Osteonecrosis Of Femoral Head Research Articles

Rapid Discovery of Potential Drugs for Osteonecrosis of Femoral Head Based on Gene Expression Omnibus Database and Connectivity Map.

ObjectiveTo use Gene Expression Omnibus (GEO) database coupled with Connectivity Map (CMap) databases to screen potential therapeutic drugs for osteonecrosis of femoral head (ONFH) rapidly.MethodsRaw genetic data with accession number GSE74089 that contained eight hip articular cartilage specimens from four ONFH patients and four healthy controls were obtained from the Gene Expression Omnibus (GEO) database and were then integrated using R to identify differentially expressed genes (DEGs). Subsequently, to identify several potential small molecular compounds that were most strongly negatively correlated with ONFH, a search query of DEGs was explored by using CMap.ResultsFiltering revealed 1937 DEGs with log (fold‐change) ≥1 and adjust P value < 0.001. Finally, a network of candidate targets for ONFH with 135 nodes and 660 edges was constructed through network topology analysis, including 96 up‐regulated genes and 39 down‐regulated genes. Several significant gene functions and signaling pathways associated with pathological processes of ONFH were identified via gene enrichment analysis. Based on the CMap database, some potential small molecular components that may be possible to counteract the effects of molecular signal imbalance for ONFH were identified. Neostigmine bromide with low CMap score and P value and specificity score was predicted to be the most candidate compound, involved in the “positive regulation of stem cell proliferation,” “regulation of protein autophosphorylation,” “VEGF signaling pathway,” and “ECM‐receptor interaction.”ConclusionsThe GEO and CMap databases can be effectively used in understanding the molecular changes in ONFH and provide a systematic manner to identify potential drugs for ONFH prevention and treatment. However, additional clinical and experimental research of the candidate compound is warranted.

Problems and thoughts of preserving femoral head treatment of osteonecrosis of femoral head

By literature review and experience summary, some problems are found in conservative treatment of osteonecrosis of femoral head(ONFH): lacking in researches of natural history of ONFH, disunion in classfication and the standard of outcome evaluation, lacking in high-level-evidence study and standard of treatment methods. It is necessary to improve the study on natural history of ONFH, unify the classfications and the standard of outcome evaluations, normalize the treatment methods, and design impeccable multi-centre study for improving the effect of conservative treatment of ONFH.

Influence of dexamethasone on CBG levels and the incidence of osteonecrosis of femoral head in adult rats

Objective To investigate the effect of glucocorticoid (GC) to cortisol-binding globulin (CBG) expression in rats and the correlation between the changes of CBG levels and the osteonecrosis of the femoral head (ONFH) in rats after GC treatment. Methods A total of 72 healthy adult SD rats were randomly divided into low-dose group and high-dose group by computer random grouping.Thirty-six rats of low-dose group were injected dexamethasone at a dose of 1.5 mg·kg-1·d-1.Thirty-six rats of high-dose group were injected dexamethasone at a dose of 3.0 mg·kg-1·d-1.The blood samples were regularly collected, CBG levels in blood samples were detected by Western-blotting.Rats were killed in batches, femoral head was collected and observed under light microscope after HE staining.The bone lacuna of each group was compared and the ratio of empty lacuna was calculated.Finally, the correlation between the change of CBG level and ONFH was evaluated. Results On the first day after administration, the CBG level of the two groups decreased, and reached the lowest level on the seventh day of administration, and then gradually increased.The reduction of CBG level in the high dose group was greater.With the increase of time after treatment, the number and rate of bone lacuna void in the two groups increased gradually.28 days after treatment, the number of empty bone lacunae and the rate of empty bone lacunae in the low dose group were (6.75±0.42) and (13.98±2.19)%, respectively, which were lower than those in the high dose group[(11.03±0.62) and (21.99±3.17)%, t=4.864, 3.926, all P<0.05]. Conclusion The risk of ONFH is increased with the increase of the dose of dexamethasone, and there was no significant difference between the sexes.The decrease of serum CBG level after medication is correlated with the occurrence of ONFH. Key words: Femal head necrosis; Cortisol-binding globulin; Blotting, wegtern; Dexamethasone; Rats, sprague-dawley

Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head\u2014minimum of 5\u2009year follow-up

BackgroundOsteonecrosis of the femoral head (ONFH) is a progressive disease that leads to collapse and the development of secondary arthritis. The preferred management of ONFH remains controversial. Arthroscopic-assisted management of ONFH is a new and evolving approach for hip preservation. We hypothesis that arthroscopy is able to improve ONFH outcomes by achieving accurate and minimally invasive decompression while successfully addressing concomitant intraarticular pathologies resulting in reliable mid-term outcomes.MethodsThis was a retrospective cohort analysis. All patients had atraumatic ONFH with a precollapse lesion and a minimum follow-up of 5 years.ResultsA total cohort of 11 hips (8 patients) was identified. The mean patient follow-up was 7 years ±1.48 years (range, 64—118 months). The Ficat-Alret classification found on preoperative imaging was Stage I—3 (27.2%), IIa—4 (36.4%), and IIb—4 (36.4%) hips. Four (36.4%) hips experienced mechanical issues, including locking, catching, and buckling. The most common concomitant pathology addressed at the time of arthroscopy, was labral repair/debridement—8 (73%), followed by microfracture—7 (64%). At final follow-up, 6 hips (54.5%) had not converted to THA. Upon further stratification, Stage I—100%, Stage IIa—75%, for a combined 87%, had not converted to THA, in contrast, 100% of hips categorized as Stage IIb had converted to THA. Ficat-Alret staging, especially Stage IIb, was significantly associated with conversion to THA. (p-value = 0.015) There were 0% major or minor complications.ConclusionsTo our knowledge, this is the longest reported follow-up of arthroscopic-assisted management of ONFH. Arthroscopic-assisted management is a promising surgical approach that provides safe, accurate, and minimally invasive decompression, resulting in reliable results with an acceptable conversion rate to THA.Level of evidenceLevel IV, Case Series.

Peripheral Blood Stem Cell Therapy Does Not Improve Outcomes of Femoral Head Osteonecrosis With Cap‐Shaped Separated Cartilage Defect

A combination treatment with porous tantalum rod implantation and intra-arterial infusion of peripheral blood stem cells (PBSCs) provides a promise for treating early and intermediate stages of osteonecrosis of the femoral head (ONFH). However, its clinical indications and application restrictions remain unclear. This study aims to determine the clinical, histological, and radiological outcomes of a combination treatment using mechanical support and a targeted intra-arterial infusion of PBSCs for painful ONFH with a cap-shaped separation (CSS) cartilage defect. Compared with the standard pain management (control group), this combination treatment did not improve the Harris Hip Score (HHS) at 36 months. Micro-CT and histologic analyses showed severe focal destruction in all CSS-ONFH femoral heads in both the combination and control groups. Femoral heads showed a higher percentage of bone lesions in the combination treatment group than in the control group. There was no significant difference in osteoclast number in the subchondral bone areas between the two groups. A high level of expression of inflammatory cytokines, including tumor necrosis factor-α and interleukin-1β, was detected in blood vessels around the subchondral bone in both groups. The RANKL/OPG (receptor activator of the nuclear factor-kB ligand/osteoprotegerin) ratio was also similar between the control and combination treatment groups. Our results indicate that this combination treatment is not an effective method for the treatment of patients with painful CSS-ONFH. Moreover, this combination treatment did not inhibit inflammatory osteoclastogenesis in patients with more advanced disease. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:269-276, 2020.

Treatment of Femoral Neck Fractures with Cannulated Screw Invasive Internal Fixation Assisted by Orthopaedic Surgery Robot Positioning System.

ObjectiveTo investigate the clinical efficacy and advantages of cannulated screw internal fixation assisted by the orthopaedic surgery robot positioning system in the treatment of femoral neck fractures.MethodsThe clinical data of 128 patients with femoral neck fractures which had been treated with cannulated screw internal fixation from January 2016 to July 2018 were retrospectively analyzed. Among them, 63 patients were treated with cannulated screw assisted by orthopedic robot positioning system (orthopaedic surgery robot group), and 65 patients were treated with traditional cannulated screw (traditional surgery group). The operation time, number of intraoperative fluoroscopy, number of guide needle placements, and the amount of operative blood loss were compared between the two groups. The success rate of one‐time nail placement and the fracture healing rate were calculated. Fracture healing and internal fixation were observed. The hip joint function was evaluated by the Harris hip score 1 year after operation.ResultsAll patients were followed up for 12 to 24 months. The operation time was 65.70 ± 9.87 min in the robot group and 73.74 ± 9.78 min in the traditional group. The number of intraoperative fluoroscopy was 13.67 ± 4.39 times in the robot group and 17.09 ± 4.02 times in the traditional group. The number of guide needle placements was 9.95 ± 3.72 times in the robot group and 13.78 ± 4.39 times in the traditional surgery group. The success rate of one‐time nail placement was 100% (63/63) in the robot group and 49.23% (32/65) in the traditional group. The amount of operative blood loss was 15.25 ± 6.21 mL in the robot group and 25.51 ± 6.97 mL in the traditional group. Compared with the traditional group, the robot group had shorter operation time, less fluoroscopy, less needle placement, less bleeding, and higher success rate of one‐time nail placement. There was a significant difference between the two groups (P < 0.05). In the robot group, there was no infection, loosening of internal fixation, fracture displacement, and osteonecrosis of femoral head during the follow‐up period. The fracture healing rate was 100% (63/63). In the traditional group, there were two cases of loosening of internal fixation and one case of osteonecrosis of femoral head during the follow‐up period. The fracture healing rate was 100% (65/65). All patients were evaluated for hip joint function 1 year after operation. The Harris hip score in the robot group was 86.86 ± 4.74, and the Harris hip score in the traditional surgery group was 83.08 ± 5.44. Compared with the traditional group, the Harris hip score in the robot group was higher than that in the traditional group. There was significant difference between the two groups (P < 0.05). The excellent and good rate were 92.06% (58/63) in the robot group and 80% (52/65) in the traditional group. There was no significant difference between the two groups (P > 0.05).ConclusionCannulated screw internal fixation assisted by the orthopaedic surgery robot positioning system is an ideal method for the treatment of femoral neck fractures. This method has the advantages of relatively simple operation, more accurate screw placement during operation, high success rate of one‐time nail placement, short operation time, less surgical trauma, less radiation, and good recovery of hip function.

Pain relief with core decompression and autologous bone graft in osteonecrosis of femoral head in grade 2

Background: Osteonecrosis of femoral head means death of osteocytes with subsequent structural changes leading to femoral head collapse and secondary osteoarthritis of hip joint. Avascular term is reserved for osteonecrosis due to interruption of nutrient arteries as result of fracture of femoral neck and dislocation of hip joint. The most common presenting symptom in osteonecrosis is pain in hip joint. The aim of this study is to evaluate pain relief in early stage of osteonecrosis in patients operated with core decompression with bone grafting at different stage of follow up.Material and Method: In prospective study, we included 50 hips of stage 2 based on Modified Ficat and Arlet classification. We did core decompression with 8mm diameter track and filled with cancellous bone graft taken from posterior superior iliac crest. Pain relief assessed based on visual analogue score at all stage of follow up. Results and Conclusion: According to our study it is found that core de compression with bone grafting provide satisfactory outcome for pain relief if patient is selected carefully with early stage of osteonecrosis before collapse of femoral head. It is method of choice for young patient presented with early changes.

The effect of combined therapy, percutaneous concentrated autologous bone marrow transplantation and low intensity pulsed ultrasound (LIPUS) in treatment of femoral head osteonecrosis: Erratum

The effect of combined therapy, percutaneous concentrated autologous bone marrow transplantation and low intensity pulsed ultrasound (LIPUS) in treatment of femoral head osteonecrosis: Erratum

Adie’s tonic pupil in sjogren's syndrome

Adie’s tonic pupil is a neurological disorder more common in women. It is characterized by persistent unilateral mydriasis. Tonic pupil constricts poorly to light but reacts better to accommodation. It is caused by parasympathetic ciliary ganglion damage and is characterized by hypersensitivity to muscarinic receptor agonists (pilocarpine). Most cases are idiopathic, though it can be caused by autoimmune diseases, tumors, trauma, and surgery. We report a case of a 39-year-old woman with a past medical history for migrainous headache, left knee and bilateral femoral head osteonecrosis, anemia and arthritis. She was diagnosed with sjogren syndrome based on symptoms of mouth and eyes dryness, positive serum anti-RO/SSA and ANA antibodies and labial salivary gland biopsy showing lymphocytic sialadenitis. She presented with progressive vision loss in the right eye. The initial examination showed anisocoria, an afferent pupillary defect and a sector pupil palsy of the right eye. Ophthalmoscopic evaluation, visual acuity and field testing were normal. Visual-evoked potentials (VEPs) were normal. Ankle jerk reflexes were absent. The diagnosis of Adie’s tonic pupil was confirmed with rapid miotic response of the affected pupil to 0.125% pilocarpine drop. The patient was treated with Pilocarpine drops and had slightly improved symptoms. Adie’s tonic pupil is a benign, mostly idiopathic syndrome caused by parasympathetic denervation. However, it can be associated with infectious, inflammatory, malignant, or autoimmune pathologies. Systemic conditions associated with tonic pupils are rare. This is, as far as we know, the first case reported of a sjogren syndrome associated with tonic pupil.

Early transplantation of growth differentiation factor 11-silenced bone marrow stromal cells promotes osteogenesis in necrotic femoral head induced by steroid in rats

Objective To study the effect of growth differentiation factor (GDF) 11-silenced bone marrow stromal cells (BMSCs) on bone regeneration in early steroid-induced osteonecrosis of the femoral head in rats. Methods After GDF11 expression in BMSCs was inhibited by siRNA, the knockdown efficiency and transfection cytotoxicity were detected. The further experiments both in vitro (n=3) and in vivo (n=8) were divided into 4 groups respectively: blank control group (without any intervention), model group (glucocorticoid treatment), experimental group (siRNA transfection and glucocorticoid treatment) and negative control group (negative control transfection and glucocorticoid treatment). The BMSCs were induced into osteogenic differentiation. Alkaline phosphatase (ALP) staining and alizarin red staining were applied to evaluate the osteogenic differentiation ability of the cells while reverse transcription polymerase chain reaction (qRT-PCR) was employed to detect the relative expression levels of osteogenic markers. The osteogenesis in the necrotic femoral head was evaluated by microCT, H&E staining, immunohistochemistry staining and biomechanical test. Results No transfection cytotoxicity was found (P>0.05). The ALP staining and alizarin red staining showed that the osteogenic differentiation of BMSCs in the experimental group was better than that in the model group. At the level of mRNA, the relative expression of ALP, runt-related transcription factor (Runx) 2, osteocalcin (OCN) and type Ⅰ collagen (α1) (COL1A1) in the blank control group (1.00±0.09, 1.02±0.23, 1.03±0.30 and 1.02±0.25, respectively) were significantly higher than those in the model group (0.46±0.11, 0.50±0.11, 0.35±0.01 and 0.57±0.02, respectively) but significantly lower than those in the experimental group (1.97±0.30, 0.94±0.19, 1.50±0.18 and 1.28±0.37) (all P<0.05). MicroCT images and quantitative analysis showed that the bone mass in the experimental group was significantly increased compared with the model group (P<0.05). Histological examination showed better bone regeneration and higher expression of Runx2 and COL1 in the necrotic femoral head in the experimental group than in the model group. Improved biomechanical properties were shown in the experimental group compared with the model group (P<0.05). Conclusions Silence of GDF11 expression may alleviate the inhibitory effect of glucocorticoid on osteogenic differentiation of BMSCs. Early transplantation of GDF11-silenced BMSCs may promote osteogenesis in the necrotic femoral head in rats. Key words: Femoral head necrosis; Bone marrow cells; Growth differentiation factor 11; Glucocorticoids; Osteogenic differentiation

Bilateral Osteonecrosis of Femoral Head in Sickle Cell Disease: Salvage by Early Surgical Treatment in Single Sitting

Bilateral Osteonecrosis of Femoral Head in Sickle Cell Disease: Salvage by Early Surgical Treatment in Single Sitting

Icariin promotes angiogenesis in glucocorticoid-induced osteonecrosis of femoral heads: In vitro and in vivo studies.

The injury and dysfunction of the femoral head microvascular endothelial cells are associated with the pathogenesis of glucocorticoid‐induced osteonecrosis of the femoral head (ONFH). Reports indicate that icariin (ICA) can enhance vascular roles and also inhibit endothelial cell dysfunction. However, it still remains unclear whether ICA can promote angiogenesis in glucocorticoid‐induced ONFH. In this study, we investigate this hypothesis through in vitro and in vivo experiments. Results showed that 0.1 mg/mL hydrocortisone significantly suppressed bone microvascular endothelial cells (BMECs) proliferation while ICA at 10−5 mol/L reversed this inhibition. ICA significantly promoted BMECs migration, tube formation, the angiogenesis‐related cytokines expression and the activation of Akt. Furthermore, ICA enhanced Bcl‐2 expression but diminished Bax expression. According to in vivo results, rats with ICA treatment exhibited a lower ratio of empty lacunae, higher volume of blood vessels and more CD31‐positive cells. This study revealed that ICA promotes angiogenesis of BMECs in vitro and improves femoral head blood vessel volume of rats treated with glucocorticoid, suggesting the efficacy of ICA in the prevention of glucocorticoid‐induced ONFH.

Outcome after a new porous tantalum rod implantation for treatment of early-stage femoral head osteonecrosis.

Tantalum rods have been used in osteonecrosis of the femoral head (ONFH) for several years, while Zimmer trabecular metal implants have been proposed as the best choice. The aim of this study was to evaluate the effect of a new porous tantalum rod on the treatment of early ONFH. From July 2014 to December 2015, 19 patients (21 hips) were treated with Runze tantalum rod, and 20 patients (20 hips) received Zimmer tantalum prosthesis. All patients were followed up for at least 3 years. There was no significant difference in demographic characteristics and the Harris Hip Score (HHS) improvement between the two groups. Kaplan-Meier analysis did not show any statistically significant difference in survival rates. One case in the Runze group had persistent pain and required conversion to total hip arthroplasty (THA) 8 months post-surgery. Histological evaluations revealed the presence of abundant new bone ingrowth into pores of the tantalum. The osteonecrosis observed in other patients was almost unchanged. At final follow-up, progressive collapse of the femoral head or the apparent joint space narrowing had not occurred. Compared with the traditional implants, implantation of the Chinese tantalum rod in the treatment of Association Research Circulation Osseous (ARCO) stages I, and II ONFH demonstrated highly encouraging clinical results.

Surgical Outcomes of Internal Fixation Using Multiple Screws in Femoral Neck Fractures with Valgus Impaction: When Should We Consider Hip Arthroplasty? A Retrospective, Multicenter Study.

PurposeWe analyzed the surgical outcomes at two institutions after internal fixation using multiple screws in femoral neck fractures with valgus impaction to determine independent predictors and their cut-off values for nonunion and reoperation.Materials and MethodsBetween January 2006 and December 2016, 104 femoral neck fractures with valgus impaction that underwent internal fixation using multiple screws from two institutions were enrolled. The multiple logistic regression model and receiver operating characteristics analysis were used to determine the independent predictors and cut-off values for nonunion and reoperation.ResultsThere were 20 reoperations (19.2%) due to 11 nonunions (10.6%) and nine cases of femoral head osteonecrosis (8.7%). Multiple logistic regression analysis revealed that independent predictors of nonunion and reoperation were age and posterior tilt angle (P<0.05). The cut-off value for age and the posterior tilt angle for reoperation were 72.5 years and 12.2°, respectively. The patients with a posterior tilt angle of greater than 13° had poorer radiological and clinical outcomes compared with those with a posterior tilt angle of less than 13°, even though they did achieve bone union.ConclusionPrimary hip arthroplasty should be considered in patients older than 73 years of age with a posterior tilt angle greater than 13°.

Ultra-Short Anatomic Uncemented Femoral Stem and Ceramic-on-Ceramic Bearing in Patients With Idiopathic or Ethanol-Induced Femoral Head Osteonecrosis

BackgroundLong-term result of the ultra-short anatomic cementless stem in the patients with idiopathic or ethanol-induced osteonecrosis of the femoral head has not been assessed. The aim of this study is to evaluate the long-term clinical, radiographic, computed tomography scan, and dual-energy X-ray absorptiometry scanning results, and survivorship of this specific femoral stem in patients with idiopathic or ethanol-induced femoral head osteonecrosis. MethodsTwo hundred fifty-six patients (335 hips) with an average age of 49.8 years (range 20-63) were enrolled in the current study. All patients underwent dual-energy X-ray absorptiometry scanning of the acetabulum and proximal femur preoperatively and at final follow-up. Computed tomography scan was obtained in all patients at final follow-up. The mean follow-up was 14.7 years (range 13-16). ResultsAt final follow-up, the average Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, and University of California, Los Angeles activity score were 94 points, 12 points, and 8 points, respectively. Four stems (1%) underwent revision for aseptic loosening. One acetabular component (0.3%) was revised for recurrent dislocation. No hip was revised for squeaking or clicking sound. Survivorship of the femoral stem was 99.0% (95% confidence interval 94-100) and that of the acetabular component was 99.4% (95% confidence interval 95-100) at 14.7 years. ConclusionUltra-short proximal loading anatomic uncemented femoral stems with ceramic-on-ceramic bearings have excellent survivorship free from aseptic loosening and good clinical results at long term. Level of EvidenceLevel IV

Analyse 3D pour prédire les résultats des fractures cervicales fémorales Garden 1 et 2 : une étude rétrospective multicentrique

IntroductionThe aim of our study was to (1) report our surgical outcomes of internal fixation in patients with nondisplaced or valgus impaction fractures of the femoral neck; (2) introduce our new three dimensional assessment method using a combination of X-ray and CT imaging, and (3) determine which radiologic measurements significantly predicted fixation failure. HypothesisWe hypothesized that high posterior tilt angle and retroversion angle are related to high incidence of non-union and osteonecrosis. Materials and methodsFrom January 2009 to December 2016, 64 elderly patients in two institutions with nondisplaced or valgus impaction fractures of the femoral neck who had internal fixation using multiple parallel cannulated screws were enrolled. To determine the independent predictors of non-union, osteonecrosis, and reoperation, various clinical variables and radiologic variables, including the valgus angle on coronal CT images, the posterior tilt angle on Lorenz images, and the retroversion angle on axial CT images, were analyzed. ResultsNon-union was identified in nine of the 64 patients (14.1%) and nine of the 55 patients (16.4%) who achieved bony union had femoral head osteonecrosis with subsequent segmental collapse. The multiple logistic regression model showed that a low bone mineral density of the femur, a higher posterior tilt angle on Lorenz image, and a higher retroversion angle on axial CT images were independent predictors of non-union and reoperation. DiscussionPrimary hip arthroplasty should be considered when a posterior tilt angle of more than 9 degrees on Lorenz images or a retroversion angle of more than 13 degrees on axial CT images is identified in patients with osteoporotic valgus impaction fractures. Type of study and level of proofIII, retrospective comparative study.

Free graft of vascularized iliac bone flap based on deep iliac circumflex vessels for the treatment of osteonecrosis of the femoral head

Objective To investigate the feasibility and clinical efficacy of free graft of vascularized iliac bone flap based on deep iliac circumflex vessels for the treatment of osteonecrosis of femoral head (ONFH). Methods Twelve cases of ONFH (13 hips) received free graft of vascularized iliac bone flap based on deep iliac circumflex vessels from April, 2016 to July, 2017. The average Harris score was (74.7±6.9) in the second stage and (68.6±9.2) in the third stage. After debriding the necrosis bone of the femoral head, the contralateral vascularized iliac bone flap had been harvested, and then implanted into the femoral head. The deep iliac circumflex artery and its accompanying vein were anastomosed with the transverse branch (or ascending branch) of the lateral circumflex femoral artery and concomitant vein respectively. The herringbone brace was used for hip fixation for 3 weeks after operation. X-ray examination(1, 3, 6, 9 and 12 months after operation, respectively) and Harris hip score (6 and 12 months after operation, respectively) were performed to evaluate the recovery results of the femoral head. Scores were recorded and analyzed by paired t-test. The difference was considered to statistically significant if P<0.05. Results The patients were followed-up for 15 (12-20) months. The iliac bone flap of 12 patients (13 hips) healed well. There was no necrosis and collapse in 12 hips, except 1 femoral head collapsed slightly because of weight loading too early. The average Harris score was (91.6±4.5) of the second stage and (84.8±6.1) of the third stage. Compared with scores before the operation, the difference was statistically significant (P<0.05). Conclusion Free vascularized iliac bone grafting based on deep iliac circumflex vessels is an ideal treatment for ONFH head in middle and advanced stage. Key words: Osteonecrosis of the femoral head; Iliac bone flap; Deep iliac circumflex vessels; Transplantation; Harris hip score

Focused extra-corporeal shockwave treatment during early stage of osteonecrosis of femoral head.

Focused extra-corporeal shockwave treatment during early stage of osteonecrosis of femoral head.

Glucocorticoid Enhanced the Expression of Ski in Osteonecrosis of Femoral Head: The Effect on Adipogenesis of Rabbit BMSCs.

Glucocorticoid (GC)-induced osteonecrosis has been considered as the most serious side effect in long-term or over-dose steroid therapy. The decreased bone mass and increased marrow fat tissue demonstrated that GC can destroy the normal differentiation of bone marrow mesenchymal stem cells (BMSCs), which accelerates adipogenesis but not osteogenesis. However, the underlying mechanisms are still unclear. Ski, an evolutionary conserved protein, is a multifunctional transcriptional regulator that involved in regulating signaling pathways associated with adipogenesis differentiation, but the concrete function remains unclear. In this work, we first established a methylprednisolone (MPS)-induced osteonecrosis of femoral head (ONFH) rabbit model, in which the expression of Ski, PPAR-γ, and FABP4 was up-regulated compared with control group, and then we induced the isolated BMSCs from rabbit with dexamethasone (Dex) in vitro and the results showed that the Ski expression was up-regulated by Dex in a dose- and time-dependent manner. Therefore, we demonstrated that the expression of Ski was up-regulated in glucocorticoid-related osteonecrosis disease in vivo and in vitro. Moreover, the adipogenesis differentiation capacity of BMSCs was enhanced after induced by Dex, which was identified by Oil Red O staining, and the up-regulated PPAR-γ and FABP4 expression. To further study the function of Ski in BMSC after induced by Dex, Ski specific small interfering RNA (Ski-siRNA) was used. Results showed that knockdown of Ski obviously decreased adipogenesis differentiation evident by Oil Red O staining, and the expression of PPAR-γ and FABP4 was down-regulated simultaneously. Collectively, our findings suggest that Ski increased significantly during glucocorticoid-induced adipogenic differentiation of BMSCs, and the expression level was consistent with adipogenic-related proteins including PPAR-γ and FABP4. Based on the above data, we believe that Ski might become a new molecule in the treatment of GC-induced ONFH and our study could provide a basis for further study on the detailed function of Ski in ONFH.

Three-dimensional analyses to predict surgical outcomes in non-displaced or valgus impaction fractures of the femoral neck: A multicenter retrospective study

IntroductionThe aim of our study was to (1) report our surgical outcomes of internal fixation in patients with non-displaced or valgus impaction fractures of the femoral neck, (2) introduce our new three-dimensional assessment method using a combination of X-ray and CT imaging, and (3) determine which radiologic measurements significantly predicted fixation failure. HypothesisWe hypothesized that high posterior tilt angle and retroversion angle are related to high incidence of non-union and osteonecrosis. Materials and methodsFrom January 2009 to December 2016, 64 elderly patients in two institutions with non-displaced or valgus impaction fractures of the femoral neck who had internal fixation using multiple parallel cannulated screws were enrolled. To determine the independent predictors of non-union, osteonecrosis, and re-operation, various clinical variables and radiologic variables, including the valgus angle on coronal CT images, the posterior tilt angle on Lorenz images, and the retroversion angle on axial CT images, were analyzed. ResultsNon-union was identified in nine of the 64 patients (14.1%) and nine of the 55 patients (16.4%) who achieved bony union had femoral head osteonecrosis with subsequent segmental collapse. The multiple logistic regression model showed that a low bone mineral density of the femur, a higher posterior tilt angle on Lorenz image, and a higher retroversion angle on axial CT images were independent predictors of non-union and re-operation. DiscussionPrimary hip arthroplasty should be considered when a posterior tilt angle of more than 9 degrees on Lorenz images or a retroversion angle of more than 13 degrees on axial CT images is identified in patients with osteoporotic valgus impaction fractures. Type of study and level of proofIII, Retrospective comparative study.