internet (PubMed and elibrary databases) were included in the study. Articles containing actual data on the stage of osteonecrosis, the number of femoral heads operated on, the use of autologous bone marrow cells as an adjunct to the core decompression of the femoral head, the number of ineffective surgical interventions after which total hip arthroplasty was required were included.Results. Sixteen original articles (2011–2022) were analyzed, and the results of 1135 femoral heads treatment (892 with autologous bone marrow cells, 243 without autologous bone marrow cells, control group) were evaluated. Patient follow-up periods ranged from 9 to 120 months, averaging 45 months. When using autologous bone marrow cells, the need for total hip arthroplasty was observed in 168 of 892 patients (18.8 %); when core decompression was used without autologous bone marrow cells, the rate of total hip arthroplasty was 27.2 % (p &gt; 0.05). Only 2 articles out of 16 authors did not consider autologous bone marrow cells to be reasonable in the core decompression of femoral head.Conclusion. The use of autologous bone marrow cells concentrate as a bioadjuvant in the core decompression slows the progression of osteonecrosis. According to the overwhelming number of authors, the core decompression using autologous bone marrow cells is highly effective, significantly reducing the intensity of pain syndrome and improving the function of the hip joint. The results will be more encouraging with the further development of regenerative medicine, which will provide new samples of cellular preparations for bone tissue structure restoration.

3D printing-assisted total hip arthroplasty and internal fixation for the treatment of fresh acetabular fracture and femoral head necrosis: A case report

Rationale: Posterior wall comminuted fractures of the acetabulum are typically caused by high-energy trauma, and the complex anatomical structure of the acetabulum makes their treatment challenging. However, reports of the treatment of fresh acetabular fractures combined with femoral head necrosis are extremely rare. Patient concerns: A 57-year-old male, injured in a car accident, presented with right hip pain and limited mobility. At the age of 50, the patient was diagnosed with avascular necrosis of the right femoral head, experiencing right hip pain and a limp while walking, for which conservative treatment was initiated. Diagnosis: The patient was clinically diagnosed with fresh comminuted posterior wall acetabular fracture and late-stage femoral head necrosis. Interventions: We applied 3D printing technology and computer-assisted virtual surgical techniques for preoperative planning, simulated fracture reduction, and designed personalized bone plates and screws for fixation of the posterior wall of the acetabulum. A single-stage total hip arthroplasty was performed to treat femoral head necrosis. Outcomes: He began walking with the assistance of a walker 1 month after surgery, and at 6 months post-surgery, the acetabular posterior wall fracture had effectively healed, allowing the patient to return to work. Lessons: The application of 3D printing technology in acetabular internal fixation and total hip arthroplasty is helpful for fracture assessment, facilitates smooth surgery, promotes fracture reduction and healing, restores hip joint function, and ensures a high level of safety.

Long-Term Results in the Treatment of Avascular Necrosis of Femoral Head with Free Vascularized Fibular Graft

Objective: to evaluate outcomes of vascularized fibula flap used for Avascular necrosis of femoral head. Outcomes were recorded by post-operative Harris hip and radiological improvement of the femoral head. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2019 to Jan 2020. Methodology: Cases were recruited from 2005-2018 (SIH) performed by the same Orthopaedic and Plastic Surgeon. Data from 30 patients was reviewed. Ethical approval and consent of the patient were taken before the utilization of their data. Results: A total of 30 patients were included, comprising 27(90%) males and 3(10%) females. The mean age was 28.3± years. Pre-operative Harris Hip scores were fair in 17(56.7%) and poor in 13(43.3%) patients. Post operatively these scores improvedv and were noted to be excellent in 10(33.3%), good in 18(60%) and fair in 2(6,7%) patients. Radiological improvement was seen in 20(80%) patients, 8(23.3%) showed no change and 2(6.7%) went into progression. The radiological improvement was significantly associated with aetiology (p=0.004) and Avascular necrosis of HIP (p=0.007). Conclusion: A vascularized fibular graft is an effective treatment option for avascular necrosis of the femoral head in terms of improved radiological outcomes and post-operative Harris Hip scores.

A Successful Management of Ankylosing Spondylitis with Avascular Necrosis Through Ayurveda

This case report aimed to reveal an Ayurvedic approach to a atypical case of Ankylosing Spondylitis with bilateral avascular necrosis of femoral head. Ankylosing Spondylitis (AS) is a condition posing major challenge to health care system.&#x0D; A 29-year-old male subject was diagnosed with ankylosing spondylitis and avascular necrosis of bilateral femur head. By the clinical presentation and thorough Ayurvedic examinations of the subject the case was diagnosed as Gambheera Vatarakta with Asthisoushirya. The case was successfully managed with both Shodhana and Shamana Upacharas according to Ayurveda i.e., for Asthisoushirya, Khara Abhishyandi Snigdha Gunayukta Dravya Prayogam, Asthi Poshakam, Ghrita or Ksheera processed with Tikta Rasa and Vataraktahara Chikitsa, Ama Pachana, Rakta Prasadana, Sneha Virechana and Basti for Gambheera Vatarakta was followed and significant prognosis was achieved.

Total hip replacement among sickle cell patients in alow-income country-Yemen.

Sickle cell patients presented with progressive hip pain and limitation of daily activities, as evidenced by low preoperative hip scores and failed conservative therapy. Management of femoral head avascular necrosis (AVN) using total hip replacement (THR) in sickle cell disease (SCD) is widespread in developed countries, but it is still in its initiation stage in developing countries. The outcome of using cementless THR among SCD patients is still unknown with lack of published studies from regional countries. This study aimed to evaluate the outcome of using cementless primary THR among patients with sickle cell disease with end-stage hip avascular necrosis in Yemen. Thirty cementless primary total hip arthroplasty (THA) were performed for AVN of the femoral head in 27 sickle cell patients, at Al.-Thawra Modern General Hospital-Sana'a, Yemen, from January 2018 to December 2022. The mean age of the patients was 27 ± fiveyears (ranged 18-37years) with a male to female ratio was 3:1. Steinberg staging for hip AVN was stage IV, one patient (3%); stage VI, thirteen patients (45%); and stage V, sixteen patients (51%). THR was on right side 14 (52%), left side 10 (37%), and bilateral 3 (11%). The implant used was ceramic on polyethylene acetabular liner. All patients showed improvement in Harris hip score from preoperative mean hip score was 25 ± 8 points to postoperative mean hip score was 88 ± 6 points at the last follow-up. Mean of the length of stay in hospital was 12.7 ± eightdays (ranged from 4 to 32days); the mean operating time was 107 ± 23min. Three cases had superficial wound infection; four patients had five intraoperative fractures; two cases had pulmonary complications; one case had abdominal crisis. All patients had postoperative leg length discrepancy less than 2cm. None had deep infection, nerve injury, wound hematoma, aseptic loosing, dislocation, DVT, heterotopic ossification, or death. THR in SCD has a good outcome using cementless THA with a low rate of complication in Yemen, a developing country.

The McMaster osteotomy-a novel surgical treatment to chronic slipped capital femoral epiphysis: description ofsurgical technique andcase study.

Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder that can lead to complex proximal femur deformities and devastating consequences such as avascular necrosis, femoroacetabular impingement syndrome and early-onset osteoarthritis. Existing surgical techniques are often insufficient to fully address the constellation of multiplanar deformities in patients with severe SCFE. Therefore, the McMaster Osteotomy, a novel intertrochanteric proximal femur osteotomy, was developed to improve anatomic correction and hip mechanics in patients with chronic SCFE. The McMaster Osteotomy was implemented in two patients (A: 16-year-old male, B: 17-year-old female) with proximal femur deformities due to chronic SCFE. Surgical planning was facilitated with a 3D-printed pelvic model generated from a CT scan of a patient with the SCFE deformity. Patient B also underwent concurrent arthroscopic osteochondroplasty and labral repair. Pre- and post-operative function and radiographic measurements were recorded. Post-operatively, patient A's neck-shaft angle improved from 125° to 136°, Southwick angle from 52° to 33°, neck length from 66 mm to 80 mm and hip internal rotation from 5° to 25°. Patient B's post-operative neck-shaft angle improved from 122° to 136°, Southwick angle from 25° to 15°, neck length from 76 mm to 84 mm, hip internal rotation from 5° to 20° and alpha angle from 87.6° to 44.3°. Both patients are pain-free and have obtained full union of their osteotomies. The McMaster Osteotomy is a versatile technique that can produce a more anatomic reconstruction of hip anatomy and restoration of abductor mechanics. As an extracapsular technique, the risk of femoral head avascular necrosis is minimized.