Development Of Femoral Head Osteonecrosis Research Articles

Femoral Head Vascularity After Arthroscopic Femoral Osteochondroplasty: An In Vivo Dynamic Contrast-Enhanced MRI Study.

A serious concern with surgical procedures around the hip joint is iatrogenic injury of the arterial supply to the femoral head (FH) and consequent development of FH osteonecrosis. Cam-type morphology can extend to the posterosuperior area. Understanding the limit of the posterior superior extension of the femoral osteochondroplasty is paramount to avoid underresection and residual impingement while maintaining FH vascularity. The aim of this study was to quantify the impact of arthroscopic femoral osteochondroplasty on the FH vascular supply. It was hypothesized that keeping the superior extension of the resection zone anterior to the 12-o'clock position would maintain FH vascularity. Case series; Level of evidence, 4. Ten adult patients undergoing arthroscopic femoroacetabular impingement (FAI) surgery were included in the study. Computed tomography (CT) scans were obtained before and after arthroscopic osteochondroplasty to define the extension of resection margins. To quantify FH vascularity, postoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was obtained at 2 time points: immediately after surgery and at the 3-month follow-up. Custom MRI analysis software was used to quantify perfusion. CT scan analysis demonstrated that the superior resection margin was maintained anterior to the 12-o'clock position in half of the patients. The remining 5 patients had a mean posterior extension of 11.4° ± 7.5°. The immediate postoperative DCE-MRI revealed diminished venous outflow in the operative side but no difference in overall FH perfusion. At the 3-month follow-up DCE-MRI, there was no perfusion difference between the operative and nonoperative FHs. This study provides previously unreported quantitative MRI data on in vivo perfusion of the FH after the commonly performed arthroscopic femoral osteochondroplasty for the treatment of cam-type FAI. Maintaining resection margins anterior to the 12-o'clock position, or even 10° posteriorly, was not observed to impair perfusion to the FH.

Postacute sequelae of SARS-CoV-2 infection. Osteonecrosis must not be overlooked

Recovery from COVID-19 is not always uneventful, especially in critically ill hospitalized patients. Persistent symptoms including fatigue/ weakness, shortness of breath, anxiety, and depression have been described at one-year follow-up. Furthermore, symptoms from the musculoskeletal system like joint pain or stiffness are underreported in studies with long-term follow-up of up to one year. Infection with SARS-CoV-2 itself has been associated with endothelial damage, and together with high-dose corticosteroid treatment, it is predisposed to the dissemination of microthrombi and the development of femoral head osteonecrosis (FHOn), as it has been shown during the previous (2003–2004) coronavirus outbreaks. A resurgence of FHOn cases is anticipated but this is not reflected in the existing studies with long-term follow-up. Prompt diagnosis is critical for early treatment and possibly for the hip joint preservation. Patients with COVID-19 treated with corticosteroids should be screened for avascular necrosis early after discharge from the hospital. Every healthcare worker involved in the management of these patients should maintain a high level of suspicion and should be alert when patients report symptoms such as vague aches at the buttocks, hip area, adductors, and/or above the knee. Studies are needed to identify risk factors for FHOn including disease severity, type of steroid, cumulative dose, and duration of treatment.

Plasma C-terminal cross-linking telopeptide of type II collagen as a biomarker in advanced stages of femoral head osteonecrosis

AimThe aim of this study is to investigate the potential role of C-terminal cross-linking telopeptide of type II collagen (CTX-II) in the development of femoral head osteonecrosis (FHN).Materials and methodsOne hundred and thirty-two patients diagnosed with FHN and 66 age- and sex-matched healthy subjects were included in this cross-sectional case-control study between May 2016 and November 2016. Bone histomorphology, cartilaginous immunohistochemistry, Western blotting, and level of plasma CTX-II, as well as the receiver operating characteristic (ROC) curve, were evaluated. ResultsImmunohistochemistry and Western blotting showed that CTX-II was abundantly detected in the cartilage of FHN samples in stages III & IV. Plasma CTX-II levels were significantly higher in FHN patients in the advanced stages (III & IV) than was the level in the control group (164.81% and 198.15% higher in stages III & IV, respectively). However, the levels of CTX-II did not differ significantly among the FHN patients with different etiology or other clinical data. ConclusionOur result suggests that the degeneration of cartilage has already begun in stage III, even though a relatively normal articular gap can be found in the X-ray. Plasma CTX-II level may be a biomarker of the development of FHN.

Quantitative Assessment of Femoral Head Perfusion Following Arthroscopic Femoral Osteochondroplasty: A Cadaveric Study.

Disruption of the arterial supply to the femoral head, and subsequent development of femoral head osteonecrosis, is of serious concern with intracapsular hip procedures. However, the effect of arthroscopic femoral osteochondroplasty on femoral head perfusion is unknown. We aimed to quantify the effects of both standard and posterosuperior extension of arthroscopic femoral osteochondroplasty on femoral head vascularity. We hypothesized that extension of the superior resection zone posteriorly would negatively affect femoral head perfusion. In 12 cadaveric pelvic specimens, we cannulated the medial femoral circumflex artery (MFCA). One hip per pelvis was randomly selected to be in 1 of 2 experimental groups based on the superior extent of the osteochondroplasty: standard resection (resection anterior to the 12 o'clock [0° of 360°] position) or extended resection (resection extended posterior to the 12 o'clock position). Computed tomography (CT) scans were obtained prior to and following arthroscopic resection to delineate the resection margins. Gadolinium enhancement on magnetic resonance imaging (MRI) was quantified in the femoral head by volumetric analysis using custom software. A polyurethane compound was injected and gross dissection of the vasculature was performed. Extension of the osteochondroplasty posteriorly (the extended-resection group), to a mean of 41.3° (range, 34° to 47°) posterior to the 12 o'clock position, decreased femoral head perfusion by a mean of 28% (range, 18% to 38%). The standard-resection group demonstrated a mean decrease in femoral head perfusion of 7% (range, 4% to 11%). Correlation analysis demonstrated a significant negative correlation (correlation coefficient, -0.877; p < 0.001; R = 0.747). For every 1° that the superior resection margin extended posteriorly, a corresponding 0.88% decrease in femoral head perfusion was found. Femoral head perfusion is almost fully maintained with arthroscopic osteochondroplasty when the superior resection margin is anterior to the 12 o'clock position. Perfusion is also well maintained if the superior resection margin is extended no more than 10° posterior to 12 o'clock. Further posterior extension correlated with greater decreases in femoral head perfusion. Our study provides previously unreported quantitative MRI data on femoral head perfusion following arthroscopic femoral osteochondroplasty for the treatment of cam-type femoroacetabular impingement.

Advanced MRI Techniques for the Hip Joint: Focus on the Postoperative Hip.

Imaging the hip joint with optimized MRI protocol parameters provides the radiologist with the ability to reliably diagnose complex hip abnormalities. The institution of appropriate metal artifact reduction techniques and dedicated sequences can enhance visualization of the periprosthetic bone and soft tissues and allow improved detection of the more frequently encountered total hip arthroplasty-related conditions, such as mechanical loosening, polyethylene wear, and adverse local tissue reactions. Finally, through the use of dynamic contrast-enhanced MRI, abnormal femoral head perfusion, one of the most common complications associated with femoral neck fracture internal fixation, can be detected before the development of femoral head osteonecrosis, subchondral collapse, and secondary osteoarthritis. Thus, through the institution of the techniques described in this review article, the challenges associated with MRI of hip arthroplasty and instrumentation can be overcome, allowing for the diagnosis of common associated complications.

The effect of corticosteroids on development of femoral head osteonecrosis in patients after kidney transplantation

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Logistic regression analysis of risk factors for femoral head osteonecrosis after healed intertrochanteric fractures.

To evaluate the potential risk factors of the development of femoral head osteonecrosis after healed intertrochanteric fractures. We retrospectively reviewed all patients who were operated upon with closed reduction and internal fixation for intertrochanteric fractures by our medical group from December 1993 to December 2012. Patients with healed fractures were identified. Age, gender, comorbidities favouring osteonecrosis, causes of injuries, fracture patterns, the location of the primary fracture line, time from injury to surgery, fixation methods, and the development of femur head osteonecrosis of these patients were summarised. Univariate and multivariate logistic regression analysis were performed to evaluate the correlation between potential risk factors and the development of femoral head osteonecrosis. A total of 916 patients with healed intertrochanteric fractures were identified. Femoral head osteonecrosis was found in 8 cases (0.87%). According to the results of univariate logistic regression, a more proximal fracture line, fixation with dynamic hip screws and age were found to be statistically significant factors. The results of multivariate logistic regression analysis indicated that the statistically significant predictors of femoral head osteonecrosis were younger age (odds ratio [OR] = 17.103; 95% confidence interval [CI], 1.988-147.111), a more proximal fracture line (OR = 31.439; 95% CI, 3.700-267.119) and applying dynamic hip screw as the internal fixation (OR = 11.114; 95% CI, 2.064-59.854). Regular follow-up is commended in young patients with a proximal fracture line who underwent closed reduction and internal fixation with dynamic hip screw, even though the bone had healed.

Predictive Role of Cytokine Gene Polymorphisms for the Development of Femoral Head Osteonecrosis

Introduction: Osteonecrosis (ON) is a multifactorial disease that leads to hip destruction. Lately, much focus has been at femoral head preservation with nonsurgical methods. In this study we examined the polymorphisms of IL-1α, IL-1R, IL-1RA, IL-4Rα, IL-1β, IL-12,γIFN, TGF-β, TNF-a, IL-2, IL-4, IL-6 and IL-10 genes for evaluation of their contribution in ON.Material and methods: DNA was extracted from 112 ON patients and 438 healthy donors. Analysis of the polymorphisms was completed using the PCR-SSP method. Statistical analysis was performed using theχ2test to compare the genotype and allelic frequency distribution.Results: The CT and GA genotypes of the IL-1α(-889) and TNF-a (-238) genes were found higher in the patients (51.8% and 10.8%, respectively) compared to the healthy donors (39.7% and 2.1%, respectively). In TGF-βcodon 25, the G to C polymorphism in the homozygous state was found in 1.8% of the patients and the C allele frequency was 8.9%, whereas the G allele frequency was 91.1%. Also, at the IL-10 (-1082) gene the GG genotype was 16.2% in the controls whereas in the patients was 7.2%.Conclusions: Based on the above, we showed that certain genotypes of the IL-1α, TGF-β, IL-10 and TNF-a genes could be related in the pathogenesis of a complicated disease, such as osteonecrosis. The presence of one of the above mentioned polymorphisms or the simultaneous carriage of more than one may further increase the risk for osteonecrosis, especially in those at high risk, such as patients receiving corticosteroids.

Predictive role of cytokine gene polymorphisms for the development of femoral head osteonecrosis.

Introduction: Osteonecrosis (ON) is a multifactorial disease that leads to hip destruction. Lately, much focus has been at femoral head preservation with nonsurgical methods. In this study we examined the polymorphisms of IL-1α, IL-1R, IL-1RA, IL-4Rα, IL-1β, IL-12, γIFN, TGF-β, TNF-a, IL-2, IL-4, IL-6 and IL-10 genes for evaluation of their contribution in ON. Material and methods: DNA was extracted from 112 ON patients and 438 healthy donors. Analysis of the polymorphisms was completed using the PCR-SSP method. Statistical analysis was performed using the χ2 test to compare the genotype and allelic frequency distribution. Results: The CT and GA genotypes of the IL-1α (-889) and TNF-a (-238) genes were found higher in the patients (51.8% and 10.8%, respectively) compared to the healthy donors (39.7% and 2.1%, respectively). In TGF-β codon 25, the G to C polymorphism in the homozygous state was found in 1.8% of the patients and the C allele frequency was 8.9%, whereas the G allele frequency was 91.1%. Also, at the IL-10 (-1082) gene the GG genotype was 16.2% in the controls whereas in the patients was 7.2%. Conclusions: Based on the above, we showed that certain genotypes of the IL-1α, TGF-β, IL-10 and TNF-a genes could be related in the pathogenesis of a complicated disease, such as osteonecrosis. The presence of one of the above mentioned polymorphisms or the simultaneous carriage of more than one may further increase the risk for osteonecrosis, especially in those at high risk, such as patients receiving corticosteroids.

Correlation between baseline femoral neck marrow status and the development of femoral head osteonecrosis in corticosteroid-treated patients: a longitudinal study of MR imaging

Objective: To test the hypothesis that the development of corticosteroid (CS)-associated femoral head osteonecrosis (ON) is influenced by baseline femoral neck marrow status.

Correlation between baseline femoral neck marrow status and the development of femoral head osteonecrosis in corticosteroid-treated patients: A longitudinal study by MR imaging

Objective To test the hypothesis that the development of corticosteroid (CS)-associated femoral head osteonecrosis (ON) is influenced by baseline femoral neck marrow status. Patients and methods The population consisted of 20 untreated patients with a newly diagnosed rheumatic disease in whom a standardized CS regimen was planned. Before CS treatment, baseline femoral neck marrow status was determined by magnetic resonance (MR) imaging on T1-weighted images (proportion of surface area of femoral neck and intertrochanteric area occupied by fatty marrow; index of marrow conversion [IMC]) and on a quantitative MR sequence (bulk T1 values of femoral head and neck). The presence of ON was assessed by coronal T1-weighted MR images of the hips at 6 and 12 months. Results None of the patients suffered from ON at baseline. Four patients (20%) developed bilateral femoral head ON at 6 months. The mean percentage of fat marrow in the femoral neck before treatment was significantly higher in ON-positive than in ON-negative patients ( p = 0.0025). The mean baseline femoral neck IMC value, which parallels the degree of red to yellow marrow conversion, was higher in ON-positive than in ON-negative patients ( p = 0.089). The mean baseline bulk T1 value of the femoral neck (but not of the femoral head), which inversely correlates with the amount of fat marrow, was significantly shorter in ON-positive than in ON-negative patients ( p = 0.0298). Conclusion The development of CS-associated femoral head ON is correlated with a high fat content in the proximal femur before CS therapy.

Osteonecrosis of the femoral head in patients with inflammatory arthritis or asthma receiving corticosteroid therapy.

The utilization of corticosteroids in the management of acute and chronic inflammatory processes, such as asthma or inflammatory arthritis, has been implicated in the adverse effects of multiple organ systems. One potential area of these negative consequences in the use of corticosteroids is the development of osteonecrosis of the femoral head. A direct time/dosage relationship for treatment with corticosteroids of patients with an established diagnosis of asthma or inflammatory arthritis and femoral osteonecrosis is unknown. A prospective study was undertaken to evaluate the use of corticosteroids and the incidence of osteonecrosis of the femoral head and potentially establish a time/dosage relationship in this patient population. No direct relationship between corticosteroid dosage and the development of femoral head osteonecrosis in 1420 hip-years was demonstrated at 10-year follow up.

Vascular occlusion and cartilage disorders in osteonecrosis of the femoral head in rats.

The aim of our study was to clarify the role of lateral epiphyseal vessels in the development of femoral head osteonecrosis in rats. We did this by performing histological and immunological studies on rats at the age that they are most prone to spontaneous osteonecrosis. We observed that obstruction of the lateral epiphyseal vessels occurred at the site of cartilage penetration. This obstruction preceded the development of osteonecrosis in adjacent areas of the femoral head. We propose that a similar mechanism may be responsible, in part, for the development of Perthes disease in man.