Early Osteonecrosis Of Femoral Head Research Articles

A single sequence MRI-based deep learning radiomics model in the diagnosis of early osteonecrosis of femoral head.

The objective of this study was to create and assess a Deep Learning-Based Radiomics model using a single sequence MRI that could accurately predict early Femoral Head Osteonecrosis (ONFH). This is the first time such a model was used for the diagnosis of early ONFH. Its simpler than the previously published multi-sequence MRI radiomics based method, and it implements Deep learning to improve on radiomics. It has the potential to be highly beneficial in the early stages of diagnosis and treatment planning. MRI scans from 150 patients in total (80 healthy, 70 necrotic) were used, and split into training and testing sets in a 7:3 ratio. Handcrafted as well as deep learning features were retrieved from Tesla 2 weighted (T2W1) MRI slices. After a rigorous selection process, these features were used to construct three models: a Radiomics-based (Rad-model), a Deep Learning-based (DL-model), and a Deep Learning-based Radiomics (DLR-model). The performance of these models in predicting early ONFH was evaluated by comparing them using the receiver operating characteristic (ROC) and decision curve analysis (DCA). 1,197 handcrafted radiomics and 512 DL features were extracted then processed; after the final selection: 15 features were used for the Rad-model, 12 features for the DL-model, and only 9 features were selected for the DLR-model. The most effective algorithm that was used in all of the models was Logistic regression (LR). The Rad-model depicted good results outperforming the DL-model; AUC = 0.944 (95%CI, 0.862-1.000) and AUC = 0.930 (95%CI, 0.838-1.000) respectively. The DLR-model showed superior results to both Rad-model and the DL-model; AUC = 0.968 (95%CI, 0.909-1.000); and a sensitivity of 0.95 and specificity of 0.920. The DCA showed that DLR had a greater net clinical benefit in detecting early ONFH. Using a single sequence MRI scan, our work constructed and verified a Deep Learning-Based Radiomics Model for early ONFH diagnosis. This strategy outperformed a Deep learning technique based on Resnet18 and a model based on Radiomics. This straightforward method can offer essential diagnostic data promptly and enhance early therapy strategizing for individuals with ONFH, all while utilizing just one MRI sequence and a more standardized and objective interpretation of MRI images.

Quantitative analysis of local microcirculation changes in early osteonecrosis of femoral head: DCE-MRI findings.

This study aims to quantitatively analyze the changes in local microcirculation in early osteonecrosis of the femoral head (ONFH) by dynamic contrast-enhanced (DCE) MRI and to explore the pathophysiological mechanisms of early ONFH. We selected 49 patients (98 hips) aged 21-59years who were clinically diagnosed with early ONFH. A total of 77 femoral heads were diagnosed with different degrees of necrosis according to the Association Research Circulation Osseous (ARCO) staging system, and 21 femoral heads were judged to be completely healthy. All patients underwent DCE-MRI scanning. Pseudocolor images and time-signal intensity curves were generated by Tissue 4D processing software. The volume transfer constant (K trans), extracellular extravascular space, also known as vascular leakage (V e), and transfer rate constant (K ep) of healthy and different areas of necrotic femoral heads were measured on perfusion parameter maps. The differences and characteristics of these parameters in healthy and different areas of necrotic femoral heads were analyzed. The signal accumulation in healthy femoral heads is lower than that of necrotic femoral heads in pseudocolor images. The time-signal intensity curve of healthy femoral heads is along the horizontal direction, while they all have upward trends for different areas of necrotic femoral heads. The mean value of K trans of healthy femoral heads was lower than the integration of necrotic, boundary, and other areas (F = 3.133, P = .036). The K ep value of healthy femoral heads was higher than the integration of lesion areas (F = 6.273, P = .001). The mean V e value of healthy femoral heads was smaller than that of the lesion areas (F = 3.872, P = .016). The comparisons of parameters between different areas and comparisons among healthy areas and lesion areas showed different results. ONFH is a complex ischemic lesion caused by changes in local microcirculation. It mainly manifests as increased permeability of the vascular wall, blood stasis in the posterior circulation, high intraosseous pressure in the femoral head, and decreased arterial blood flow. The application of DCE-MRI scanning to quantitatively analyze the visual manifestations of microcirculation after early ONFH is an ideal method to study the microcirculation changes of necrotic femoral heads.

Analysis of peripheral bone reconstruction after the failure of hip osteonecrosis treatment with porous tantalum rod implantation.

Failure of porous tantalum rod (PTR) implantation in treating early osteonecrosis of femoral head (ONFH) has been frequently reported, but the underlying mechanism remains uncertain, which raised the concern of its efficacy. The study aimed to discuss the underlying mechanism from the perspectives of bone reconstruction and pathological changes. Five patients with PTR implantation experienced total hip arthroplasty (THA) due to recurrent pain, whose femoral heads were collected as "tantalum group." Normal (fracture) and necrotic femoral heads were respectively collected (both n = 5) after THA. The bone quality and structure, biomechanical properties, and histopathological features were analyzed by micro-CT scanning, mechanical measurement, and histological examination. Both the tantalum group and necrotic group had significantly poorer bone quantity and quality than the normal group. Three-dimensional imaging reconstruction showed that the trabeculae of the tantalum group were poorest in quality. Significant differences in terms of bone quality, structure, and biomechanical properties were present between the inside and outside regions around PTR, which revealed abnormal bone reconstruction. Biomechanical analysis revealed inferior properties in the tantalum group and necrosis group. H&E staining demonstrated neutrophil infiltration among the peripheral trabeculae around PTR, and the inflammation cells were significantly more abundant than that in the normal and necrosis groups. Abnormal bone reconstruction around PTR was an important cause for failure of PTR implantation in the treatment of ONFH, which was related to biomechanical stress distribution and chronic inflammation infiltration. Insufficient biomechanical support and inflammatory trabeculae edema might account for the recurrent pain.

Minimally invasive surgical treatment of brucellar osteoarthritis complicated with early osteonecrosis of femoral head

Minimally invasive surgical treatment of brucellar osteoarthritis complicated with early osteonecrosis of femoral head

Osteonecrosis of the Femoral Head Safely Healed with Autologous, Expanded, Bone Marrow-Derived Mesenchymal Stromal Cells in a Multicentric Trial with Minimum 5 Years Follow-Up.

Background: Osteonecrosis (ON) of the femoral head represents a potentially severe disease of the hip where the lack of bone regeneration may lead to femoral head collapse and secondary osteoarthritis, with serious pain and disability. The aim of this European, multicentric clinical trial was to prove safety and early efficacy to heal early femoral head ON in patients through minimally invasive surgical implantation of autologous mesenchymal stromal cells (MSC) expanded from bone marrow (BM) under good manufacturing practices (GMP). Methods: Twenty-two patients with femoral head ON (up to ARCO 2C) were recruited and surgically treated in France, Germany, Italy and Spain with BM-derived, expanded autologous MSC (total dose 140 million MSC in 7 mL). The investigational advanced therapy medicinal product (ATMP) was expanded from BM under the same protocol in all four countries and approved by each National Competent Authority. Patients were followed during two years for safety, based on adverse events, and for efficacy, based on clinical assessment (pain and hip score) and imaging (X-rays and MRIs). Patients were also reviewed after 5 to 6 years at latest follow-up for final outcome. Results: No severe adverse event was recalled as related to the ATMP. At 12 months, 16/20 per protocol and 16/22 under intention-to-treat (2 drop-out at 3 and 5 months) maintained head sphericity and showed bone regeneration. Of the 4 hips with ON progression, 3 required total hip replacement (THR). At 5 years, one patient (healed at 2 years visit) was not located, and 16/21 showed no progression or THR, 4/21 had received THR (all in the first year) and 1 had progressed one stage without THR. Conclusions: Expanded MSCs implantation was safe. Early efficacy was confirmed in 80% of cases under protocol at 2 years. At 5 years, the overall results were maintained and 19% converted to THR, all in the first year.

An Automatic Classification of the Early Osteonecrosis of Femoral Head with Deep Learning

Osteonecrosis of Femoral Head (ONFH) is a common complication in orthopaedics, wherein femoral structures are usually damaged due to the impairment or interruption of femoral head blood supply. In this study, an automatic approach for the classification of the early ONFH with deep learning has been proposed. All femoral CT slices according to their spatial locations with the Convolutional Neural Network (CNN) are first classified. Therefore, all CT slices are divided into upper, middle or lower segments of femur head. Then the femur head areas can be segmented with the Conditional Generative Adversarial Network (CGAN) for each part. The Convolutional Autoencoder is employed to reduce dimensions and extract features of femur head, and finally K-means clustering is used for an unsupervised classification of the early ONFH. To invalidate the effectiveness of the proposed approach, the experiments on the dataset with 120 patients are carried out. The experimental results show that the segmentation accuracy is higher than 95%. The Convolutional Autoencoder can reduce the dimension of data, the Peak Signal- to-Noise Ratios (PSNRs) are better than 34dB for inputs and outputs. Meanwhile, there is a great intra-category similarity, and a significant inter-category difference. The research on the classification of the early ONFH has a valuable clinical merit, and hopefully it can assist physicians to apply more individualized treatment for patient.

Mid- to long-term results of modified non-vascularized allogeneic fibula grafting combined with core decompression and bone grafting for early femoral head necrosis

PurposeThe aim of this study was to determine mid-and-long term follow-up results of patients with early femoral head osteonecrosis who were treated by modified free vascularized fibular grafting combined with core decompression and bone grafting.MethodsForty-four patients at early ONFH were included in this study. Visual analog scale (VAS) pain scores, range of hip motion (ROM), and Harris hip score (HHS) were recorded to assess the clinical outcome; Western Ontario McMaster Osteoarthritis index (WOMAC) scores and Short Form 36 health survey (SF-36) were conducted to measure the living quality; X-ray film or magnetic resonance imaging (MRI) was used to evaluate radiographic progression; survivorship was defined as patients did not undergo the total hip arthroplasty (THA) or fusion at the last follow-up. Median follow-up was 7.4 years (6–8.2 years).ResultsThe mean VAS score, ROM, and HHS were significantly improved at the final follow-up compared with preoperative values (p < 0.001). Health assessment including WOMAC scores and SF-36 were also better than those preoperatively (p < 0.001). Seven patients progressed to Ficat III and the four patients progressed to Ficat IV with osteoarthritis. Eight patients who cannot tolerate the pain and had poor living quality underwent THA.ConclusionModified non-vascularized allogeneic fibula Grafting combined with core decompression and bone grafting could improve the clinical outcomes and enhance the quality of life for patients with early ONFH.

Comparison of sartorius muscle-pedicle and circumflex iliac deep bone flap grafts in the treatment of early non-traumatic osteonecrosis of femoral head in young adults

ObjectiveThe aim of this study was to retrospectively compare and evaluate the midterm curative effect of two different bone flap grafts in the treatment of early non-traumatic osteonecrosis of the femoral head (ONFH). MethodsA total of 180 patients (199 hips) with early non-traumatic ONFH received surgical treatment by sartorius muscle-pedicle bone flap graft (SMBF) (104 patients, 64 males and 40 females; mean age 34.67 ± 3.24 years) or circumflex iliac deep bone flap graft (CIDBF) (76 patients, 44 males and 32 females; mean age: 35.54 ± 3.37 years) from July 2004 to July 2009. The comparison between the groups was made with Harris score before and after surgery, length of incision, operative time, amount of bleeding, postoperative X-ray. Association Research Circulation Osseous (ARCO) staging was performed. ResultsThe preoperative Harris hip score of two groups were 68.26 ± 1.26 and 69.35 ± 1.31, respectively. Patients' ARCO staging indicated 36 hips of stage IIa, 115 hips of stage IIb and 48 hips of stage IIc. The etiology of ONFH mainly including hormones (93 patients), alcohol (64 patients) and other (23 patients). The mean follow-up time of SMBF and CIDBF groups were (51.78 ± 2.35) and (52.73 ± 3.71) months, respectively. The time of removing sutures, operation time, amount of bleeding and length of incision in SMBF group were superior to those in the CIDBF group, and those differences between the SMBF and CIDBF groups were not significant (all p values > 0.28). The Harris score between the two groups was similar after operation and postoperative 12 month, and the difference was not statistically significant (p > 0.05), whereas the difference of the postoperative 24 and 48 months was statistically significant (p ˂ 0.05). X-ray analysis showed improvement of osteonecrosis in both two groups after surgery, and as time went on, the total hip amount decreased, the replacement amount increased. ConclusionBoth bone flap grafts appear to be effective methods for treatment of early osteonecrosis of femoral head (ARCOⅡ), and the SMBF is a relatively simple technique and easy for mastering, and it is a reliable method for clinical application. Level of evidenceLevel III, Therapeutic Study.

Autologous Iliac Bone Graft Mixed with Blood Stem Cells for Early Femoral Head Osteonecrosis

Autologous Iliac Bone Graft Mixed with Blood Stem Cells for Early Femoral Head Osteonecrosis

Digital subtraction angiography in selection of the vascularized greater trochanter bone grafting for treatment of osteonecrosis of femoral head

The aim of this report is to present our experience on the use of the digital subtraction angiography (DSA) in selection of the vascularized greater trochanter bone grafting for the treatment of the osteonecrosis of femoral head (ONFH) in early stages. Between January 2005 and June 2007, DSA was used to evaluate the blood perfusion of the early stages ONFH in 32 patients (45 hips). There were 18 males and 14 females with an average age of 30 years old. Twenty-one hips were in ARCO stage I, and 24 in ARCO stage II. The arterial blood supply insufficiency was found in 22 hips by DSA, and the venous stasis in 23 hips. The hips with artery blood supply insufficiency received the vascularized greater trochanter bone grafting, and the hips with the venous stasis received the core decompression. All of patients were followed-up with an average of 4.8 years (ranging 2.4-6.6 years). The preoperative Harris Hip score (HHS) in the patients with arterial blood supply insufficiency was 48.18 ± 7.81 and the postoperative HHS was 93.27 ± 3.03. The preoperative HHS in the patients with venous stasis was 44.04 ± 6.40, and the postoperative HHS 92.65 ± .93. The postoperative DSA showed an improved perfusion of the femoral head in 44 hips. Our experience showed that DSA would help to select the appropriate procedure for treatment of ONFH in the early stage.

Loss of sympathetic nerve fibers in vital intertrochanteric bone cylinders lateral to osteonecrosis of the femoral head

ObjectivesAlthough etiology in osteonecrosis of the femoral head mainly depends on alterations of bone blood flow, vasoregulatory nerve fibers of the sympathetic and sensory nervous system have never been investigated in bone of osteonecrosis patients. This study aimed to demonstrate density of sympathetic and sensory nerve fibers in femoral head and, for comparison, adjacent periosteum, and synovium of the hip joint in patients with osteonecrosis. MethodsImmunofluorescence staining techniques were applied using specific nerve fiber markers. A total of 10 patients with early femoral head osteonecrosis (ARCO I-II), 10 with late femoral head osteonecrosis (ARCO III-IV), and 10 patients with osteoarthritis of the hip were investigated. ResultsIn the bone of the femoral head, density of sympathetic nerve fibers was lower in early and late osteonecrosis compared to osteoarthritis. There was a marked preponderance of sympathetic over sensory nerve fibers in bone of osteoarthritis patients, which was opposite in early and late femoral head osteonecrosis. In periosteum, density of sympathetic nerve fibers was similar in all three groups but density of sensory nerve fibers and cellularity were higher in early osteonecrosis compared to the other two groups. Discussion/ConclusionsDue to the different affinity of norepinephrine for α-adrenoceptors (high affinity) and β-adrenoceptors (low affinity), the loss of sympathetic nerve fibers relative to sensory nerve fibers in femoral head osteonecrosis might change the femoral head blood flow (towards α-adrenergic vasoconstriction). Higher density of sensory nerve fibers and cellularity in periosteum might indicate an inflammatory response in early osteonecrosis.

Treatment of early osteonecrosis of femoral head by core decompression and autograft of mesenchymal stem cell cultured in vitro under arthroscopy: experiment with rabbits

To observe the therapeutic effect of core decompression and autograft of mesenchymal stem cells (MSCs) cultured in vitro under arthroscopy in treatment of early osteonecrosis of femoral head. Thirty-six rabbits were made into models of early osteonecrosis of femoral head of the right leg, and then randomly divided into 3 equal groups: Group A group as control group, Group B group undergoing simple core decompression under arthroscopy by clearing out of necrotic bone, and Group C undergoing core decompression and implantation of MSCs. Four and 8 weeks later 6 rabbits from each group underwent roentgenography and then were killed with their femoral heads taken out to undergo histological examination. Four weeks later new bone was evident in the implantation field of Group C while fibrous tissues were evident in the femoral head of Group B. Pathological examination showed regular shape and normal density of femoral head in Group C and irregular shape and low density of femoral head in Group B. X-ray photograph 8 weeks after treatment showed that the femoral head articular surface of Group A collapsed, uneven density and defect of spongy bone were seen in Group B, and the shape of femoral head of Group C was regular without collapse and the original defect had been repaired. With strong osteogenic function, MSCs improve the repair of ischemic necrosis of femoral head and can be used in treatment of early osteonecrosis of femoral head via core decompression and autograft of MSCs cultured in vitro under arthroscopy.

Steroid-induced Early Changes in the Femoral Head and Hip Joint in Rats

Purpose: To determine if the early changes to the articular cartilage and synovium of the hip joint in relation to steroid-induced osteonecrosis of the femoral head is either as a preceding factor or as a secondary consequence in the pathomechanism. Materials and Methods: Thirty-two Sprague Dawley rats were divided into two groups, 16 receiving a steroid injection and 16 as a control group. Tissue samples of the hip joint were taken from 4 rats from each group every 4 weeks over a 16 week period. The specimens were investigated for the early changes to the articular cartilage, subchondral bone of the femoral head and the synovium after H & E staining and toluidine blue stain. Five histological criteria were applied to determine the cartilage status. Results: Histologically, there was a gradual increase in chondrocyte cloning in the steroid injection group. In addition, synovial hypertrophy and the enlargement of fatty cysts with the loss of hematopoietic cells were observed. Conclusion: Synovial hypertrophy and some evidences of articular cartilage degeneration associated with steroid-induced early femoral head osteonecrosis appears to be the result of a direct inflammatory reaction to the steroid injection. This suggests that early presentation of the pathologic lesion in the hip joint might occur without definitive radiological evidence of femoral head osteonecrosis.

Clinical on arthroscope treatment of early osteonecrosis of femoral head by autograft of mesenchymal stem cells

目的 探讨关节镜监视下髓芯减压自体骨髓间充质干细胞体外培养自体回植治疗早期股骨头缺血性坏死的方法及疗效.方法 根据ARCO分期,选取早期股骨头缺血性坏死病例13例,其中ⅠC期2例,ⅡA期4例,ⅡB期5例,ⅡC期2例.在实施髓芯减压术的同时植入体外分离培养获得的骨髓间充质干细胞.结果 经1.5年随访及磁共振检查,股骨头坏死体积由32.5%降至5.7%,Harris评分显著提高.结论 关节镜监视下髓芯减压并自体骨髓间充质干细胞体外培养回植安全、有效,对早期股骨头缺血性坏死患者为一种有效的治疗选择。