Femoral Head In Young Patients Research Articles

Osteonecrosis of femoral head in young patients with femoral neck fracture: a retrospective study of 250 patients followed for average of 7.5 years

ObjectiveTo investigate the risk factors for osteonecrosis of the femoral head (ONFH) after the treatment of femoral neck fracture in patients under 60 years old.MethodsA total of 250 cases of femoral neck fracture treated at 3 hospitals in Xuzhou from January 2002 to January 2016 were studied. The patients were followed up for 1~15 years, and the clinical data on femoral head necrosis after the femoral neck operation were analysed retrospectively. Risk factors were recorded, including age, gender, preoperative traction, time from injury to operation, reduction method, type of reduction, BMI, ASA classification, and quality of reduction. Logistic regression analysis was used to evaluate the independent risk factors for ONFH after treatment of femoral neck fracture.ResultsThe duration of follow-up was 1~15 years, with an average of 7.5 years. None of the 250 patients had fracture non-union, but 40 (16%) had necrosis of the femoral head. The time to necrosis of the femoral head was 1~7 years after the operation, with an average of 3.8 years. Univariate analysis showed that the type of fracture, the quality of reduction, the removal of internal fixation, BMI and ASA classification were risk factors affecting necrosis of the femoral head in patients with femoral neck fracture, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that internal fixation, fracture type (displacement), reduction quality (dissatisfaction), BMI (> 25), and ASA grade (III + IV) were independent risk factors affecting femoral head necrosis in patients with femoral neck fracture.ConclusionA variety of high-risk factors for femoral head necrosis are present after surgery with hollow compression screws for femoral neck fracture in adults. Removal of internal fixation, type of fracture, quality of reduction, BMI, and ASA classification were the most important risk factors influencing the development of femoral head necrosis. During treatment, there should be some targeted measures to reduce the incidence of necrosis of the femoral head.

Bipolar versus total hip arthroplasty in the treatment of avascular necrosis of the femoral head in young patients.

The authors evaluate medium-term results of bipolar and total hip arthroplasty as a treatment for avascular necrosis of the femoral head. Between 1990 and 2000, 57 hips (45 patients) were treated with a bipolar (BHA: 37 hips) or total hip arthroplasty (THA: 20 hips) depending on the radiographic and macroscopic aspect of the acetabulum. At surgery, all patients were under 65 years of age (average: 45.09 years). All had the same cementless hydroxylapatite coated femoral stem inserted through an anterolateral approach. The BHA were followed during a mean of 4.49 years. One BHA was lost to follow-up. Seven out of 36 hips (19.44%) were considered failures: three due to a poor functional result (Harris Hip Score (HHS) <70) and four which needed conversion to THA for groin pain. Two hips were revised for periprosthetic fracture. Twenty BHA (55.56%) had a good or excellent result (HHSY80). The THA were followed for a mean of 4.32 years. One THA was lost to follow-up. Four out of 19 hips (21.05%) were considered as failures. Three due to a poor functional result (HHS<70) and one which needed cup revision for recurrent dislocation. Fifteen THA (78.95%) had a good or excellent functional result (HHSY80). BHA as a treatment of avascular necrosis of the femoral head in young patients preserves bone stock for later revisions and can lead to excellent results. But the outcome seems less predictable than after THA. Groin pain associated to BHA can be treated successfully with conversion to THA if necessary. (Hip International 2002; 2: 142-9).

Treatment of osteonecrosis of femoral head in young patients by surface replacement of femoral head

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Osteonecrosis of hip is a pathological condition that affects usually young adults. Articular surface replacement (ASR) is considered to be a viable option in young patients. The study was done with the aim to analyse and to recommend the management of osteonecrosis of femoral head in young patients by surface replacement of femoral head as ideal procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The present study was conducted in 30 patients with osteonecrosis of the femoral head who attended to OPD at Santhiram Medical College and General Hospital, Nandyal, A.P during the period of April 2016 to September 2017. Articular surface replacement of the femoral head was the surgical procedure done in all the patients. The success of the treatment was analysed by Harris hip scoring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Maximum number of patients (60%) was below 40 years of age. Male dominance (77%) was seen in the study. According to Ficat and Arlet classification 12 cases (40%) were under the category of stage II-B and 18 cases (60%) were of stage III. Postoperatively about 90% of patients had postoperative Harris hip score of &amp;gt;80 points. Surgery was succeeded in 10 hips of stage II-B and 15 hips in stage III. According to Harris hip scoring excellent results were obtained in 15 (50%), good in 12 (40%), fair in 2 (6.67%) and poor result 1 (3.3%) patient.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The study concludes that the surface replacement is an anatomical hip arthroplasty with preservations of more than 70% of bone stock of femoral head and the ability of the patients to sit cross-legged and squat, which is the desire of the Indian population.&lt;/p&gt;

Long-term results of rotational acetabular osteotomy for osteonecrosis with collapse of the femoral head in young patients.

The surgical treatment of osteonecrosis with collapse of the femoral head is still controversial. The purpose of this study was to investigate the clinical outcome of rotational acetabular osteotomy by Ninomiya and Tagawa for osteonecrosis of the femoral head in young patients. Rotational acetabular osteotomy was performed in 202 consecutive patients between 1995 and 2003. Among them, rotational acetabular osteotomy with osteonecrosis of the femoral head was performed in 31 patients (42 hips). The mean age at the time of surgery was 31.2years (range 16-45). The mean duration of follow-up was 16.1years (range 13.1-21years). The mean preoperative Japanese Orthopedic Association hip score of 56.8 points improved to a mean of 72.4 points at the final follow-up. The 10-year survival rate with conversion to total hip arthroplasty as an end-point was 91.9%, and the 15-year survival rate was 75.5%, the 20-year survival rate was 67.9%. The conversion to total hip arthroplasty was performed in nine hips. The average time to the conversion to total hip arthroplasty was 12.1years. Even though the necrotized range is wide, if normal cartilage remains on the lateral side of the femoral head, it can be utilized for the weight-bearing region by laterally rotating the acetabulum. Since the outcome was favorable, we believe that this is a valuable treatment option for this disease.

Arthroscopic-assisted retrograde mosaicplasty for an osteochondral defect of the femoral head without performing surgical hip dislocation.

Osteochondral autograft transplantation (mosaicplasty) for the osteochondral defects of the femoral head is generally performed with safe dislocation of the hip joint. Here, we present a 27-year-old male patient who had a symptomatic osteochondral defect of the femoral head and underwent mosaicplasty applied by hip arthroscopy without surgical hip dislocation. The preoperative radiological evaluation showed a focal osteochondral defect on the weight-bearing surface of the femoral head. With the assistance of hip arthroscopy, the defect area was reconstructed with osteochondral plug, which was taken from the ipsilateral knee, inserted in a retrograde fashion, and positioned with the spherical surface of the femoral head cartilage under fluoroscopic and arthroscopic control. At the final follow-up (26 months postoperatively), he had full range of motion (ROM) without pain and radiographic evaluation showed near complete incorporation of the graft with preservation of the native joint space. Mosaicplasty can be applied in a retrograde fashion with the assistance of hip arthroscopy without using surgical hip dislocation and may be an alternative treatment option for the osteochondral defects of the femoral head in young patients.

The rates of wear of X3 highly cross-linked polyethylene at five years when coupled with a 36 mm diameter ceramic femoral head in young patients.

Polyethylene wear debris can cause osteolysis and the failure of total hip arthroplasty. We present the five-year wear rates of a highly cross-linked polyethylene (X3) bearing surface when used in conjunction with a 36 mm ceramic femoral head. This was a prospective study of a cohort of 100 THAs in 93 patients. Pain and activity scores were measured pre- and post-operatively. Femoral head penetration was measured at two months, one year, two years and at five years using validated edge-detecting software (PolyWare Auto). At a mean of 5.08 years (3.93 to 6.01), 85 hips in 78 patients were available for study. The mean age of these patients was 59.08 years (42 to 73, the mean age of males (n = 34) was 59.15 years, and females (n = 44) was 59.02 years). All patients had significant improvement in their functional scores (p < 0.001). The steady state two-dimensional linear wear rate was 0.109 mm/year. The steady state volumetric wear rate was 29.61 mm(3)/year. No significant correlation was found between rate of wear and age (p = 0.34), acetabular component size (p = 0.12) or clinical score (p = 0.74). Our study shows low steady state wear rates at five years in X3 highly cross-linked polyethylene in conjunction with a 36 mm ceramic femoral head. The linear wear rate was almost identical to the osteolysis threshold of 0.1 mm/year recommended in the literature.

Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations.

Femoral neck fractures in young patients are usually caused by a high-energy trauma, which results in a perpendicular fracture. Although efforts are focused on preserving the femoral head in young patients, vertical femoral neck fracture is a problematic orthopedic injury due to the domination of shear forces. Due to controversy regarding which fixation method is the best choice, the purpose of this study was to find the most stable fixation method for this kind of fracture. This study includes experimental testing on cadaveric bone samples and finite element analysis (FEA) for three fracture fixation techniques, namely cannulated screws (CSs), dynamic hip screw with derotational screw (DHS + DS), and proximal femoral locking plate (PFLP). Experimental results of bone-implant stiffness, average femoral head displacement, failure load, failure energy, and relative position of the fractured fragments indicate that DHS + DS offers the strongest structure for stabilizing a vertical femoral neck fracture. Experimental data and FEA results both indicate that under static loading, the DHS + DS method of fixation produces the lowest femoral head displacement and interfragmentary movement, followed by PFLP and then CSs. The results of this research suggest that, based on the clinical assumption that a restricted weight-bearing regimen is recommended in the postoperative rehabilitation protocol, the DHS + DS method of fixation is a better choice compared to CSs and PFLP for a vertical femoral neck fracture fixation in young adults.

Common factors associated with osteonecrosis of the femoral head in young patients requiring total hip arthroplasty.

Osteonecrosis of the femoral head is a pathologic condition that commonly affects young patients and requires treatment with total hip arthroplasty (THA). The most common factors associated with osteonecrosis in young patients have not been previously described in the literature. A retrospective study was conducted to describe the most common factors associated with osteonecrosis in patients aged 35 or younger requiring a primary THA. This study included 235 patients and found that the most common factor associated with osteonecrosis was corticosteroid use (61%), followed by idiopathic causes (11%), trauma (9%), other causes (8%), haemoglobinopathies (7%), and alcoholism (3%). There was no significant difference in age between risk groups (p-value = 0.35), however there were significant differences in sex (p-value = 0.02) and unilateral versus bilateral surgery (p-value<0.01). Several factors are associated with the development of osteonecrosis of the femoral head in young patients, and these factors should be given consideration in determining disease aetiology and counselling patients.

Pathologic proximal femoral fracture complicating aneurysmal bone cyst: management and alternatives of fixation in eight patients

Pathologic proximal femoral fracture complicating an aneurysmal bone cyst is a situation sometimes met in clinical practice. It combines the difficulties of tumor eradication, reconstruction of the created bone defect and rigid fixation of the fracture with preservation of the femoral head in young patients. This study included eight patients who presented with pathologic proximal femoral fractures that proved to be aneurysmal bone cysts. There were six women and two men. The ages ranged from 18–28 years. Surgical treatment consisted of curettage and grafting of the lesion and internal fixation of the fracture. Four internal fixation devices were used. A dynamic hip screw was used in three patients, a 130°-angled blade plate in two patients, a condylar blade-plate in two patients and in one patient with severe bone loss, a barrel plate (150°) was used with a fibular graft inserted inside the barrel and impacted into the femoral head. Follow-up ranged from 6–42 months. All fractures united. No recurrence of the tumor was seen until the latest follow-up. Failure of fixation occurred in one patient after fracture collapse and migration of the dynamic hip screw. Overall results were excellent in six patients and good in two patients (using modified Hospital for Special Surgery score). The ideal treatment plan includes effective curettage through a wide exposure in addition to cancellous bone grafting and rigid internal fixation with the optional use of a fibular strut graft in difficult cases. All devices designed for the proximal femur can be used provided that there is anatomical reduction and rigid fixation.

Reversed flow lateral circumflex femoral vessels as recipients for free fibular grafting in treatment of femoral head osteonecrosis

Free fibular bone grafting is an effective treatment for early osteonecrosis of the femoral head in young patients. However, recipient vessels are often small rendering microvascular anastomosis difficult. We have developed a novel technique using retrograde flow through the branches of the lateral circumflex femoral artery to use the proximal end of the artery as the recipient vessel. A vessel diameter of up to 5 mm is obtained providing a good match with the peroneal vessels. We used this technique to perform vascularized bone grafting of the femoral head in 10 patients with Ficat grade 2 and 3 osteonecrosis. Pulsatile retrograde flow from the lateral circumflex femoral artery was observed in each case. Retrospective review gave a median follow up of 52 months (range 17-99). Symptoms improved in all 10 cases. There was no radiological deterioration over the period of follow-up in eight cases. One patient underwent conversion to a total hip replacement 24 months after surgery. These results compare favorably with other studies. The lateral circumflex femoral artery turnover technique is a reliable and useful technique in vascularized bone grafting of the femoral head.

Femoral Resurfacing in Young Patients with Hematologic Cancer and Osteonecrosis

Resurfacing hemiarthroplasties were performed to treat advanced osteonecrosis of 20 femoral heads in 14 patients (median age, 19.8 years; range, 15.1-27.4 years), treated for hematologic cancer in childhood or adolescence. Seven hips in five patients were revised to total hip arthroplasties (THA) because of pain; three of these showed radiographic loosening of the femoral head resurfacing component. The median time from resurfacing to revision was 2.4 years (range, 0.9-4.8 years). Marginal Cox-regression analysis, adjusting for correlations owing to bilateral involvement, showed positive association of revision-free survival of the prosthesis with patient's age; time from resurfacing to the end of anticancer therapy, end of glucocorticosteroid therapy; percentage of joint space at the last radiograph; and size of the lesion has a negative association with revision-free survival. Because of this study's exploratory nature, p values were not adjusted for the number of statistical comparisons. Among 14 patients, the probability of not requiring resurfacing prosthesis revision was 66% (SE, +/-15%; 95% CI, 44%-100%) at 3 years. Osteonecrosis of the femoral head in young patients treated for hematologic cancer in childhood or adolescence poses a serious challenge to the orthopaedic surgeon. The data of this preliminary study suggest that in selected patients resurfacing hemiarthroplasty may delay the need for THA for 3-7 years. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Osteosynthesis for a T-Shaped Fracture of the Femoral Neck and Trochanter: A Case Report

Ipsilateral fractures of the femoral neck and trochanter are uncommon. We report a 30-year-old man with a T-shaped fracture separating the trochanter and neck from the head. He underwent osteosynthesis using a dynamic compression plate, screws, and pins. Bone union occurred 4 months postoperatively. At the one-year follow-up, the patient was free of pain and had no evidence of avascular necrosis. It is important to preserve the femoral head in young patients by preventing further compromise of the tenuous blood supply.

Result of Sugioka's Transtrochanteric Osteotomy for Osteonecrosis of Femoral Head

Purpose: The results of Sugioka's transtrochanteric rotational osteotomy are controversial. While many Japanese studies have reported favorable results, European and American studies have been disappointing. We present the results of Sugioka's rotational osteotomy for extensive osteonecrosis of the femoral head in young patients. Methods and Materials: Between April. 1994 and May. 2004, Sugioka's osteotomy was performed for osteonecrosis involving a large part of the weight bearing area on 49 hips (46 patients). Of these 49 hips, 45 (43 patients) were available for follow-up. The patients were followed up for at least 2 years with an average of 52 months (range: 24-132 months). The major causes of osteonecrosis were chronic alcohol abuse in 33 hips. The mean age of the patients at the time of surgery was 31 years (range: 21-46), and the male to female ratio was 39:6. Six, 17 and 22 hips were classified as stage IIA, IIb and III using the Ficat and Alert classification, respectively. Results: Thirty three of the 45 hips (74%) survived clinically and radiologically. Of these, the clinical results were excellent, good and fair in 15, 12 and 6 hips, respectively. Major complications were encountered in 12 hips [Progressive severe varus deformity in 7 hips (15%)], femur neck fracture in 3 hips (6%) and deep infection in 2 hips (4%). Among these 12 hips, seven hips (15%) required secondary THA. Five other hips (11%) were also subsequently converted to THA due to progressive collapse of the femoral head after the transtrochanteric osteotomy. Conclusion: Transtrochanteric osteotomy can be used to treat osteonecrosis of the femoral head in young patients with extensive necrotic lesions of the femoral head. However, Sugioka osteotomy should be used with caution due to its high incidence of complications.

Rotational Acetabular Osteotomy for Osteonecrosis With Collapse of the Femoral Head in Young Patients

Rotational Acetabular Osteotomy for Osteonecrosis With Collapse of the Femoral Head in Young Patients

Rotational Acetabular Osteotomy for Osteonecrosis with Collapse of the Femoral Head in Young Patients

While rotational acetabular osteotomy has been reported to be successful for the treatment of osteoarthritis of the dysplastic hip, little is known about its efficacy in the treatment of osteonecrosis of the femoral head. We retrospectively reviewed the results for a consecutive series of twenty-one patients (twenty-five hips) who had undergone rotational acetabular osteotomy between 1995 and 2001 for the treatment of extensive osteonecrosis of the femoral head associated with collapse. All but two of the patients had a history of steroid therapy as part of a treatment regimen for various diseases. At the time of surgery, the mean age of the five men and sixteen women was 29.0 years. The mean duration of follow-up was forty-nine months. No patient was lost to follow-up. The lesions were classified according to the staging system described by Steinberg et al., and the extent of necrosis was measured with use of the criteria described by Kerboul et al. Clinical evaluation was performed with use of the scoring system of Merle d'Aubigne and Postel. Radiographic evaluation was performed with use of yearly serial anteroposterior and lateral plain radiographs. The mean Merle d'Aubigne and Postel score improved from 11.3 points preoperatively to 14.9 points at the time of the final follow-up (p < 0.001). The mean pain score improved from 3.0 to 5.6 points (p < 0.001). However, the mean mobility score was 5.3 points preoperatively but only 4.9 points postoperatively (p = 0.1). All of the osteotomy sites showed radiographic evidence of osseous union at the time of the latest follow-up. Collapse of the femoral head progressed in seven hips, but in six of these hips the change in the extent of collapse was <2 mm. In the present study of young patients with extensive osteonecrosis and collapse of the femoral head, rotational acetabular osteotomy was associated with symptomatic relief and absence of substantial collapse of the femoral head at the time of early to intermediate-term follow-up.

Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement

Objective: To use the surgical samples of patients with femoro-acetabular impingement due to a nonspherical head to analyze tissue morphology and early cartilage changes in a mechanical model of hip osteoarthritis (OA). Design: An aberrant nonspherical shape of the femoral head has been assumed to cause an abutment conflict (impingement mechanism) of the hip with subsequent cartilage lesions of the acetabular rim and surface alterations of the nonspherical portion of the head. In this study, 22 samples of the nonspherical portions of the head have been obtained during hip surgery from young adults (mean 30.4 years, range 19–45 years) with an impingement conflict. The samples were first compared with tissue from the same area obtained from six age-matched deceased persons (control group) with normal hip morphology and second with cartilage from 14 older patients with advanced OA. All samples were characterized histologically and hyaline cartilage was graded according to the Mankin criteria. They were further subjected to examination on a molecular basis by immunohistology for cartilage oligomeric matrix protein (COMP), tenascin-C and a collagenase cleavage product (COL2-3/4C long) and by in situ hybridization for collagen type I and collagen type II. Results: All samples from the patient group revealed hyaline cartilage with degenerative signs. According to the Mankin criteria, the cartilage alterations were significantly different when compared with the control group ( p=0.007) but were less distinct when compared with cartilage from patients with advanced OA ( p=0.014). Positive staining and distribution pattern for COMP, tenascin-C and COL2-3/4C longshowed similarities between the samples from the impingement group and osteoarthritic cartilage but they were distinctly different when compared with healthy cartilage. Levels of collagen I and II transcripts were upregulated in 6 and 10, respectively, of the 14 samples with OA and in 9 and 12, respectively, of the 22 samples from the impingement group. None of the samples from the control group showed upregulation of Collagen I and II mRNA. Conclusions: The aberrant nonspherical portion of the femoral head in young patients with an impingement conflict consists of hyaline cartilage which shows clear degenerative signs similar to the findings in osteoarthritic cartilage. The tissue alterations are distinctly different when compared with a control group, which substantiates an impingement conflict as an early mechanism for degeneration at the hip joint periphery.

Bipolar versus total hip arthroplasty in the treatment of avascular necrosis of the femoral head in young patients.

The authors evaluate medium-term results of bipolar and total hip arthroplasty as a treatment for avascular necrosis of the femoral head. Between 1990 and 2000, 57 hips (45 patients) were treated with a bipolar (BHA: 37 hips) or total hip arthroplasty (THA: 20 hips) depending on the radiographic and macroscopic aspect of the acetabulum. At surgery, all patients were under 65 years of age (average: 45.09 years). All had the same cementless hydroxylapatite coated femoral stem inserted through an anterolateral approach. The BHA were followed during a mean of 4.49 years. One BHA was lost to follow-up. Seven out of 36 hips (19.44%) were considered failures: three due to a poor functional result (Harris Hip Score (HHS) <70) and four which needed conversion to THA for groin pain. Two hips were revised for periprosthetic fracture. Twenty BHA (55.56%) had a good or excellent result (HHSY80). The THA were followed for a mean of 4.32 years. One THA was lost to follow-up. Four out of 19 hips (21.05%) were considered as failures. Three due to a poor functional result (HHS<70) and one which needed cup revision for recurrent dislocation. Fifteen THA (78.95%) had a good or excellent functional result (HHSY80). BHA as a treatment of avascular necrosis of the femoral head in young patients preserves bone stock for later revisions and can lead to excellent results. But the outcome seems less predictable than after THA. Groin pain associated to BHA can be treated successfully with conversion to THA if necessary. (Hip International 2002; 2: 142-9).

Osteonecrosis of the femoral head treated with total hip arthroplasty without cement.

With use of porous-coated implants, total hip arthroplasty was performed in a consecutive series of thirty patients (thirty-five hips) who had a preoperative diagnosis of late-stage (Ficat and Arlet stage-III or IV) osteonecrosis of the femoral head. The patients were evaluated clinically and radiographically, and the data were recorded in a prospective manner. The average duration of follow-up was seven and one-half years (range, five to ten years). The average age of the patients at the time of the operation was thirty-two years (range, twenty-one to forty years). Signs of osseointegration of the femoral stem to the host bone were demonstrated in thirty-three hips (94 per cent). In the porous-coated hemispherical acetabular cups of these hips, an optimum bone-implant interface was identified and maintained, suggesting bone ingrowth. The rate of revision was 3 per cent (one hip) for the femoral side and 6 per cent (two hips) for the acetabular side, for an over-all rate of 6 per cent. All patients maintained a high level of activity postoperatively. There was moderate or severe remodeling of proximal femoral resorptive bone and stress-shielding in six hips (17 per cent) and osteolytic reactions in six hips. Complications were frequent (six hips) and included one deep infection; two dislocations; two instances of heterotopic ossification; and one fracture of the calcar femorale, which occurred intraoperatively. The thirty patients had a lower rate of revision and improved clinical outcomes compared with other reported series of young patients managed with total hip arthroplasty with cement who had the same diagnosis and similar postoperative follow-up. However, the latter series involved implants of an earlier design that had been inserted with older techniques of cementing. When arthroplasty is considered for the treatment of late-stage osteonecrosis of the femoral head in young patients, the use of total hip implants without cement that allow for bone ingrowth appears to be a viable alternative to arthroplasty with use of cement. However, longer follow-up is needed to determine the outcome of the osteolytic reactions that we observed. We therefore recommend this procedure with some caution because of the high rate of complications and the potential for failure of the arthroplasty related to the osteolytic reactions.