Avascular Necrosis Of Femoral Head Research Articles

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

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

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

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

Twenty-Three-Year-Old Collegiate Soccer Athlete With Bilateral Femoral Head Avascular Necrosis: A Case Report

A 23-year-old collegiate club soccer player reported to his athletic trainer right hip flexor pain and no recalled mechanism. Diagnostic imaging revealed bilateral avascular necrosis (AVN) of both femoral heads. Medical intervention included bilateral core decompression surgery. The majority of reported AVN cases are pediatric patients and adults over 50 years old, following trauma (i.e., femoral fracture) being the main risk factor. Although not seen often in athletic populations, athletic trainers should be aware of the possibility of AVN in patients. AVN is a life-altering condition and accurately documenting all patient encounters, and proper interprofessional collaboration is imperative for positive outcomes.

The effects of prophylactic tadalafil use on VEGF expression in the rabbit model of steroid-induced femoral head avascular necrosis.

The purpose of this study was to examine the effect of prophylactic tadalafil use on a steroid-induced femoral head avascular necrosis model in terms of microscopic, imaging, and molecular biological changes. Twenty-four New Zealand rabbits were divided into 3 equal groups. Eight rabbits were designated as the control group and did not receive treatment. Rabbits in group 1 (G1) received 0.1 mg/kg Escherichia coli lipopolysaccharide (LPS) intravenously and 40 mg/ kg methylprednisolone sodium succinate (MP) was administered intramuscularly for 3 days consecutively. Rabbits in group 2 (G2) were given 5 mg/kg tadalafil orally for 10 consecutive days. Starting on the eighth day, 0.1 mg/kg LPS was given, and following this 40 mg/kg MP injections were administered for 3 days. All animals were sacrificed 3 weeks after the final MP injection. Magnetic resonance imaging was performed, and bilateral femora were harvested. Half of the femoral head was stored for Vascular Endothelial Growth Factor (VEGF) examination with Western blot analysis. The other half was examined microscopically for the presence of osteonecrosis. In G1, 15 out of 16 hips (93%) of the 8 rabbits had osteonecrosis compared to 8 out of 12 hips (67%) of 6 rabbits in G2 (P > .05). The VEGF expression in G2 was significantly higher than in the control group and G1 (P < .05 and P < .001, respectively). There was no significant difference in VEGF expression between the control group and G1 (P > .05). This study has shown us that femoral head osteonecrosis can be reliably induced with LPS and corticosteroid, as described in the literature. Prophylactic tadalafil use did not decrease the occurrence of osteonecrosis significantly. However, it significantly increased VEGF expression in the femoral head independent of the effects of steroids and LPS.

Efficacy of autologous stem cell therapy in femoral head avascular necrosis: a comparative study

ObjectiveAvascular necrosis of the femoral head is a disease usually seen in middle-aged individuals. Although many aetiological factors have been blamed, there are still aetiological factors that have not been fully elucidated. Although treatment options show a wide range, early and appropriate treatment is of great importance to preserve the hip joint. In our study, we compared the results of core decompression and core decompression combined with bone marrow mesenchymal stem cell implantation in patients with avascular necrosis of the femoral head.Material methodIn this retrospective study, Steinberg stage 1–2 patients operated on for avascular necrosis of the femoral head between 2018 and 2023 were analysed. Separate groups were formed from patients who underwent isolated core decompression and core decompression + bone marrow mesenchymal stem cell implantation. Age, gender, Steinberg staging, aetiology of the disease, follow-up period, progression to hip arthroplasty, Vas scores, Harris hip scores (HHS), and complications were evaluated. Harris hip scores at preoperative and 2-year follow-up periods; VAS scores at preoperative, 3-month, 6-month, 1-year, and 2-year follow-up periods were analysed.ResultsIn the study, 44 patients were analysed. While 25 patients underwent core decompression only (group 1), 19 patients underwent core decompression and bone marrow mesenchymal stem cell implantation (group 2). The mean age of the patients in group 1 was 39.3 ± 6.5 years, and the mean age of the patients in group 2 was 38.4 ± 6.7 years. The mean follow-up was 31.85 ± 4.4 months in group 1 and 32.2 ± 4.1 months in group 2. Total hip arthroplasty was performed in 2 of the patients in group 1 (one of the patients underwent total hip arthroplasty at month 28 and the other at month 33).ConclusionThe treatment of avascular necrosis of the femoral head varies according to various staging methods. Early diagnosis of the disease and correct treatment are very important for the patient's quality of life in the future. In our research, we found that patients who received both core decompression and stem cell implantation for early-stage avascular necrosis of the femoral head exhibited decreased pain at the 6-month, 1-year, and 2-year follow-up examinations. Additionally, their hip function improved at the 24-month mark according to the HHS evaluation.

AYURVEDIC MANAGEMENT OF FEMORAL HEAD OF AVASCULAR NECROSIS WITH PANCHTIKTAKSHEER MAJJA BASTI AND MAHAMANJISHTHADI GHAN VATI: A CASE STUDY

Avascular necrosis (AVN) is a condition where there is interruption of the blood supply which proceeds to necrosis of bone components and causes collapse of bones. In Ayurveda it can be compared with a disease Asthimajjjagata Vata due to close resemblance in symptomatology and pathogenesis of both disease entities. The aim of this study is to find out an effective treatment protocol for it. The present case study is upon a 36-year-old male patient that diagnosed with avascular necrosis of femoral head having complaints of pain in left hip region for 6 months which was associated with difficulty in walking, sitting, squatting and climbing stairs which results to change in the gait. This patient was treated with Panchtikta Ksheer Majja Basti and Mahamanjishthadi Ghan Vati. Assessment was done after treatment and follow up of 15 days. The therapies yielded complete symptomatic relief from pain, tenderness, general debility and improvement in the gait. After the treatment pain was reduced significantly with improvement in range of movements. Even the patient was able to walk and climb stairs without pain and stiffness. There was a reduction in VAS pain scale and marked improvement was noticed.

The effect of inflammation on the course of experimental aseptic necrosis of femoral head

Aseptic necrosis of the femoral head is a staged process in which osteodestruction is replaced by the bone repair. The outcome of this disease may be characterized by severe discongruence of the hip joint area, disability of the patient. Recently, the research interest is drawn to molecular and cellular mechanisms of bone homeostasis disorders and ways of its correction. A number of studies have demonstrated the role of nonspecific inflammation in pathogenesis of aseptic necrosis. However, a more detailed study of dynamic changes in the activity of osteogenesis signaling pathways is required. The aim of this study was to assess the role of molecular patterns of inflammation and osteogenesis during aseptic necrosis of femoral head in experimental model. Surgical induction of aseptic necrosis of the femoral head was performed in 16 rats, which were removed biweekly from experiment (by 4 animals), for 8 weeks. The expression of genes encoding proteins involved in osteogenesis regulation was studied by qPCR with reverse transcription. Concentration of VCAM1, MMP9 proteins was assessed by immunoblotting. The results of our study demonstrated heterogenous dynamics of changes in molecular and cellular disorders associated with bone homeostasis regulation in pathogenesis of aseptic necrosis. For the first two weeks after surgical procedure, the expression of HIF1α and TNFα genes, as well as the concentration of MMP9 and VCAM1 proteins, were determined as predictor factors. After 1 month, VCAM1 protein concentration and TNFα gene expression acted as protector factors, whereas IL6 gene and MMP9 protein were considered predictive factors. After 6 weeks, the development of aseptic necrosis was promoted by expression of the IL4 gene, and after 8 weeks, by IL6 gene. Thus, an important role in regulation of osteoresorption belongs to nonspecific inflammation, which can be triggered by acute tissue hypoxia. A significant effect of the inflammation process persists up to 8 weeks after induction of avascular necrosis of femoral head. Pathogenesis of bone destruction is associated not only with an increased activity of osteoclastogenesis, but also with a decreased intensity of osteoblastogenesis. In general, the molecular and cellular pattern of bone homeostasis disorders varies depending on the stage of aseptic necrosis.

The correlation between transient osteoporosis of the hip and pregnancy: A review.

Transient osteoporosis of the hip is indubitably a comparatively infrequent entity affecting both men and women worldwide. Its occurrence in the course of pregnancy, specifically in the third trimester, and lactation are of paramount concernment. The exact association between transient hip osteoporosis and pregnancy is precarious. Etiology and potential pathophysiological mechanisms behind this correlation are still to be utterly defined. Magnetic resonance imaging is highly regarded as the gold standard imaging method for assiduous assessment of this disorder. Physicians of copious medical specialties should practice scrupulous techniques for early and pertinent diagnosis when pregnant women are presented with persistent hip pain, as differential diagnosis with femoral head avascular necrosis can be exceedingly arduous. Treatment is predominantly conservative with protected weight-bearing and analgesic medication in the first line of management. In terms of prognosis, the disease ordinarily resolves spontaneously after a few months. Further research is required in order to elucidate the ambiguity surrounding the establishment of globally approved diagnosis and treatment guidelines for pregnancy-associated transient hip osteoporosis. This paper aims to accentuate the significance of this particular disorder by providing a succinct review of the existing literature, augmenting clinicians' knowledge about the features of pregnancy-related transient proximal femur osteoporosis.

Icariin-loaded 3D-printed porous Ti6Al4V reconstruction rods for the treatment of necrotic femoral heads.

Avascular necrosis of the femoral head is a prevalent hip joint disease. Due to the damage and destruction of the blood supply of the femoral head, the ischemic necrosis of bone cells and bone marrow leads to the structural changes and the collapse of the femoral head. In this study, an icariin-loaded 3D-printed porous Ti6Al4V reconstruction rod (referred to as reconstruction rod) was prepared by 3D printing technology. The mechanical validity of the reconstruction rod was verified by finite element analysis. Through infilling of mercapto hyaluronic acid hydrogel containing icariin into the porous structure, the loading of icariin was achieved. The biological efficacy of the reconstruction rod was confirmed through in vitro cell experiments, which demonstrated its ability to enhance MC3T3-E1 cell proliferation and facilitate cellular adhesion and spreading. The therapeutic efficacy of the reconstruction rod was validated in vivo through a femoral head necrosis model using animal experiments. The results demonstrated that the reconstruction rod facilitated osteogenesis and neovascularization, leading to effective osseointegration between bone and implant. This study provides innovative strategy for the treatment of early avascular necrosis of the femoral head. STATEMENT OF SIGNIFICANCE: The bioactivity of medical titanium alloy implants plays an important role in bone tissue engineering. This study proposed a medicine and device integrated designed porous Ti6Al4V reconstruction rod for avascular necrosis of the femoral head, whose macroscopic structure was customized by selective laser melting. The bionic porous structure of the reconstruction rod promoted the growth of bone tissue and formed an effective interface integration. Meanwhile, the loaded icariin promoted new bone and vascular regeneration, and increased the bone mass and bone density. Therefore, the implantation of reconstruction rod interfered with the further development of necrosis and provided a positive therapeutic effect. This study provides innovative strategies for the treatment of early avascular necrosis of femoral head.

Comparing pinning in situ andcapital realignment procedures forsevere, stable slipped capital femoral epiphysis: a systematic review.

In severe, stable slipped capital femoral epiphysis, it is unclear whether pinning in situ (PIS) or capital realignment procedures (CRPs) are superior. Our primary aim was to compare patient-reported outcome measures (PROMs) following each strategy. Secondary aims were to compare rates of femoral head avascular necrosis (AVN) and complications. MEDLINE, Embase and Cochrane databases were searched according to an agreed strategy. Narrative review articles, case reports, letters to the editor and articles not written in English were excluded. The risk of bias was assessed using the Newcastle-Ottawa Scale. Of the 132 citations identified, 127 were excluded following de-duplication and application of the exclusion criteria. Three observational studies comparing PIS with CRP and two case series considering CRP alone were identified. One article was considered fair quality, and four articles were considered poor. In total, 198 hips from five studies were included (66 PIS, 132 CRP). PIS was associated with moderate-good functional outcomes, and CRP with good-high outcomes. Two comparative studies reported significantly better PROMs following CRP. AVN was reported in 1.5% following PIS and 10.6% following CRP. Regarding other complications, chondrolysis occurred in 3.0% following PIS and 2.4% following CRP. Femoroacetabular impingement rates were markedly higher following PIS (60.6% versus 2.3%). Reoperation rates were also greater following PIS (34.5% versus 13.3%). PIS tends to be associated with favourable AVN rates, but CRP with favourable PROMs and complication rates. However, comparisons were drawn from heterogeneous studies lacking long-term follow-up. Further high-quality research is required.

Smith c/b ratio and teardrop figure measurements; Can it be used in the follow-up of patients who underwent salter innominate osteotomy?

This study aimed to investigate the effectiveness of radiological parameters used in the follow-up of patients who underwent salter innominate osteotomy (SIO) for the treatment of developmental dysplasia of the hip. Acetabular index, c/b ratio, teardrop width, femoral head teardrop distance (TDD), and acetabular teardrop angle were measured on anteroposterior pelvic radiographs of patients who underwent SIO between 2017 and 2020. The patients were divided into 2 groups according to their preoperative Tönnis stage. Twenty-five (51%) hips of 23 patients with Tönnis stage 2 were classified into group 1, and 24 (49%) of 17 patients with Tönnis stages 3 and 4 were classified into group 2. Changes in radiologic parameters over time and between the groups were statistically evaluated. The study included 49 hips of 40 patients (37 female and 3 male). The age at surgery was 26.53 (18-53) months. After a mean follow-up period of 33.7 ± 12.8 months, there was no statistically significant difference between Groups 1 and 2 in terms of clinical, radiological and femoral head avascular necrosis results (P = .591, P = 956, P = .492). The changes in radiological parameters over time and between groups were statistically significant. (P < .001). Only the TDD and c/b ratio were significantly different between groups 1 and 2 (P = .002 and P < .001, respectively). In our study, along with acetabular index, the c/b ratio, teardrop width, TDD, and acetabular teardrop angle significantly changed after SIO and could be used as a guide for patient follow-up.

A Molecular Troika of Angiogenesis, Coagulopathy and Endothelial Dysfunction in the Pathology of Avascular Necrosis of Femoral Head: A Comprehensive Review.

Avascular necrosis of the femoral head (ANFH) is a painful disorder characterized by the cessation of blood supply to the femoral head, leading to its death and subsequent joint collapse. Influenced by several risk factors, including corticosteroid use, excessive alcohol intake, hypercholesterolemia, smoking and some inflammatory disorders, along with cancer, its clinical consequences are thrombus formation due to underlying inflammation and endothelial dysfunction, which collaborates with coagulopathy and impaired angiogenesis. Nonetheless, angiogenesis resolves the obstructed free flow of the blood by providing alternative routes. Clinical manifestations of early stage of ANFH mimic cysts or lesions in subchondral bone, vasculitis and transient osteoporosis of the hip, rendering it difficult to diagnose, complex to understand and complicated to cure. To date, the treatment methods for ANFH are controversial as no foolproof curative strategy is available, and these depend upon different severity levels of the ANFH. From an in-depth understanding of the pathological determinants of ANFH, it is clear that impaired angiogenesis, coagulopathy and endothelial dysfunction contribute significantly. The present review has set two aims, firstly to examine the role and relevance of this molecular triad (impaired angiogenesis, coagulopathy and endothelial dysfunction) in ANFH pathology and secondly to propose some putative therapeutic strategies, delineating the fact that, for the better management of ANFH, a combined strategy to curtail this molecular triangle must be composed rather than focusing on individual contributions.

Severity of hip dysplasia as the major factor affecting outcome of closed reduction in children with hip dysplasia.

The objective of this study was to analyze a multicenter cohort of children with developmental dysplasia of the hip (DDH) who underwent treatment with closed reduction. We sought to report the effects that severity of hip dysplasia and age have on the development of femoral head avascular necrosis (AVN) and the need for additional procedures. All patients with DDH and minimum 2 years of follow-up who underwent closed reduction were identified. The following variables were recorded: sex, laterality of hip involvement, age, acetabular index (AI), and International Hip Dysplasia Institute (IHDI) grade. The effects of patient age and pre-procedure IHDI grade on the rate of AVN and need for additional procedures after the closed reduction were analyzed using an alpha of 0.05. Seventy-eight total hips were included in the final analysis. The average patient age was 12 months. AVN of the femoral head was reported in 24 hips (30.8%) and 32 hips (41.0%) required additional surgery. Higher pre-op IHDI grade was associated with higher risk of developing Bucholz-Ogden grades II-IV AVN of the femoral head ( P = 0.025) and requiring additional surgery ( P = 0.033) regardless of patient age. There were no statistically significant differences for the effect of age on the measured outcomes ( P > 0.05). These findings suggest that severity of dislocation (IHDI grade) is a significant risk factor for the development of AVN and need for additional procedure.

Ayurvedic management of Avascular Necrosis of Femoral Head - A Case Study

Osteonecrosis is a degenerative bone condition characterized by the death of cellular components of the bone secondary to an interruption of the subchondral blood supply. Also known as avascular necrosis. Avascular necrosis can be correlated to Asthi Majja Gata Vata and / or Asthi Dhatu Kshaya manifesting symptoms like Bhedo Asthi Parvanam (breaking type of pain in bones and joints), Sandhi Shula (joint pain), Mamsakshaya (muscular wasting), Balakshaya (weakness), Aswapna Santataruk (disturbed sleep due to continuous pain) and Sandhi Shaithilyam (afflicted joints) with Shiryanti Iva Cha Asthini Durbalani (destruction of bony tissue causing generalized weakness), Pratata Vata Rogini (other aggravated features of Vata). A wide range of treatment modalities have been mentioned in Ayurveda that are effective in such manifestations. A case of AVN with bilateral femoral head was treated with Shodhan followed by Brimhan. For Shodhan Jaladhauti, Bashpa Swedan, Vaitaran Basti and Manjhishthadi Niruha Basti was planned and Shashtishali Pinda Sweda and Panchatikta Kshir Basti were given along with internal medication. Patient was observed for symptomatic improvements based on the assessment done by the Harris Hip Score and the range of movement of the hip joint before and after treatment. The therapy provided marked relief in pain with improvement in gait and improved quality of life. Ayurvedic management provides significant relief and improves the quality of life.

Avascular necrosis of femoral head following COVID-19 infection.

It is crucial to be aware of post-COVID-19 non-pulmonary complications. Avascular necrosis (AVN) is one of these complications. It should be noted that the risk of AVN persists in individuals who have recovered from the COVID-19 infection. The current study aims to report several cases of AVN after being infected with SARS-CoV-2. This is a single-centre retrospective case series conducted over a 2-year period (January 2021-December 2022) involving individuals who developed AVN after being infected with COVID-19. The study included a total of 17 patients. The mean age of patients was 38.65±6.1 years. Twelve of them were male (70.6%) and five were female (29.4%), with a ratio of 3:1. The mean BMI of the patients was 28.3±2.4kg/m2. Eleven (64.7%) patients reported administering steroid injections throughout the infection course. The mean interval between COVID-19 infection and presentation to the clinic was 6.53 months. The majority of patients (82.3%) complained of bilateral hip pain. Limping was observed in 47% of the cases. MRI showed AVN in all cases. Bilateral core decompression was performed in five cases (29.4%), total hip replacement in three cases (17.6%), and conservative treatment in nine cases (53%). The ongoing pandemic may have many long-term sequelae. There is a risk of developing AVN after COVID-19.

A RARE CAUSE OF RADICULOPATHY: FEMORAL HEAD AVASCULAR NECROSIS

Insufficient blood flow to the proximal femur causes osteonecrosis of the femoral head, which is known as femoral head avascular necrosis (AVN). The underlying pathogenesis is unclear, risk factors are likely to influence microcirculation somewhat, but this has not been confirmed by research. In more than 75% of cases, avascular necrosis affects the femoral head. Methods: From August 2019 to March 2022, 4 patients with FBAN were analyzed retrospectively. The findings seen in the hip MRI radiographs of the patients were reported radiologically as FBAN. It was staged with the Ficat and Arlet classifications. Visual analog scale (VAS) was used in the current clinics of the patients. Results: Patients with severe back, hip, and leg pain whose clinic and radiology do not match with lumbar pathology should plan a hip MRI. Because of this, it may be misleading for people with severe radiculopathy, and this radiculopathy may not even be real. The pain is really coming from the hip, but it is often felt in the lumbosacral region and the buttocks. This makes it easy to make the wrong diagnosis.

Role of a Panchatikta Ksheer Basti and Pipplayadi Anuvasna Basti on Conservative Management of Avascular Necrosis of the Bilateral Femoral Head (Asthi Majja Gata Vata)

The most typical form of bone necrosis is avascular necrosis (AVN) of the femoral head. The goals of AVN treatment are to maintain structure, function and pan alleviation. Numerous surgical techniques are used to treat the problem, but they are all expensive and have a bad prognosis. These procedures include drilling and inserting bone grafts, performing modified Whitman or Colonna reconstructions and inserting prostheses. Avascular necrosis symptoms are more comparable to Asthivha Srotodusti Vikara (musculoskeletal origin illnesses) and can be taken into consideration with Gambhir Avastha (chronic stage). The goal of the current case study was to assess the effectiveness of the Ayurvedic system in the conservative management of AVN. In the current instance a 34 yrs male was diagnosed with AVN of bilateral hip joint and was treated with Panchtikta Ksheera Basti, Pipplayadi Anuvasna Basti and other drugs. Based on the patient’s sign and symptoms both before and after treatment we looked for symptomatic improvements. The gait, discomfort, tenderness and range of movement were significantly improved as a result of the therapy. Ayurvedic principles conservative therapy of AVN significantly reduced signs and symptoms while enhancing quality of life.

Ursolic acid alleviates steroid-induced avascular necrosis of the femoral head in mouse by inhibiting apoptosis and rescuing osteogenic differentiation

Steroid-induced avascular necrosis of femoral head (SANFH) is a common disorder worldwide with high disability. Overdose of glucocorticoid (GC) is the most common non-traumatic cause of SANFH. Up until now, there are limited therapeutic strategies for curing SANFH, and the mechanisms underlying SANFH progression remain unclear. Nevertheless, Osteogenic dysfunction is considered to be one of the crucial pathobiological mechanisms in the development of SANFH, which involves mouse bone marrow mesenchymal stem cells (BMSCs) apoptosis and osteogenic differentiation disorder. Ursolic acid (UA), an important component of the Chinese medicine formula Yougui Yin, has a wide range of pharmacological properties such as anti-tumor, anti-inflammatory and bone remodeling. Due to the positive effect of Yougui Yin on bone remodeling, the purpose of this study was to investigate the effects of UA on dexamethasone (DEX)-induced SANFH in vitro and vivo. In vitro, we demonstrated that UA can promote mouse BMSCs proliferation and resist DEX-induced apoptosis by CCK8, Western blotting, TUNEL and so on. In addition, vitro experiments such as ALP and Alizarin red staining assay showed that UA had a beneficial effect on the osteogenic differentiation of mouse BMSCs. In vivo, the results of H&E staining, immunohistochemistry staining, Elisa and micro-CT analysis showed that UA had a bone repair-promoting effect in SANFH model. Moreover, the results of Western blot and TUNEL experiments showed that UA could delay the disease progression of SANFH in mice by inhibiting apoptosis. Overall, our study suggests that UA is a potential compound for the treatment of SANFH.

The use of extracorporeal shock wave therapy (ESWT) in treating osteonecrosis of the femoral head (AVNFH): a retrospective study.

As most of the cases of avascular necrosis (AVN) in Saudi Arabia is seen in young population and as literature showed good effect of extracorporeal shock wave therapy (ESWT) in reducing pain and oedema in avascular necrosis and delaying the need of surgical intervention. Our purpose of this study is to assess the effectiveness of ESWT in reducing pain, improving range of motion (ROM) and delaying the surgical intervention in patient with AVN of femoral head and compare our results to published literature. We have treated 24 patients, 13 males and 11 females with a mean age of 29 years (range 14-48) with 34 hips affected. There were 14 unilateral and ten bilateral lesions. In our series 11 out of 24 patients (45.8%) were due to sickle cell disease. Other causes included idiopathic in five patients (20.8%), corticosteroids use and systemic lupus erythematous in three patients each (12.5% each) and post-traumatic AVN in two patients (8.3%). Extracorporeal shock wave therapy was implanted in FICAT stage I, II and III. All patients had two sessions of extracorporeal shock wave therapy, four to six weeks apart, each with 4000 impulses divided into four points. Radiological and MRI assessment were performed at regular time intervals with a minimum follow-up of two years. Clinical assessment was based on Visual Analog Scale and Harris Hip Score (HHS). The end point outcome measurement was the need for any operative intervention. Operative intervention was necessary in eight out of 34 hips (23.5%), within an average of 2.5 years (range 1 to 5 years). A hip salvage was achieved in 76.5%. Function was improved with the Harris Hip Score from a mean of 54.6 to 80.4 (P value using paired t test ≤ 0.05). Pain assessed with Visual Analog Scale improved from 5.73 to 2.75 (P value using paired t test ≤ 0.05). We do recommend the use of ESWT in treating AVN of bone whether of femoral head or other sites prior to the collapse of the articular surface. Further studies are needed to compare using two or more sessions as well as using four or six points for ESWT.

Study on Avascular Necrosis of Femoral Head in Ayurveda with Its Management – A Case Series Study

ABSTRACT Avascular necrosis (AVN) often affects bones with a single terminal blood supply, such as the femoral head, carpals, talus, and humerus. Femoral head is one of the most common sites for AVN and its cause can be primary or secondary to other pathology. It occurs because of an interruption in the blood supply to the femoral head that causes bone death. It was first described in 1738 by Munro. Treatment depends on the severity of the disease, as well as the patient’s age and general health. Treatment outcomes correlate directly with the stage of the disease and no medical treatment has proven effective in preventing or arresting the disease process. Hence, in this case series study, four patients presenting with similar complaints of pain and stiffness in the hip joint (right/left/bilateral) and difficulty in walking and climbing stairs were studied. All of the patients were adults above 30 years and included two male and two female patients. Examinations of the patients were done both according to modern and Ayurvedic parameters. The subjective and objective criteria assessed before and after treatment included the number of joints involved, gait, muscle wasting, straight leg raise test, pain, tenderness, stiffness, and decreased range of motion. Astavidha and Dashavidha Pariksha were done for all the patients. Detailed history was taken to evaluate the specific Nidanas and based on the Lakshana and the Nidanas, the involved Dosha, Dushya, Agni, and Srotas were evaluated and the Samprapti was designed accordingly for each patient separately. Diagnosis was confirmed on X-rays or magnetic resonance imaging of the hip joints. These cases were studied taking the etiologies, the clinically manifested signs and symptoms into consideration and correlated with the disease Asthi-Majjagata Vata mentioned in the classics. Ayurvedic management principles were adopted accordingly such as Nidan Parivarjanam, Deepan-Pachana, Snehapana, Abhyanga, Nadisveda, and Basti along with internal medicines and mobilization exercises. The symptoms such as pain and stiffness improved with just 7 days of treatment and by the completion of the Tiktakshira Basti, the patient had significant improvement in the signs and symptoms such as pain, stiffness, tenderness, and restricted mobility. On discharge, all the patients had overall health improvement. Follow-up of the patients was advised after 15 days from discharge.