Idiopathic Femoral Head Necrosis Research Articles

Global trends in the research on Legg-Calve-Perthes disease in Web of Science.

Legg-Calve-Perthes disease (LCPD) is a form of idiopathic femoral head necrosis that can lead to permanent femoral head deformities and premature osteoarthritis in children under the age of 15. Its pathogenesis is utterly and remains to be clarified. Although many research publications on LCPD have emerged during the last few decades, few systematic bibliometric analyses of these articles have been reported. A bibliometric analysis was performed to investigate the development processes and hotspots, as well as the collaboration and influence among countries, institutions, authors, journals, and keywords of papers relevant to LCPD from the Web of Science Core Collection (WoSCC) during the period from 1 January 2000 to 30 June 2023. A total of 2,205 researchers from 916 institutions across 53 countries/regions have contributed to 673 papers published in 199 academic journals. The research on LCPD has shown significant fluctuations but a gradual increase in the number of articles published over the last two decades. The United States leads in the number of publications of LCPD, with the Texas Scottish Rite Hospital for Children being the most productive institution. English, as the most widely used language in the world, was undoubtedly the most popular language. Herring JA, who acted as both the corresponding and first author, has contributed to the most co-cited papers published. The most number of LCPD papers are published in the Journal of Pediatric Orthopaedics, whereas the Journal of Bone and Joint Surgery American Volume garnered the highest total citations, indicating the great importance of these two journals in the field of orthopedics. The most frequently used keywords in published articles were related to the symptoms, mechanisms, and prognosis, revealing the research focus of most scholars. Our research described the development trends and hotspots in the research field of LCPD and will help researchers make better decisions.

Relationship of idiopathic femoral head necrosis with blood lipid metabolism and coagulation function: A propensity score-based analysis.

Nontraumatic osteonecrosis of the femoral head (ONFH) can be corticosteroid-induced, alcohol-induced, and idiopathic ONFH (IONFH). Although corticosteroid- and alcohol-induced ONFH has been investigated extensively regarding its relationship with blood lipids and coagulation factor levels. However, the effect of blood lipid metabolism and coagulation function on IONFH has rarely been studied. Therefore, this study aimed to analyse the relationship of IONFH with blood lipid and coagulation indicators. Total 680 patients diagnosed with IONFH in our institution during January 2011-June 2019 who met the inclusion criteria composed the case group; 613 healthy persons who underwent physical examination at our institution during the same period composed the control group. Propensity scores were used for baseline feature matching, and two matching groups each with 450 patients were established. After the matching, blood lipid and coagulation factor levels of both groups were comparatively analysed. The case group showed significantly higher total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) levels, low-density/high-density lipoprotein (LDL/HDL) ratio, and apolipoprotein B (Apo-B) levels than the control group (p < 0.05). Conversely, the HDL and apolipoprotein A (Apo-AI) levels in the case group were significantly lower than those in the control group (p < 0.05). Regarding coagulation indicators, the activated partial thromboplastin time and prothrombin time were lower in the case group than in the control group; however, the differences were insignificant (p > 0.05). Furthermore, fibrinogen (FIB) levels and thrombin time (TT) in the case group were higher than those in the control group. There were significant differences between the two groups only in terms of FIB levels (p < 0.05), while TT was not significantly different (p > 0.05). IONFH has strong associations with blood lipid metabolism and coagulation function, which provide an avenue for exploring the mechanism of IONFH.

Study on the outcome of patients with aseptic femoral head necrosis treated with percutaneous multiple small-diameter drilling core decompression: a retrospective cohort study based on magnetic resonance imaging and equivalent sphere model analysis

BackgroundAseptic necrosis of the femoral head (ANFH) has a high incidence in the community and causes substantial problems with health as well as economic and social stress. Core decompression is the most commonly used treatment for early ANFH. Although many studies have reported on the efficacy of femoral head core decompression surgery for ANFH, there are still some shortcomings in assessing the severity of femoral head necrosis, the location distribution, and changes in necrotic lesions before and after surgery. Magnetic resonance imaging (MRI) and equivalent sphere model analysis were used to further clarify the clinical efficacy of percutaneous multiple small-diameter drilling core decompression in patients with ANFH.MethodsFrom July 2013 to November 2016, 24 patients (32 cases of the hip joint) with ANFH who underwent percutaneous multiple small-diameter drilling core decompression were selected, and a retrospective analysis was conducted. MRI as well as VAS, OHS-C, and HHS scores were used to evaluate joint function in all patients before and 6, 12, and 24 months after the operation.ResultsTwenty-four months after the operation, 10 hips were amputated. The survival rates of alcoholic femoral head necrosis (AFNH), idiopathic femoral head necrosis (IFHN), and steroid-induced femoral head necrosis (SIFHN) patients at 24 months were 100%, 85.7% (− 2 hips), and 0.0% (− 8 hips), respectively. The MRI and equivalent sphere analysis results revealed that the anterior superior medial quadrant was the area most prone to osteonecrosis, and the posterior superior medial quadrant was the area second most prone to necrosis. After the operation, the average percentage of the AFHN necrosis area in the total volume of the femoral head decreased from 14.5 to 10.3%, and the average percentage of the IFHN necrosis area decreased from 16.3 to 9.2%; however, the average percentage of the necrosis area for SIFHN increased from 30.4 to 33.1%.ConclusionPercutaneous multiple small-diameter drilling core decompression significantly reduced the lesion volume for AFHN and IFHN, but the effect on SIFHN was not good.

A case report: Atypical bilateral idiopathic femoral head necrosis requiring differentiation from tumor

A case report: Atypical bilateral idiopathic femoral head necrosis requiring differentiation from tumor

The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems

Background and purpose — In total hip replacements, stem design may affect the occurrence of periprosthetic femoral fracture. We studied risk factors for fractures around and distal to the 2 most used cemented femoral stems in Sweden.Patients and methods — This is a register study including all standard primary Lubinus SPII and Exeter Polished stems operated in Sweden between 2001 and 2009. The outcome was any kind of reoperation due to fracture around (Vancouver type B) or distal to the stem (Vancouver type C), with use of age, sex, diagnosis at primary THR, and year of index operation as covariates in a Cox regression analysis. A separate analysis of the primary osteoarthritis patient group was done in order to evaluate eventual influence of the surgical approach (lateral versus posterior) on the risk for Vancouver type B fractures.Results — The Exeter stem had a 10-times (95% CI 7–13) higher risk for type B fractures, compared with the Lubinus, while no statistically significant difference was noticed for type C fractures. The elderly, and patients with hip fracture or idiopathic femoral head necrosis, had a higher risk for both fracture types. Inflammatory arthritis was a risk factor only for type C fractures. Type B fractures were more common in men, and type C in women. A lateral approach was associated with decreased risk for Type B fracture.Interpretation — Stem design influenced the risk for type B, but not for type C fracture. The influence of surgical approach on the risk for periprosthetic femoral fracture should be studied further.

Hüftgelenkersatz bei jungen Menschen unter 40 Jahren

At Orthopedic Department of Homburg/Saar University Clinic there were - between 1974 and 1985 - altogether 270 cementless total hip replacements by AUTOPHOR-arthroplasty in 243 patients, who were 40 years of age and younger at time of operation. The male patients mostly suffered from posttraumatic joint destructions or idiopathic femoral head necrosis, the female patients from dysplasia coxarthritis. In 43.3% there were previous hip operations in the past. 6 septic failures (5 times removal of prosthesis); 33 (12.2%) aseptic failures, mostly of the femoral component with following exchange operation. Clinical and roentgenological control of 170 cases (septic and aseptic failures excluded). Subjectively good and very good results in 82.3%. Evaluation of clinical datas acc. to the scheme of Merle d'Aubigné. Improvement of preoperative situation (5.4 points average) to 14.7 points average postoperatively. In most of the patients, a professional and social integration could be achieved; only 28 patients received a pension. With regards to the functional inferior alternatives of resection hip rsp. hip arthrodesis, THR by cementless prostheses in young patients with severe joint destructions seems to be justifiable and recommendable - according to our medium-term results.

Long-term results of free vascularized fibular grafting for femoral head necrosis.

The current authors report on the long-term results of free vascularized fibula transplantation for the treatment of idiopathic femoral head necrosis. Briefly, the technique introduced by the authors in 1978 involves the excision of the necrosed bone and its replacement by autologous cancellous bone taken from the iliac crest. The contralateral fibula with its nutrient vessels is introduced through the head and neck of the femur and the vessels are anastomosed microsurgically to the anterior circumflex artery and vein. The current study assesses 60 patients (68 hips) operated on from 1978 to 1985 with an average followup of 18 years (range, 15-22 years). The overall results were good in 52% of the patients. In relation to the stage of necrosis according to the classification system of Marcus et al, good results were achieved in 80% of the patients with Stages II and III disease. In relation to patient age, good results were obtained in 80% of the patients operated on before the age of 40 years. The long-term results indicate that the method of free vascularized fibula transplantation used by the authors is a valuable method for the treatment of idiopathic osteonecrosis of the femoral head for patients younger than 40 years of age with Stage II or III necrosis.

Microvascular Fibular Grafts in Skeleton Reconstruction

Extensive bone defects from any cause require large bone grafts. Such large defects usually cannot be repaired by conventional, nonvascularized cancellous grafts. Before the advent of microsurgery, many of these lesions could not be cured, and amputation was often the only solution. The bone may be transferred alone or in combination with skin or muscle or both. Idiopathic femoral head necrosis is 1 of the main indications for free microvascular (fibular) transfer. The authors propose a new classification for idiopathic femoral head necrosis. A technique that has been used for the past 14 years, on providing mechanical support and improved blood supply to the femoral head, is described. The fibula is favored for its mechanical properties and its vascular pedicle, and because it is easier to harvest.

Free Microvascular Fibular Transfer for Idiopathic Femoral Head Necrosis: Long-Term Follow-Up

The authors discuss free microvascular bone transfers in general, and propose a new classification for idiopathic femoral head necrosis. They then present a technique they have been using for 11 years, with the goals of providing both mechanical support and an improved blood supply to the femoral head. This technique involves clearing the necrotic area of the femoral head, filling the area with cancellous bone taken from the greater and lesser trochanters, and transferring a fibular microvascular graft. The approach is transtrochanteric and spares the capsule. Vascular anastomosis is done with the lateral branches of the deep femoral artery, sparing the anterior circumflex artery which is important to the blood supply of the femoral head. Forty-five cases have been surgically managed over 11 years. Eighteen cases with follow-up longer than five years were analyzed, providing an 84 percent successful outcome with both very good and good results.

当科におけるＪ‐２型人工骨頭置換術の成績

We studied a group of 22 patients (7 males and 15 females) which consist of 20 cases of femoral neck fracture and 2 cases of idiopathic femoral head necrosis, treated by J-2 type prosthesis during 1984-1990. Age distribution of these cases were 45 to 92 years old (mean: 75.4 years), and were followed from 2 months to 6 years and 7 months (mean: 2 years and 6 months).Postoperative OA hip score of the Japanese Orthopaedic Association (J. O. A. Score) was 80.1 points on an average. Rsults were discussed to J. O. A. score, ability of transfer, bone atrophy, thinness or thickness of cortical bone, central migration, sinking and pathology of one death case.

Contribution to the Diagnosis of Idiopathic Femoral Head Necrosis by Scintigraphy with 99mTc-MDP Assessed Quantitatively by Computer

The authors have studied by quantification the bone uptake of 99mTc-MDP in femoral head necrosis in order to evaluate in an objective manner conventional scintigraphy, and thus to increase the sensitiveness and efficacy of an exploration for an early diagnosis of these patients. Twenty cases of femoral necrosis have been studied, diagnosed in all cases by histopathological analysis; in twelve of them the process was unilateral and in the other eight bilateral. All explorations were carried out with 99mTc-MDP, a gamma camera and a PDP 11/40 computer for the quantitative study with the obtention of indices relating the activity between the femoral heads and, of these, to a normal vertebra. Quantification in the control group showed that the uptake of the nuclide was similar in both femoral heads and is lower than this in the vertebra. In all cases of unilateral necrosis the abnormal deviations of the indices relating the pathological head to the contralateral head and the lumbar vertebra were significant. In bilateral femoral head necrosis, an increase has been observed in all indices, although only the index relating the contralateral femoral head suspect of a lesion to vertebral activity was statistically significant. The proposed method for quantifying can be carried out easily and is very useful for diagnosing femoral necrosis since it improves the results of a subjective assessment of the scintigraphic image and can earlier detect the abnormal uptake of the lesion.

Complete destruction of both femoral heads following idiopathic necrosis of the femoral heads in a diabetic patient with hyperuricemia and hyperlipoproteinemia

A practically complete destruction of both femoral heads including the femoral necks and acetabula was encountered in a 69-year-old patient with diabetes, which varied in intensity. This destruction, documented by radiographs which had been taken 8 years prior, had started as the typical picture of "idiopathic femoral head necrosis". In addition to diabetes, hyperuricemia and hyperlipoproteinemia were present at the time when the femoral head necrosis was first evidenced. One episode of gout was recorded. In recent years, following therapy, the hyperurecemia and hyperlipoproteinemia had normalized. The question is raised, as to whether or not the present radiological findings represent a complication of aseptic femoral head necrosis, combined with a diabetic arthropathy of the hip joints. Details of the angiographic findings and a spondylopathy, which have all the characteristics of a neuropathic spondylopathy, would favor this hypothesis. When associated with a diabetic condition, generalized osteoporosis and hypertrophic spondylosis of such a particular nature require special mention.

Autoradiography and Histology in a Case of Idiopathic Femoral Head Necrosis

The necrotic femoral head in a patient with a transplanted kidney was examined autoradiographically (with fluorine--18 and Technitium--99 m--Polyphosphate) and histologically (i.e. with long interval Tetracycline labellings). A well circumscribed area of necrotic bone was demonstrated in the weight bearing part of the caput giving evidence of a solitary infarction. The demarcation zone showed revascularization, and appositional bone formation accounted for the increased density. Foci of necrotic bone were observed further away from the necrotic area indicating an originally more extensive vascular insufficiency. In the subchondral bone a fissure had arisen probably due to rarefaction of bone during the process of revascularization. It is suggested that the vascular insufficiency was a result of a reduced resistance of the bone tissue altered by steroid therapy.