Collapse Of Head Research Articles

POSSIBILITIES OF ENDOPROSTHETICS IN PATIENTS WITH THE CONSEQUENCES OF SHOULDER JOINT INJURIES

The use of shoulder joint replacement has increased significantly since the early 2000s. The method, initially used as the gold standard for the treatment of osteoarthritis, has long gone beyond the generally accepted indications, expanding its use for the treatment of shoulder joint injuries and their consequences. The new generation of implants has led to improved outcomes such as functionality, range of motion in the shoulder joint and patient satisfaction. The decision to perform anatomical endoprosthetics (hemiarthroplasty, total shoulder joint replacement) depends on the degree of osteopenia, the viability of the humerus head, the integrity of the tubercles or the functional state of the rotator cuff of the shoulder. This type of arthroplasty remains for patients with a functional rotator cuff. Reversible endoprosthetics is today the preferred treatment option for non-fusion or improper fusion of the proximal humerus with a collapse of the humerus head or a non-functioning rotator cuff. Despite the limitations and complications reported in the literature, revision arthroplasty has a good potential for functional improvement in patients with the consequences of injuries of the proximal humerus. This is a group of patients, which is a difficult task for a surgeon. As further research is carried out, implant designs and their clinical application will continue to evolve.

The Value of the Frog Lateral View Radiograph for Detecting Collapse of Femur Head Necrosis: A Retrospective Study of 1001 Cases.

AimsThe collapse in femur head necrosis is generally detected by CT or MRI which are not primary routine examination at every follow-up in developing countries. The purpose of this study was to verify the reliability of the frog lateral view radiograph in detecting the collapse of femoral head.MethodsWe retrospectively included 1001 hips of 620 patients with femur head necrosis. The anteroposterior view and frog lateral view of X-ray standard radiographs, CT and MRI of patients were collected and simultaneously evaluated by three orthopedists to evaluate the condition of collapse according to the unified standard. The inter-observer reliability of each view of X-ray for detecting the collapse were analyzed through the weighted Cohen's kappa index. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each evaluation method were also calculated.ResultsA moderate or substantial reliability was indicated in the evaluation of frog lateral view radiograph, whereas the anteroposterior view only showed fair or poor reliability. Using the CT or MRI results of collapse as the gold standard, the frog lateral view indicated higher sensitivity and accuracy than the anteroposterior view (sensitivity: 82.8 vs. 64.9%; accuracy: 87.1 vs. 73.9%). The combination of the anteroposterior view and frog lateral view indicated higher reliability than individual views.ConclusionThe frog lateral view radiograph has higher sensitivity and accuracy than anteroposterior view. It is a complementary method to AP view for detecting the collapse in femur head necrosis during the follow-up, which has moderate or substantial inter-observer reliability.

Bilobalide Improves Steroid-Induced Avascular Necrosis of the Femoral Head through PI3K/AKT Pathway

Steroid-induced avascular necrosis of the femoral head is a metabolic disease that results from the use of glucocorticoid drugs, leading to impaired blood supply to the femoral head and death of bone cells and altered bone marrow composition, which in turn lead to structural changes, collapse of the femoral head, and articular dysfunction. It is a challenging disorder to manage due to frequent collapse of the femoral head and dysfunction of the hip joint often requiring joint arthroplasty surgery. Therefore, there is a critical need to develop effective strategies to prevent and treat this condition. Bilobalide, an intermediate metabolite of ginkgolide, is known to inhibit apoptosis, protects damaged cells, and protects the brain from injury. However, the role of bilobalide in steroid-induced avascular necrosis of the femoral head is poorly understood. In this study, we investigated the role of bilobalide in steroid-induced avascular necrosis of the femoral head in rats. Our data show that bilobalide reduced femoral head inflammation and oxidative stress in steroid-induced avascular necrosis of the femoral head in rats. Bilobalide reduced the apoptosis of femoral head cells in steroid-induced avascular necrosis of the femoral head in rats. In addition, bilobalide improved bone tissue injury in steroid-induced avascular necrosis of the femoral head in rats. Mechanically, bilobalide improved steroid-induced avascular necrosis of the femoral head through PI3K/AKT pathway. We therefore suggest that bilobalide may serve as a promising drug for steroid-induced avascular necrosis of the femoral head.

Spontaneous bilateral femoral neck subcapital fractures in bilateral osteonecrosis of the femoral head: A case report and review of the literature

Femoral neck fracture rarely occurs during the course of osteonecrosis of the femoral head (ONFH). We report a case of spontaneous bilateral femoral neck subcapital fractures in the presence of bilateral ONFH. A 30-year-old man developed bilateral hip pain while working. Plain radiographs revealed bilateral displaced subcapital fractures of the femoral neck. Magnetic resonance imaging (MRI) scans demonstrated a typical finding of bilateral ONFH. The fractures were treated with bilateral total hip arthroplasty. He had recovered satisfactorily and could return to work without any problem. ONFH rarely causes bilateral femoral neck fractures. We performed routine laboratory blood examinations and biochemical and endocrine tests, which excluded the possibility of any underlying metabolic disorders. We also performed MRI to evaluate the severity of ONFH. Fractures occurred in the subcapital area between the interface of necrotic and regenerative bone. ONFH may suddenly deteriorate to become a femoral neck fracture without head collapse or any recognizable trauma event. Although rare, bilateral hip involvement is possible. Care should be directed to the proper diagnosis and appropriate treatment of such fractures.

Do bisphosphonates alter the clinico-radiological profile of children with Perthes disease? A systematic review and meta-analysis.

This meta-analysis is aimed to analyze the efficacy of bisphosphonates in the management of Perthes disease. A total of 8 animal and 7 human studies have been shortlisted for this analysis. In human studies, common variables for pain, Harris Hip Score (HHS), propensity for femoral head collapse, and total hip arthroplasty (THA), were assessed. In contrast, in animal studies, the data was recorded for epiphyseal quotient, trabecular volume, trabecular separation, trabecular thickness, and trabecular number. Meta-analysis of human studies on ONFH (Osteo-Necrosis of Femoral Head) revealed a statistically significant outcome in HHS [p<0.001; (95% CI: 4.79 - 8.87)], collapse of the femoral head [p=0.079; (95% CI: -0.16 - 0.01)], and THA [p=0.002; (95% CI: -0.19 - -0.04)] whereas the pain score showed an insignificant outcome [p=0.067; (95% CI: -0.62 - 0.04)]. The meta-analysis of selected variables in animal studies revealed a noteworthy outcome in bone volume (p<0.001, 95% Cl), trabecular number (p<0.001, 95% Cl), trabecular thickness (p<0.013, 95% Cl) and trabecular separation (p<0.026, 95% Cl) but not in epiphyseal quotient. Further, analysis of stratified datasets in animal studies revealed a contradictory outcome with significant observations described later in the paper. The use of bisphosphonates holds a promising treatment option in Perthes disease. Although, good quality RCTs are needed to validate it further.

A novel mutation of COL2A1 in a large Chinese family with avascular necrosis of the femoral head

Avascular necrosis of the femoral head (ANFH) is a debilitating bone disease, characterized by collapse of the femoral head and subsequent loss of hip joint function. Heterozygous mutations in COL2A1 have been identified to cause familial ANFH. Here we report on a large Chinese family with ANFH and a novel heterozygous mutation (c.3517 G > A, p.Gly1173Ser) in exon 50 of COL2A1 in the Gly-X–Y domain. Previously, only five different COL2A1 mutations have been described in patients with familial ANFH. Therefore, our findings provide significant clues to the phenotype–genotype relationships in familial ANFH and may be helpful in clinical diagnosis. Furthermore, these results should assist further studies of the mechanisms underlying collagen diseases.

Femoral neck bone autograft for the core decompression treatment of the hip osteonecrosis: Surgical technique

Background: Hip joint preserving procedures delay the progression of the femoral head osteonecrosis. Non-vascularised autologous bone grafts have been used to fill the necrotic area and prevent the collapse of the femoral head. Harvesting and use of autologous femoral neck bone graft, minimizing the donor site complications and favoring the bone regeneration after core decompression. Methods: 17 patients in early stage of the femoral head osteonecrosis were operated, 12 males and 5 females with mean age of 45.3 years old. Were treated with core decompression and autograft harvested from the femoral neck. All the patients were evaluated with an MRI preoperatively, and at the follow up with X-rays of the hip and functional clinical scores. Results: We didn’t observe any complications both at the donor site and the hip at any stage of the follow up. All the patients returned to previous everyday activities, free of pain. There was a significant improvement regarding the functional scores. Conclusion: We present the surgical technique of using femoral neck bone autograft for the treatment of the femoral head osteonecrosis. The technique is simply and sufficient in most early and midterm cases adding an advantage to the minimal invasing and join preserving technique of core decompression.

Systems analysis of avascular necrosis of femoral head using integrative data analysis and literature mining delineates pathways associated with disease

Avascular necrosis of femoral head (AVNFH) is a debilitating disease, which affects the middle aged population. Though the disease is managed using bisphosphonate, it eventually leads to total hip replacement due to collapse of femoral head. Studies regarding the association of single nucleotide polymorphisms with AVNFH, transcriptomics, proteomics, metabolomics, biophysical, ultrastructural and histopathology have been carried out. Functional validation of SNPs was carried out using literature. An integrated systems analysis using the available datasets might help to gain further insights into the disease process. We have carried out an analysis of transcriptomic data from GEO-database, SNPs associated with AVNFH, proteomic and metabolomic data collected from literature. Based on deficiency of vitamins in AVNFH, an enzyme-cofactor network was generated. The datasets are analyzed using ClueGO and the genes are binned into pathways. Metabolomic datasets are analyzed using MetaboAnalyst. Centrality analysis using CytoNCA on the data sets showed cystathionine beta synthase and methylmalonyl-CoA-mutase to be common to 3 out of 4 datasets. Further, the genes common to at least two data sets were analyzed using DisGeNET, which showed their involvement with various diseases, most of which were risk factors associated with AVNFH. Our analysis shows elevated homocysteine, hypoxia, coagulation, Osteoclast differentiation and endochondral ossification as the major pathways associated with disease which correlated with histopathology, IHC, MRI, Micro-Raman spectroscopy etc. The analysis shows AVNFH to be a multi-systemic disease and provides molecular signatures that are characteristic to the disease process.

Biomechanical analysis of fibular graft techniques for nontraumatic osteonecrosis of the femoral head: a finite element analysis

BackgroundFree vascularized fibula graft (FVFG) techniques have most consistently demonstrated beneficial effects in young patients diagnosed with nontraumatic osteonecrosis of the femoral head (NONFH), and the core track technique (CTT) in particular is the most commonly used technique. As an alternative to CTT, the modified light bulb technique (LBT) has been reported to have a higher success rate. However, its biomechanical outcomes are poorly understood. This study aimed to compare the biomechanical properties of modified LBT with those of CTT in treating NONFH.MethodsTwo types (C1 and C2) of NONFH finite element models were established on the basis of a healthy subject and the Japanese Investigation Committee (JIC) classification system, and the CTT and LBT procedures were simulated in each type of model. The average von Mises stresses and stiffness of the proximal femur were calculated by applying a load of 250% of the body weight on the femoral head to simulate walking conditions. In addition, two patient-specific models were built and simulated under the same boundary conditions to further validate the LBT.ResultsIn the healthy subject-derived models, both the LBT and CTT resulted in reduced stresses in the weight-bearing area, central femoral head, femoral neck, and trochanteric and subtrochanteric regions and increased structural stiffness after surgery. In the weight-bearing area, the CTT reduced the stress more than the LBT did (36.19% vs 31.45%) for type C1 NONFH and less than the LBT did (23.63% vs 26.76%) for type C2 NONFH. In the patient-specific models, the stiffness and stresses also increased and decreased, respectively, from before to after surgery, which is consistent with the results of healthy subject-derived models.ConclusionThe biomechanical effects of the LBT and CTT differ by the JIC type of NONFH. In terms of preventing the collapse of the femoral head, the LBT may be more effective for JIC type C2 NONFH and may be a suitable alternative to the CTT, while for JIC type C1 NONFH, the CTT is still a better choice. Both techniques can improve the biomechanical properties of NONFH by reducing the proximal femoral stress and increasing the structural stiffness.

Legg-Calve-Perthes disease in an 8-year old girl with Acrodysostosis type 1 on growth hormone therapy: case report

BackgroundAcrodyostosis type 1 (ACRDYS1) is a rare skeletal dysplasia, and sometimes it can be misdiagnosed as pseudohypoparathyroidism type 1A (PHP1A), a subtype of Albright hereditary osteodystrophy (AHO), due to overlapping features. Growth hormone releasing hormone (GHRH) resistance with severe short stature is common in both ACRDYS1 and PHP1A (Emily L. Germain-Lee, et al. J Clin Endocrinol Metab, 88:4059–4069, 2003). Whereas growth hormone (GH) treatment has been studied in patients with PHP1a, the same is not true for the rarer ACRDYS1. Here in we report an adverse orthopedic outcome in a patient with ACRDYS1 with severe short stature treated with growth hormone. Our experience could have implications for the treatment of other patients with this disorder.Case presentationWe report a case of Legg-Calve-Perthes Disease (LCPD) in an 8-year old female with ACRDYS1 treated with GH. She initially presented with marked short stature (height Z-score − 3.46) with a low normal insulin like growth factor-1 (IGF1) level, and had biochemical evidence of thyrotropin and parathyroid hormone resistance. GH therapy was initiated at 0.35 mg/kg/week leading to increased growth velocity. After 7 months on GH, she developed right knee pain. Radiographic images revealed flattening of her right femoral head consistent with LCPD. GH was discontinued. Six weeks later, radiographs revealed further collapse of the entire femoral head. Her lesion stabilized after 8 months with conservative management and she never resumed GH. Her final adult height is 4′2″ (128 cm).ConclusionPatients with ACRDYS1 on GH therapy may be at increased risk of LCPD. This has not been reported in patients with PHP1A treated with GH. Clinicians and families need to be aware of this potential complication when counseling about GH treatment.

Effects of bone-resorptive lesion on stress distribution of the femoral head and on progression in patients with osteonecrosis of the femoral head

Objective To investigate effects of bone-resorptive lesion on stress distribution of femoral head and on progression in patients with osteonecrosis of the femoral head (ONFH). Methods From April 2014 to September 2018, a total of 155 femoral heads from 94 patients diagnosed with ARCO stage II and III ONFH were retrospectively reviewed, including 77 males and 17 females with aged 39.90±10.45 years old (ranged from 18-64 years). The hips were divided into two groups according to whether there were bone-resorptive lesions. Further, we compared whether there was statistical difference between the two groups in staging. Then, a case of ARCO II hip joint without bone-resorptive lesion was selected from the included patients. Six femoral head with different diameters of spherical bone-resorptive lesion of 5 mm, 7 mm, 10 mm, 14 mm, 18 mm, and 23 mm were simulated. The influence of bone-resorptive lesion on the stress distribution of necrotic area and a spherical shell extending 1 mm radially around the bone-resorptive lesion was investigated by finite element method in slow walking conditions. Results Of the 155 ONFH hips, 67 hips are complicated by bone-resorptive lesions, of which 17 were ARCO II, 50 were ARCO III. A total of 88 hips did not contain bone-resorptive lesions, of which 58 were ARCO II, ARCO III 30 cases. The proportion of ARCO stage II in the group with bone-resorptive lesions was significantly higher than that in the group without bone-resorptive lesions (χ2=25.03, P=0.000). The finite element stress distribution cloud diagram showed that there was a stress concentration area around the bone-resorptive lesions. The maximum von Mises stress around bone-resorptive lesions in the models that contained a synthetic bone-resorptive lesions were significantly higher than those reported in the matched, non-synthetic bone-resorptive lesions finite element models (t=3.139, P=0.026). The values for maximum von Mises stress around bone-resorptive lesions were 6.94±1.78 MPa and 5.01±0.35 MPa for the group with synthetic bone-resorptive lesions and the group non-synthetic bone-resorptive lesions, respectively. There was a positive correlation between the diameter of bone-resorptive lesions and the maximum and mean von Mises stress of necrotic areas as well as the maximum von Mises stress around bone-resorptive lesions. Conclusion Bone-resorptive lesions can increase the maximum stress and average stress in the necrotic area. The larger the bone-resorptive lesion, the more the stress increases. There is a stress concentration area around the bone-resorptive lesions, which may accelerate the collapse of the femoral head. Key words: Femur head necrosis; Bone resorption; Finite element analysis

Early results of surgery for femoroacetabular impingement in patients with osteonecrosis of femoral head.

Purpose: Femoroacetabular impingement and its surgical treatment have not been described before in osteonecrosis of femoral head. We present here outcomes of 15 patients with femoroacetabular impingement secondary to osteonecrosis of femoral head. This results from partial collapse of femoral head, particularly in the anterosuperior region, secondary to osteonecrosis. With subsequent remodelling, periphery of the femoral head flattens and osteophytes form in this area. All these patients were managed with open/arthroscopic osteochondroplasty of femoral head.Methods: These patients were symptomatic for hip impingement. Cam deformity was studied using computed tomography and magnetic resonance imaging. In six patients open osteochondroplasty was carried out using surgical hip dislocation. In nine patients arthroscopic femoral head osteochondroplasty was done. All the patients were followed up for hip pain (VAS), Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and hip range of motion.Results: A statistically significant improvement in the VAS for pain, HHS, and WOMAC score was noted. Average HHS improved from 71.3 (SD, 13) to 89.7 (SD, 14.5), p-value 0.0079. Average WOMAC improved from 73.6 (SD, 15.4) to 92.4 (SD, 16), p-value 0.0154. Impingement test became negative in all the patients. A significant improvement in hip ROM was noted. There was no conversion to total hip arthroplasty. All patients could sit on the floor cross-legged and squat.Conclusion: Some patients with partial collapse of femoral head due to osteonecrosis present chiefly with symptoms of femoroacetabular impingement. They should be identified as osteochondroplasty gives successful results in these patients.Level of evidence − IV

Application of U-shaped transdermal surgical navigator based on three-dimensional reverse design in cannulated screwing for femoral neck fracture

Objective To explore application of our self-designed U-shaped transdermal surgical navi-gator based on three-dimensional reverse design in cannulated screwing for femoral neck fracture. Methods A retrospective study was done of 5 patients with femoral neck fracture who had been treated from August 2016 to March 2017. They were 3 men and 2 women, aged from 33 to 60 years (average, 46.5 years). Thin layer CT scanning was conducted on the patients’ affected hip (at the left side in 2 cases and at the right side in 3). Based on their CT data, 3D design software and 3D printing technique were used to manufacture the U-shaped transdermal surgical navigator and a real-sized model of the fracture. Operations were simulated using the U-shaped transdermal surgical navigator on the fracture model to determine the angle, depth and location of the screwing. Fixation of the fracture with cannulated screws was conducted after confirmation of satisfactory surgical parameters. The postoperative X-ray films of the patients were reviewed. Evaluations were con-ducted of the screw position, operating time, volume of operative bleeding, and number of intraoperative X-ray shots. Results The screw positions in the 5 patients were consistent with their preoperative de-sign. Four patients had only one shot of fluoroscopy and one patient 3 shots. Their operating time ranged from 15 to 30 minutes, averaging 22.5 minutes; their bleeding ranged from 5 to 10 mL, averaging 7.5 mL. The 5 patients were followed up for an average of 4.5 months (from 3 to 6 months). By the Harris scoring at their final follow-ups, one was excellent, 3 good and one fair. No complications like pain, functional impairment of the joint, or collapse or necrosis of the femoral head occurred during the follow-up. Conclusions Our self-designed U-shaped transdermal surgical navigator based on three-dimensional reverse design can signifi-cantly improve the accuracy and safety of the cannulated screwing for femoral neck fractures. The operation is minimally invasive, reducing operating time and intraoperative blood loss. Key words: Femoral neck fractures; Fracture fixation, internal; Surgical navigation; Imag-ing, three dimensional; 3D printing technology

Correlation Between Steroid-Induced Osteonecrosis of The Femoral Head and Hepatic CYP3A Activity: A Systematic Review and Meta-Analysis

ABSTRACTBackground: Steroid-induced osteonecrosis of the femoral head (ONFH) in young adults is a challenging disorder that can impairs the quality of life of a patient. The disease also leads to frequent occurrences of collapse of the femoral head and resultant dysfunction of the hip joint. In recent years, some scholars have studied steroid-induced lipid metabolism disorder and achieved the effect of steroid-induced ONFH treatment. This study aims to review the investigations on the hepatic CYP3A (cytochrome P4503A enzyme) genetic polymorphisms in steroid-induced ONFH patients. We then further explore its activity correlation with the development of steroid-induced ONFH in a rabbit model. Methods: A systematic literature search of articles was conducted in PubMed, Web of Science, Google Scholar, Springerlink, and the Chinese National Knowledge Infrastructure database up to February 2017. Twelve relevant articles were retrieved. The odds ratios, standard mean difference, and 95% confidence intervals were calculated to assess the effect of hepatic CYP3A activity on the rabbit model with steroid-induced ONFH. Fixed-effects and random-effects models were used to analyze the heterogeneity. Begg's funnel plot was used to assess publication bias. Results: High hepatic CYP3A activity significantly decreased the risk for steroid-induced ONFH in the rabbit model (p <. 05). The CYP3A gene may be potentially associated with increased risk of steroid-induced ONFH in the human allele model. Conclusion: The study suggests that high hepatic CYP3A activity decreases the risk of steroid-induced ONFH.

Seqex Therapy in Osteonecrosis of the Femoral Head: A Case Report

The cause of non-traumatic Avascular Necrosis of the femoral head (AVN) is unknown in a large proportion of cases. Unless diagnosed early and treated appropriately, it can progress to collapse of the femoral head leading to early degenerative arthrosis. With the advent of modern imaging techniques, AVN can be detected early. Accurate diagnosis of AVN leads to appropriate selection of effective joint-preserving treatment. Techniques aimed at preserving the femoral head, including core decompression, and vascularized/nonvascularized bone graft which are often advised for early necrosis, have shown varying clinical outcomes.

Clinical research of free vascularized fibular grafting for osteonecrosis of femoral head

Objective To evaluate the clinical results of free vascularized fibular grafting (FVFG) for the treatment of osteonecrosis of the femoral head (ONFH). Methods From July, 2009 to January, 2013, 85 cases (120 hips) of ONFH were treated with free vascularized fibular grafting. These cases included 61 males (87 hips) and 24 females (33 hips) with an average age of 36.5 years (22-51 years) ; 7 hips (ⅠA 2 hips, ⅠB 3 hips, ⅠC 2 hips) were at stage Ⅰ, 98 hips (ⅡA 24 hips, ⅡB 39 hips, ⅡC 35 hips) at stage Ⅱ and 15 hips (ⅢA 9 hips, ⅢB 4 hips, ⅢC 2 hips) at stage Ⅲ according to the classification system of Association Research Circulation Osseous (ARCO). The mean preoperative Harris hip score was (60.21±6.85) points (42-71 points) , The follow-up items included the X-ray examination, the Harris scores of the hip, and the evaluation of the complications. Results Eighty-three cases (117 hips) were followed up. The average duration of follow-up was 25 months (range from 12 months to 42 months). The mean postoperative Harris hip score was increased to (81.26±5.84) points (67-91 points) by the end of the follow-up, compared with the preoperation, the score improved significantly, the difference was statistically significant (P<0.05). Comparing with postoperative X-ray, 101 hips (86.3%) were improved, 12 hips (10.3%) had no significant changes and deterioration occurred in 4 hips (3.4%). Conclusion The free vascularized fibular grafting is an effective method for treating osteonecrosis of and preventing the collapse of the femoral head. Key words: Osteonecrosis of the femoral head; Free vascularized fibular grafting; Harris scores; Micro-surgical technique

Past decade on hip-preserving surgery for osteonecrosis of femoral head treatment in China

As a common disease in orthopedics, osteonecrosis of the femoral head (ONFH) frequently occurs among young and middle-aged people. Hip joint preserving surgery has attracted more and more attention due to the fact that artificial joint prosthesis has a certain useful life and the rate of hip joint revision is high and the higher risk of many complications. There are a large number of operative methods for preserving hip joint in clinical practice without definitive curative effects. Core decompression and impaction bone grafting with simple operative methods can relieve internal pressure of femoral head and pain symptoms, but they cannot remove necrotic bone completely. Hence, they are only used for ONFH in the early stage. Vascularized bone transplantation can fill defects of the former, as it can not only completely remove necrotic bone, but also provide bone graft with nourishing vessels for femoral head, being beneficial to reconstruct the bone structure of femoral head. Subsequently, the application of tantalum rod can provide mechanical support for femoral head to prevent the collapse of femoral head. The emergence of stem cell transplantation has created a new approach to preserve hip joint for ONFH, which promotes the regeneration of bone cells and assists femoral head in repair, often combined with other operative methods and using characteristics of superior proliferation and differentiation of stem cells. Hip joint preserving surgery, in recent years, has been performed increasingly, and has obtained improvement in clinical effects. The multiple combination of a variety of its operative methods provides more effective treatments for ONFH. It is an essential notion that hip joint preserving surgery, however with any operative method, should as far as possible select a surgical plan with little trauma, simple methods and little injury to bone structure of hip joint based on ensuring the efficacy.

Predicting necrotic femoral head collapse using computed tomographic and X-ray imaging before hip arthroplasty: study protocol and results of a single-center, open-label, diagnostic trial

Background and objectives: Determining whether the femoral head collapses and the degree of collapse of the articular cartilage of the femoral head can help select the best surgical treatment plan for patients with osteonecrosis of the femoral head. Currently, articular cartilage collapse > 2 mm or Design: A single-center, open-label, diagnostic trial. Methods: We proposed, and subsequently conducted, a single-center, open-label, diagnostic trial at the Third Hospital, Hebei Medical University, China. Eighty-six patients with unilateral osteonecrosis of the femoral head who underwent total hip arthroplasty were randomized into three groups. In the X-ray group, changes in femoral head height were measured on anteroposterior X-ray images of the pelvis (healthy and affected sides of the hip) at preoperative week 1. In the CT group, changes in femoral head height were measured using bilateral hip CT scans (healthy side and affected side) at preoperative week 1. In the specimen group, the femoral head on the affected side was resected surgically and measured directly with a ruler and vernier caliper. The primary outcome of the trial was the sensitivity of the three methods to detect femoral head collapse. The secondary outcomes were specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and diagnostic accuracy of the three methods to detect femoral head collapse; the consistency of X-ray and CT scans to diagnosis femoral head collapse; changes in the height of the middle, medial, and lateral femoral head measured by the three methods; and morphological changes in the femoral head observed by the three methods. Results: Changes in the height of the femoral head detected by different methods: The heights of the middle, medial and lateral femoral head were not significantly different on the affected side (P > 0.05). Discussion: This trial analyzed femoral head height using X-ray, CT, ruler and vernier caliper to precisely predict collapse of the necrotic femoral head, and provides imaging guidance for clinicians to select the best surgical management for osteonecrosis of the femoral head. Trial registration: ClinicalTrials.gov identifier: NCT03351153.

The physiopathology of avascular necrosis of the femoral head: an update

The physiopathology of the femoral head bone necrosis is similar for children and for adults. The disease is characterized by apoptosis of bone cells – bone marrow and bone forming cells-resulting in head collapse with a subsequent lesion of the overlying cartilage, and therefore flattening of the rounded surface shape of the head articulating with the acetabulum, provoking, eventually, secondary osteoarthritis. When the disease becomes clinically evident already destructive phenomena have occurred and collapse will eventually ensue. In children, because epiphyseal cartilage has growth capabilities, lost epiphyseal height can be recovered, however in adults collapse is irreversible. In this paper the physiopathology of this disease is examined as well as its implication for treatment. Prevention by genetic studies is discussed.

Bisphosphonate in the prevention of collapse of the femoral head in non-traumatic osteonecrosis

Osteonecrosis (ON) is one of the major debilitating skeletal disorders. Most patients with ON of the femoral head eventually need surgery, usually total hip arthroplasty (THA), within a few years of onset. Previous reports showed that alendronate has a pharmacological effect in reducing osteoclastic activity and that it significantly reduced the incidence of collapse of the femoral head in the osteonecrotic hip in case control study. Further prospective, multicenter, randomized, trials with double-blind or open label were conducted by treatment with alendronate or zolendronate. In this review, we mainly focus on the prospective, multicenter, randomized, trials to evaluate the effect of bisphosphonates in the treatment of ON. With the current evidence, the effect of bisphosphonate on osteonecrosis of the femoral head remains controversial. Due to the possible side effects, careful selection of patients is advised and prolonged administration of bisphosphonate should be avoided, especially in young patients. Further studies may be necessary to clarify its clinical effects and optimal period of application.