Avascular Osteonecrosis Research Articles

Hypopituitarism and Legg-Calve-Perthes disease related to difficult delivery.

Legg-Calve-Perthes (LCP) disease is characterized by idiopathic avascular osteonecrosis of the epiphysis of the femur head. The main factor that plays a role in the etiology of the disease is decreased blood flow to the epiphysis. Many predisposing factors have been suggested in the etiology of LCP disease, and most have varying degrees of effects. Here we present the case of a boy aged 4 years and 10 months with complaints of short stature and a diagnosis of multiple hypophyseal hormone deficiency, in whom LCP disease and difficult birth-related pituitary stalk interruption syndrome were identified by anamnesis. The present case revealed that LCP disease and hypophyseal hormone deficiency could be secondary to difficult birth and that LCP disease could be secondary to insulin-like growth factor 1 deficiency. Additionally, to the best of our knowledge there is no published case on the relation between LCP disease and insulin-like growth factor 1 deficiency. Therefore, we believe that this case is worthy of presentation.

Hypoxia-inducible factor prolyl hydroxylase inhibitor prevents steroid-associated osteonecrosis of the femoral head in rabbits by promoting angiogenesis and inhibiting apoptosis.

The purpose of this study was to investigate the preventive effect of ethyl 3,4-dihydroxybenzoate(EDHB) on steroid-associated femoral head osteonecrosis(ONFH) in a rabbit model. New Zealand white rabbits were randomly divided into two groups (prevention group and model group), each containing 24 rabbits. Osteonecrosis was induced by lipopolysaccharide(LPS) combined with methylprednisolone(MPS). The prevention group received an intraperitoneal injection of EDHB at 50 mg/kg body weight every other day starting three days before establishing rabbit models of osteonecrosis, for a total of nine doses. Osteonecrosis was verified by haematoxylin-eosin (HE) staining. The expression of HIF-1α and VEGF was analyzed by immunohistochemistry. Angiogenesis, apoptosis and microstructural parameters were also analyzed. The rabbit models of osteonecrosis were successfully established and observed by HE staining. Histopathological observations indicated that EDHB reduced the rate of empty lacunae and the incidence of osteonecrosis. Immunohistochemical staining for HIF-1α and VEGF suggested that EDHB therapy inhibited degradation of HIF-1α and promoted expression of VEGF. Ink artery infusion angiography and microvessel density analysis revealed that there were more microvessels in the prevention group than in the model group. The TUNEL apoptosis assay suggested that EDHB intervention could reduce the number of apoptotic cells in avascular osteonecrosis of the femoral head. Micro-CT scanning indicated that the treatment group had better microstructural parameters than the model group. EDHB prevents steroid-associated osteonecrosis of the femoral head in rabbits by promoting angiogenesis and inhibiting apoptosis of bone cells and hematopoietic tissue.

Considerações da Implantologia sobre a osteonecrose dos maxilares potencializada pela terapia com bisfosfonatos

Traumatic lesions or surgical interventions, such as: exodontics or the implants placement, promote infection of the necrotic area with microorganisms present in the oral cavity. In spite of lower statistically incidence, the osteonecrosis potentiated by bisphosphonates constitutes alteration of high morbidity, causing drastic decrease of comfort and quality of life for the patients with committed immunity. The objective of this work is to do a review about the pharmacological bisphosphonates action in patients rehabilitated with implants and the aetiology of failures induced by avascular osteonecrosis of the jaws.

Avascular osteonecrosis mechanism – between osteoporosis and antiphospholipid syndrome

HIV infected patients receiving antiretroviral therapy (ART) can develop avascular osteonecrosis, 45 times greater than the general population. Avascular osteonecrosis increased in the last few years in patients with HIV infection. The most important mechanisms for avascular osteonecrosis in HIV-infected patients are: changes in bone metabolism, especially osteoporosis correlated with protease inhibitors and coagulopathy and antiphospholipid syndrome, frequently described in HIV infection. Aim: to describe different mechanisms of avascular osteonecrosis We present two HIV-infected patients under antiretroviral therapy who developed avascular osteonecrosis. First patient, male, 38 year-old, with AIDS-C3, with good immuno-virological outcome under AZT-3TC and lopinavir/ritonavir, developed severe osteoporosis after 5 years of ART, diagnosed by DXA test with a T-score <-2,5. The patient had: C4-C5-C6 severe osteoporosis with high fracture risk, with segmental instrumentation applied at those levels, and then bilateral avascular necrosis of femoral head (ANFH) with bilateral hip arthroplasty. ART regimen was changed and the patient received 3TC-ABC and Nevirapine. The patient didn’t have other risk factors for avascular osteonecrosis or osteoporosis: nonsmoker, normal CD4, undetectable viral load, without dyslipidemia. Despite ART changes, the patient developed bilateral osteonecrosis of the right knee and of both humeral heads. The second patient, male, 23 year-old with HIV-B3, was treated in 2007 with AZT-3TC and lopinavir/ritonavir. After 9 months of ART the patient had normal CD4 count and undetectable viral load but developed right ANFH stage II, diagnosed by MRI, without surgery recommendation. DXA didn’t show signs of osteoporosis or osteopenia. The ART regimen was changed and the patient received 3TC-ABC and raltegravir with good ANFH outcome. After one year the patient discontinued the ART. One year later symptoms related with avascular osteonecrosis reappeared and bilateral ANFH was diagnosed by MRI. The patient had low CD4 count (<200/cmm), high HIV viral load and positive antiphospholipid antibodies. The patient had risk factors for coagulopathies: smoker, recreational drug user, alcohol consumer, uncontrolled HIV infection with low CD4. We restarted the same regimen with 3TC-ABC and raltegravir with a good outcome for bone affliction. When HIV infection was well-controlled, the antiphospholipid antibodies became negative and bone affliction was improved. We emphasize the importance of metabolic disturbances in HIV-infected patients, among them avascular osteonecrosis with different mechanisms. Both, ART and uncontrolled HIV infection can affect bone metabolism and vascularization.

Corticosteroid administration within 2 weeks after renal transplantation affects the incidence of femoral head osteonecrosis

Background and purpose — It has been suggested that avascular osteonecrosis (AVN) of the femoral head occurs early after systemic steroid administration. The purpose of this study was to investigate the risks regarding development of AVN at a very early stage after renal transplantation.Methods — The presence or absence of AVN was determined by MRI at 4 weeks, at 6–12 weeks, at 24 weeks, and at 12 months after renal transplantation in 286 patients (183 males) with a mean age of 39 (16–65) years. The relationship between AVN and age, sex, absence or presence of acute rejection (AR), type of transplanted kidney (living or cadaveric), type of immune suppressor, and total dose of orally administered steroids given in the 2-week period after transplantation was investigated.Results — There were no statistically significant correlations between the development of AVN and age, sex, absence or presence of AR, type of transplanted kidney, or type of immune suppressor. A significant dose-response relationship was found between development of AVN and the total dose of steroid administered in the first 2 weeks after surgery.Interpretation — We found a relationship between AVN development and steroid dose in the early postoperative period, and we also showed a dose-response relationship.

Glucocorticoids and irreversible damage in patients with systemic lupus erythematosus

The aim of this study was to analyse the relationship between glucocorticoids and damage accrual in SLE. We report an observational cohort study including 230 patients with SLE enrolled at diagnosis with 5 years of follow-up. Damage was calculated using the SLICC damage index. Glucocorticoid-related damage was defined as avascular osteonecrosis, osteoporotic fractures, diabetes mellitus or cataracts. Prednisone doses were calculated at the end of the fourth year of follow-up (prednisone-4). A categorical prednisone-4 variable was constructed: no prednisone, ≤7.5 mg/day (low dose), >7.5 mg/day (medium-high dose). The relationship between methylprednisolone pulses and damage was also tested. By the fifth year, 188 patients (82%) had been treated with prednisone. Eighty-seven patients (37.8%) had accrued damage at 5 years. Patients with damage at year 5 had received a higher mean daily prednisone-4 dose (10.4 vs 6 mg/day, P < 0.001). The mean daily prednisone-4 dose was higher in patients accruing glucocorticoid-attributable damage (11 vs 7 mg/day, P = 0.04). Patients taking medium-high doses of prednisone-4 had a higher risk of accruing damage than those taking no prednisone [adjusted odds ratio (OR) 5.39, 95% CI 1.59, 18.27]. Patients taking medium-high doses of prednisone-4 were more likely to develop glucocorticoid-related damage than those on no prednisone (adjusted OR 9.9, 95% CI 1.1, 84). No differences were seen between patients on low doses and those on no prednisone. The cumulative dose of i.v. methylprednisolone-4 was not associated with global or glucocorticoid-related damage. Prednisone causes damage in SLE. Doses <7.5 mg/day and methylprednisolone pulses are not associated with damage accrual.

Effectiveness of extracorporeal shock wave therapy in bone marrow edema syndrome of the hip

There is no gold standard for treatment of bone marrow edema syndrome of the hip (BMESH). Usually, treatment is conservative, owing to the favorable and self limiting prognosis. In musculoskeletal disorders, the effectiveness of extracorporeal shock wave therapy (ESWT) has been widely recognized and recent research supports its use in the treatment of the first stages of avascular osteonecrosis of the proximal femur and in other conditions where bone marrow edema is present. On this basis, we performed a prospective study to evaluate the effectiveness of ESWT in normalizing the symptoms and imaging features of BMESH. Twenty consecutive symptomatic patients underwent two treatments of high-energy ESWT and were followed-up at 2, 3 and 6 months, with a final clinical follow-up at mean 15.52 ± 1.91 months. Patients underwent magnetic resonance imaging of the hip and were evaluated according to the Harris hip score. The mean improvement in HHS over the course of the study was of 58.5 ± 14.9 points (p < 0.0001), and the mean edema area reduced from 981.9 ± 453.2 mm(2) pre-treatment to 107.8 ± 248.1 mm(2) at 6 months. ESWT seems to be a powerful, non-pharmacological tool that produces rapid pain relief and functional improvement and aids the normalization of the vascular and metabolic impairments which characterize BMESH.

ПРОФИЛАКТИКА ДЕГЕНЕРАТИВНЫХ ЗАБОЛЕВАНИЙ ВИСОЧНО- НИЖНЕЧЕЛЮСТНОГО СУСТАВА

&lt;p&gt;Degenerative disease of the joints (osteoarthrosis, avascular osteonecrosis, osteochondritis dissecans, entesopathy) are characterized by a violation of the metabolism and irreversible necrobiotic changes of connective tissue. To slow the progression of degenerative diseases require a complex course of treatment, follow-up, prevention. Primary prevention includes gymnastics lessons from adolescence. Secondary prevention aims to limit the load on the temporomandibular joint (TMJ), maintenance of motor activity throughout life, correction of biome- chanics joint exception injury to the joint.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Evidence for using alendronate to treat adult avascular necrosis of the femoral head: a systematic review.

Osteonecrosis or avascular osteonecrosis (AVN) of the femoral head is a devastating multifactorial disease that affects 20 000 persons each year in the United States. The purpose of this systematic review was to determine the efficacy and safety of alendronate for adult AVN during short- and long-term follow-up. Electronic databases were searched for randomized or nonrandomized clinical trials, cohort, case-control studies, and series of cases in which alendronate was used for treatment of adult AVN of the femoral head. Relevant articles with adequate data on reduction of pain, improvement of articular function, slowing of bone collapse progression, or need for total hip arthroplasty (THA) were included after applying inclusion and exclusion criteria. Eight articles involving 788 hips with evidence level 1b to 3b were included in this systematic review. Most studies suggested a positive short-term efficacy of alendronate treatment in reducing pain, improving articular function, slowing of bone collapse progression, and delaying the need for THA for adult AVN patients. The favorable long-term results were also presented in those treated patients after 10-year follow-up. In addition, there were no severe adverse effects associated with alendronate treatment observed during short- and long-term follow-up, and most of the included studies suggested use of alendronate in early AVN with small necrotic lesion to achieve better outcomes. The findings support consideration of alendronate use for adult AVN, particularly with early stage and small necrotic size. The lack of large-scale, randomized, and double-blind studies justifies new studies to demonstrate the detailed indication and the optimized strategy of alendronate treatment. Level of evidence: Level 3a.

Percutaneous radio frequency ablation for relief of pain in a patient of hip joint avascular necrosis

Avascular osteonecrosis (AVN) of the femoral head is one of the most common skeletal complications of kidney transplantation. Patients with hip joint avascular necrosis usually undergo joint arthroplasty. However, if a patient is unfit for surgery due to some comorbidities, hip joint articular branches denervation can be done to control pain and improve functional life. There is a large variation in the contribution as well in the position of the articular branches to hip joint by obturator, femoral, and sciatic nerves. Several authors have proposed percutaneous radio frequency denervation of the hip joint to eliminate pain.In our case, the patient was having an intractable hip joint pain which was not responding to conservative drug therapy as well physiotherapy. In our patient, hip arthroplasty was contraindicated because of the high risk of infection and anticoagulants. After diagnostic block, the pain in his groin and hip disappeared immediately. The patient noted a decrease in pain (Visual Analog Scale, VAS 9-10 to 1-2) and an improvement in the ability to walk. Then we performed percutaneous radio frequency ablation of the articular branches of the obturator nerve and the femoral nerve. Nerve blocks were performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. Because optimal coagulation requires electrodes to lie parallel to the nerves, a perpendicular approach probably produced only a minimal lesion. A perpendicular approach is likely to puncture femoral vessels. Vessel puncture can be avoided if an oblique pass is used. The patient had improved ability to ambulate and the patient can carry out his daily routine activites at home without much pain and can sleep comfortably. There were no complications like motor deficit, neuritis, bleeding, or infection. Our case report gives few impressions. First, it shows that if radio contrast agent (omnipaque dye) use is restricted or contraindicated, a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve and articular branch of femoral nerve. Second, it confirms the radiological anatomy of articular branches of hip joint. Third, oblique approach is safe and gives optimum lesion.

Scaphoid Waist Nonunions Treated with Illiac Crest or Vascularized Bone Grafts

We present the results of a retrospective study looking at postoperative outcomes of treatment of scaphoid nonunions following three different techniques: Palmar (nonvascularized) iliac crest, vascularized bone-grafts dorsal and palmar. The purpose is to present the consolidation rates and discover if range of motion, grip strength and pain differ using the different grafts. Methods: We evaluated 57 cases with a mean follow-up of 6.6 months. 24 patients had nonunion of the proximal scaphoid pole with avascular osteonecrosis. Operative technique were chosen based on the vascularity, location of non-union, previous operations, and pedicle availability. Conventional graft was used in 19 patients, palmar vascularized in 15 and dorsal vascularized graft in 23. We measured and compared clinical and radiological outcomes. Results: Out of 57 nonunions 46 united. No significant difference in rate of consolidation was found between the 3 treatment groups. Highest percentage of consolidation, 87%, was in patients treated with a palmar vascularized graft, whereas the consolidation rate of dorsal vascularized graft was 78% and of iliac crest graft 79%. Grip strength improved significantly. The most in iliac crest group (from 70% to 91%) and the least in dorsal vascularized graft group (from 81% to 83%). Best range of motion in flexion/-extension was in the iliac-crest group, although not being significantly. Average Mayo score was 82. 18 patients showed an excellent, 17 a good, 13 a satisfactory and 3 a poor result. No significant difference was found between the groups. Conclusion: Vascularized grafts had a comparable consolidation rate and outcome in Mayo score as the iliac crest group, even though these cases were more problematic due to the presence of avascular necrosis. Iliac crest grafts afforded the best results concerning grip strength and range of motion. The gain in grip strength and range of motion was less with vascularized grafts.

Efficacy of alendronate for preventing collapse of femoral head in adult patients with nontraumatic osteonecrosis.

The purpose of the current review was to determine the efficacy of alendronate for preventing collapse of femoral head in adult patients with nontraumatic avascular osteonecrosis of femoral head (ANFH). Five randomized controlled trials (RCTs) involving 305 hips were included in this review, of which 3 studies investigated alendronate versus control/placebo and the other 2 studies compared the combination of alendronate and extracorporeal shockwave therapy (ESWT) with ESWT alone. Our results suggested that even the patients with extensive necrosis encountered much less collapse in the alendronate group than control group. In these RCTs, their data also indicated a positive short- and middle-term efficacy of alendronate treatment in joint function improvement and hip pain diminishment. With the presence of the outlier study, only insignificant overall efficacy of alendronate could be observed with substantial heterogeneities. In addition, we did not find any additive benefits of alendronate in combination with ESWT for preventing collapse compared to ESWT alone. In conclusion, there is still lack of strong evidence for supporting application of alendronate in adult patients with nontraumatic ANFH, which justified that large scale, randomized, and double-blind studies should be developed to demonstrate the confirmed efficacies, detailed indication, and optimized strategy of alendronate treatment.

Avascular osteonecrosis of the hip in patient after adjuvant radiotherapy for rectal cancer

death of osteocytes and osteoblasts. AVN is encountered mostly among men in their 4 or 5 decade of life. The basic treatment for osteonecrosis is surgery, and the choice of procedure is based on preoperative staging. AVN is a very rare complication in radiotherapy (RT), but it presents an important clinical problem, still underestimated in oncological practice. Case report: This report documents an extensive symmetric avascular necrosis with acetabular protrusion and femoral head deformities in a 71-yearold woman with unresectable, poorly differentiated adenocarcinoma of the recto-sigmoid region, after therapeutic pelvic irradiation. The pelvic radiography, performed 24 months after the RT, due to bilateral hip pain, revealed advanced acetabular protrusions, with secondary deformities of both femoral heads. It is necessary to take into account the bone structures, among organs at risk (OAR), involved in irradiation fields. The detailed analysis of the dose distribution, and the use of collimators, allow a decrease in the total RT dose to OAR. Osteoradionecrosis risk awareness, early diagnosis, adequate management and prompt, appropriate treatment could probably protect patients against long-term morbidity.

Prostacyclin suppresses twist expression in the presence of indomethacin in bone marrow-derived mesenchymal stromal cells.

BackgroundIloprost, a stable prostacyclin I2 analogue, seems to have an osteoblast-protective potential, whereas indomethacin suppresses new bone formation. The aim of this study was to investigate human bone marrow stromal cell (BMSC) proliferation and differentiation towards the osteoblastic lineage by administration of indomethacin and/or iloprost.Material/MethodsHuman bone marrow cells were obtained from 3 different donors (A=26 yrs/m; B=25 yrs/f, C=35 yrs/m) via vacuum aspiration of the iliac crest followed by density gradient centrifugation and flow cytometry with defined antigens (CD105+/73+/45−/14−). The cells were seeded and incubated as follows: without additives (Group 0; donor A/B/C), with 10−7 M iloprost only (Group 0+ilo; A/B), with indomethacin only in concentrations of 10−6 M (Group 1, A), 10−5 M (Group 2, B), 10−4 M (Group 3, A/B), and together with 10−7 M iloprost (Groups 4–6, A/B/C). On Day 10 and 28, UV/Vis spectrometric and immunocytochemical assays (4 samples per group and donor) were performed to investigate cell proliferation (cell count measurement) and differentiation towards the osteoblastic lineage (CD34−, CD45−, CD105+, type 1 collagen (Col1), osteocalcin (OC), alkaline phosphatase (ALP), Runx2, Twist, specific ALP-activity).ResultsIndomethacin alone suppressed BMSC differentiation towards the osteoblastic lineage by downregulation of Runx2, Col1, and ALP. In combination with indomethacin, iloprost increased cell proliferation and differentiation and it completely suppressed Twist expression at Day 10 and 28. Iloprost alone did not promote cell proliferation, but moderately enhanced Runx2 and Twist expression. However, the proliferative effects and the specific ALP-activity varied donor-dependently.ConclusionsIloprost partially antagonized the suppressing effects of indomethacin on BMSC differentiation towards the osteoblast lineage. It enhanced the expression of Runx2 and, only in the presence of indomethacin, it completely suppressed Twist. Thus, in the treatment of avascular osteonecrosis or painful bone marrow edema, the undesirable effects of indomethacin might be counterbalanced by iloprost.

Association of gene variants in TLR4 and IL-6 genes with Perthes disease

Perthes disease is idiopathic avascular osteonecrosis of the hip in children, with unknown etiology. Inflammation is present during development of Perthes disease and it is known that this process influences bone remodeling. Since genetic studies related to inflammation have not been performed in Perthes disease so far, the aim of this study was to analyze the association of frequencies of genetic variants of immune response genes, toll-like receptor 4 (TLR4) and interleukin-6 (IL-6), with this disease. The study cohort consisted of 37 patients with Perthes disease and 50 healthy controls. Polymorphisms of well described inflammatory mediators: TLR4 (Asp299Gly, Thr39911e) and 11-6 (G-174C, G-597A) were determined by polymerase chain reaction restriction fragment length polymorphism method. Results IL-6 G-174C and G-597A polymorphisms were in complete linkage disequilibrium. A statistically significant increase of heterozygote subjects for IL-6 G-174C/G-597A was found in controls in comparison to Perthes patient group (p = 0.047, OR = 2.49, 95% CI = 1.00-6.21). Also, the patient group for IL-6 G-174C/G-597A polymorphisms was not in Hardy-Weinberg equilibrium. No statistically significant differences were found between patient and control groups for TLR4 analyzed polymorphisms. A stratified analysis by the age at disease onset also did not reveal any significant difference for all analyzed polymorphisms. Conclusion Our study revealed that heterozygote subjects for the IL-6 G-174C/G-597A polymorphisms were significantly overrepresented in the control group than in the Perthes patient group. Consequently, we concluded that children who are heterozygous for these polymorphisms have a lower chance of developing Perthes disease than carriers of both homozygote genotypes.

Systematic Evaluation Of Chronic Organ Damage In Adult Sickle Cell Patients. A Seven-Year Follow-Up Study

Introduction The occurrence of organ damage in sickle cell disease (SCD) is a crucial determinant for both medical treatment and prognosis. In a previous study, we systematically analyzed the prevalence of SCD related organ damage and complications in adult sickle cell patients in a tertiary teaching hospital in the Netherlands. We now describe a seven-year follow-up of this patient cohort, to provide an insight into the course of the various forms of organ damage and SCD related complications. Methods At baseline in 2006, 110 adult patients visiting the outpatient clinic of our hospital were enrolled. All enrolled patients from the primary analysis were included for follow-up. Patients were screened for sickle cell related manifestations during visits to the outpatient clinic biannually. Various forms of sickle cell related organ damage and complications (presence of microalbuminuria, renal failure, pulmonary hypertension retinopathy, iron overload, cholelithiasis, avascular osteonecrosis, leg ulcers, acute chest syndrome, stroke, priapism and admissions for painful crises) were routinely screened according to international guidelines. Patients with genotype HbSS/HbSβ0 and HbSC/HbSβ+were grouped for further analysis. Results Of all originally included patients (N=110), nine were lost to follow-up (N=9). The mean age of the current study cohort is 37 years (IQR 27-46). Overall, 59 patients (58%) developed a new form of organ damage or new complication since baseline analysis, including eight patients who deceased (7 due to a sickle cell disease related death). In the HbSS/HbSβ0 genotype group (N=60) we found an increase in the percentage of patients who have had an Acute Chest Syndrome (29% to 47%) or have been diagnosed with avascular osteonecrosis (15% to 24%), retinopathy (23% to 34%) or pulmonary hypertension (31% to 48%). In the HbSC/HbSβ+ (N=35) group we found an increase in the occurrence of avascular osteonecrosis (9% to 14%), retinopathy (59 % to 70%) and pulmonary hypertension (9% to 19%). Furthermore, the use of hydroxycarbamide increased in both genotype groups and the frequency of admissions for painful crises remained stable for both genotype groups. Conclusion In the past period of seven years 58% of the patients in a previously well descript cohort of adult SCD patients developed a new sickle cell related complication. For some forms of organ damage or complications a substantial increase occurred dependent of a patient’s genotype. Disclosures: No relevant conflicts of interest to declare.

Reliability and validity of the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) for patients with hip disease

BackgroundThe Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) was developed to evaluate the quality of life (QOL) in patients with hip disease. This questionnaire consists of three subscales: pain; movement; and mental. The purpose of this study was to assess the reliability and validity of the JHEQ for use as a clinical evaluation tool. MethodsWe investigated patients who visited the outpatient department at our hospital and affiliated hospital between April and May 2010. The study population comprised 286 patients (239 women) with a mean age of 56.8 years. The diagnosis was osteoarthritis of the hip in 230 patients, avascular osteonecrosis of the femoral head in 49 patients, and other conditions in 7 patients. The JHEQ questionnaire, the SF-36 questionnaire as a generic QOL scale, and the Oxford hip score (OHS) as a disease-specific scale, were filled out by the patient while waiting in the outpatient department. ResultsPearson’s correlation coefficients of 0.6 were observed between JHEQ pain and SF-36 bodily pain (BP) subscales, and between JHEQ movement and SF-36 physical functioning (PF) subscales. The JHEQ mental subscale correlated with SF-36 social functioning (SF) and BP subscales. A strong negative correlation was seen between JHEQ pain and OHS pain subscales (r=−0.817). JHEQ movement subscale also showed a strong negative correlation with the OHS function subscale (r=−0.715). These results indicated the convergent validity of JHEQ. The internal consistency of pain, movement, and mental subscales of JHEQ was satisfactory, indicated by Cronbach’s α coefficients of 0.92, 0.91, and 0.94, respectively. Each subscale also showed high test–retest reliability with intra-class correlation coefficients of 0.89, 0.93, and 0.85, respectively. ConclusionsWe determined the reliability and validity of JHEQ as a self-administered questionnaire that evaluates hip disease. JHEQ is useful as a tool for evaluating patients with hip disease.

Trabecular metal screw implanted for avascular necrosis of the femoral head may complicate subsequent arthroplasty surgery

A trabecular metal screw has been suggested to treat avascular osteonecrosis of the femoral head. Non-surgical management with partial weight bearing can only be selected for early stages and very small lesions. Even in such cases, it has been proven to be ineffective in 80-90 % of patients. Conversely, the results with trabecular metal implants are not always clinically satisfactory, and some patients can show emerging pain and activity limitations that could require conversion to a total hip arthroplasty. Hereby we report the results of 6 patients who underwent this implant and describe the histopathology of the bone at the femoral neck and to speculate on the causes of complications encountered during arthroplasty surgery. The necrosis was stopped in 1 case, and 5 hips showed disease progression. Two protrusions of the screw apex were observed. In one case, rupture of the greater trochanter during prosthesis implant occurred. After trabecular metal implants for avascular osteonecrosis, some patients can require conversion to a total hip arthroplasty. Two patients had an intraoperative fracture with detachment of the greater trochanter that required wiring. Complications related to implant removal can be encountered, and the orthopedic surgeon should be aware of removal techniques.

Elevated Level of Membrane Microparticles in the Disease of Steroid-Induced Vascular Osteonecrosis

As a common disease, osteonecrosis attracts more and more attention. In this paper, we investigated the relationship between the alterations of endothelial-derived and platelet-derived microparticles and the changes of coagulation and inflammation in the steroid-induced avascular osteonecrosis of femoral head using the rabbit model. We also explored the possible mechanism of the membrane particles associated with the development of the rabbit femoral head ischemic necrosis. With a 28-day continuous observation, the level of membrane microparticles was significantly heightened after methylprednisolone treatment. The coagulating and inflammatory factors also tended to increase. The data demonstrated that the levels of membrane microparticles had significantly individual differences, which meant the increased levels of membrane microparticles may be related to hypercoagulability, thrombosis, and inflammation in microcirculation and played an important role in steroid-induced osteonecrosis. It will be very useful and helpful to guide clinical trials.

AB1477-HPR The risk of developing avascular necrosis of the hip differs greatly among collagen vascular diseases requiring treatment with high-dose glucocorticoids

BackgroundAvascular necrosis (AVN) of the hip is still one of the most serious complications associated with high-dose glucocorticoids (HDGC) treatment [1]; however, it has yet to be sufficiently appreciated among...