Treatment Of Femoral Head Necrosis Research Articles

Recent advances in nanomaterials for the treatment of femoral head necrosis.

Osteonecrosis of the femoral head (ONFH) is a condition that causes considerable pain and discomfort for patients, and its pathogenic mechanisms are not yet fully understood. While there have been many studies that suggest multiple factors may contribute to its development, current treatments involve both surgical and nonsurgical options. However, there is still much room for improvement in these treatment methods, particularly when it comes to preventing postoperative complications and optimizing surgical procedures. Nanomaterials, as a type of small molecule material, have shown great promise in treating bone tissue diseases, including ONFH. In fact, several nanocomposite materials have demonstrated specific effects in preventing ONFH, promoting bone tissue repair and growth, and optimizing surgical treatment. This article provides a comprehensive overview of current treatments for ONFH, including their advantages and limitations, and reviews the latest advances in nanomaterials for treating this condition. Additionally, this article explores the therapeutic mechanisms involved in using nanomaterials to treat ONFH and to identify new methods and ideas for improving outcomes for patients.

Etiology, pathology, and treatment of osteonecrosis of the femoral head in adolescents: A comprehensive review.

Femoral head necrosis is a common refractory disease in orthopedics, and shows a trend of getting younger. The occurrence of femoral head necrosis in adolescents is related to the use of glucocorticoids, autoimmune diseases, trauma, and other factors. Because adolescent patients are in the period of physical development, high activity requirements, and have fertility needs in the future, treatment is relatively difficult. Early artificial joint replacement may have problems such as wear and loosening, so total hip replacement is not the preferred treatment for adolescent patients with femoral head necrosis. This article will elaborate the research progress of femoral head necrosis in adolescents from 3 aspects, and summarize the benefits and side effects of core decompression combined with autologous stem cell transplantation in the treatment of early femoral head necrosis, so as to provide clinical ideas for the treatment of femoral head necrosis in adolescents.

Core decompression combined with bone marrow mononuclear cells in the treatment of femoral head necrosis: a systematic review and meta-analysis.

The effectiveness of bone marrow mononuclear cells combined with core decompression in the treatment of femoral head necrosis is controversial. The purpose of this study was to conduct a meta-analysis and systematic review of the evaluation of bone marrow mononuclear cells combined with core decompression in the treatment of femoral head necrosis, and to compare the therapeutic effect of this method with that of core decompression alone, so as to provide a basis for subsequent research and clinical treatment. We conducted detailed searches across four databases in Embase, PubMed, Web of Science, and the Cochrane Library (up to October 2023), including eight studies with a total of 370 participants and 491 hip cases. This meta-analysis followed the Preferred Reporting Project (PRISMA) guidelines. Review Manager 5.4 was used to summarize and analyze the outcome indicators and the quality and reliability of the MAs were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Eight studies were included inclusion criteria. The results of meta-analysis showed that the therapeutic effect of CD combined with BMMC on VAS was better than that of CD alone (MD =-5.32, 95%CI: -9.90, -0.74, P=0.02, I²=98%), and there was no statistically significant difference between CD combined with BMMC and CD alone in the treatment of HHS (MD =2.73, 95%CI: -2.63,8.09, P=0.32, I²=82%). We conducted sensitivity analysis, the results showed that CD joint BMMC treatment effect on the HHS is superior to the single CD (MD = 5.57, 95% CI: 1.94, 9.20, P = 0.003, I squared = 0%), both no significant differences in VAS (MD = 0.47, 95% CI: -1.74, 0.79, P=0.46, I²=83%). In this study, we found that core decompression combined with bone marrow monocyte therapy improved femoral head necrosis better than core decompression alone.

Current status of clinical research on the pathogenesis and treatment of femoral head necrosis.

Current status of clinical research on the pathogenesis and treatment of femoral head necrosis.

Expert consensus on clinical drug prevention and treatment of osteonecrosis of the femoral head(2022)

With the in-depth understanding of osteonecrosis of femoral head (ONFH), and more and more patients seeking medical treatment in the early stage of the disease, surgical treatment of femoral head necrosis alone is no longer sufficient for the current treatment of patients' demand, how to rationally and effectively apply drugs to strengthen the early prevention and treatment of femoral head necrosis and delay the progression of disease is becoming more and more important. This article combines the latest expert consensus and evidence-based medical evidence on the principles of ONFH diagnosis and treatment in Chinese and Western medicine at home and abroad, combined with domestic actual clinical application experience, and is organized by experts from Association Related to Circulation Osseous Chinese Microcirculation Society (CSM-ARCO) to write this consensus, focusing on the types of ONFH drugs, the characteristics, safety, rationality and basic principles of drug use provide reference opinions for the safe, reasonable, standardized and effective drug use of medical institutions at all levels. This consensus is only an expert guideline based on literature and clinical experience, not as a requirement for mandatory implementation, let alone as a legal basis. The clinical practice could be tailored to the actual local conditions to develop appropriate prevention and treatment measures for patients.

Chinese expert consensus on clinical drug prevention and treatment of osteonecrosis of the femoral head（2023)

The in-depth understanding of osteonecrosis of the femoral head (ONFH), has lead more and more patients to seek for medical treatment in the early stage of the disease. Surgical treatment of femoral head necrosis alone is no longer sufficient for the current patients’ demand. The rational and effective use of drugs to strengthen the prevention and early treatment of femoral head necrosis delaying the progression of the disease, is becoming more and more important. This article combines the latest expert consensus and evidence-based medical research on the principles of ONFH diagnosis and treatment according to Chinese and Western medicine and is organized by Chinese experts from the Association Related to Osseous Circulation and the Chinese Microcirculation Society (CSM-ARCO). This consensus was formulated with focus on drug types, characteristics, and safety. Rationality and consideration of basic principles of drug use will provide safe, reasonable, standardized, and effective drug use in medical institutions at all levels. This consensus is only an expert guideline based on literature and clinical experience, not a requirement for mandatory implementation. The clinical practice can be tailored to the actual local conditions to develop appropriate prevention and treatment measures for patients. Keywords: Osteonecrosis of the femoral head; Expert consensus; Drug prevention and treatment

Study on The Treatment of Osteonecrosis of The Femoral Head Based on The Classic Theory of “Blood Stasis Removal - Regeneration Bone - Fusion”

Objective Based on Traditional Chinese Medicine (TCM) classics, this paper, by searching the literature on the treatment of femoral head necrosis with TCM, aims to explain the essence of the theory of “blood stasis removal - regeneration bone - fusion”, analyze the development of modern Chinese medicine in the treatment of osteonecrosis of femoral head (ONFH), and provide new ideas for the treatment of ONFH with integrated traditional Chinese and western medicine. Methods CNKI, PubMed, Wanfang and VIP databases were searched by computer to collect literature research on the theory of “blood stasis removal - regeneration bone - fusion” and the treatment of ONFH with integrated TCM Western medicine. Based on content analysis and bibliometric analysis, the modern integrated traditional Chinese and western medicine literature database of treating ONFH with the theory of “removing blood stasis and generating bone” was established and analyzed. Results Based on the theory of “blood stasis removal - regeneration - bone fusion”, this paper found that the TCM treatment of ONFH has the clinical effect of promoting blood circulation and removing blood stasis. The essence of the modern medicine of the theory of “blood stasis removal - regeneration - bone fusion” is to eliminate the microcirculation disorders caused by microvascular regeneration and hypoperfusion, so as to promote bone regeneration, which coincides with the treatment of ONFH by western medicine. Conclusions The theory of “blood stasis removal - regeneration - bone fusion” in modern Chinese medicine has a certain scientific and valuable value, which is worth more scientific research in the future.

Method of dynamic modeling of the femoral head

The mechanism of action of therapeutic exercises can be considered as a universal form of exercise. Therapeutic physical exercises can provide both a direct load on the contact and articular surfaces (walking and exercises with crutches), and muscle load (concentric muscle contractions, motor system). The high sensitivity of the bone to mechanical signals is the basis for non-drug interventions, including physical therapy.
 The article presents the authors method of physical therapy for patients with femoral head aseptic necrosis. The gymnastics was based on a set of exercises for dynamic modelling of the femoral head, developed by Huang Keqin, a doctor of the Beijing Specialized Clinic for the Treatment of Femoral Head Necrosis, and modern concepts of bonne tissue biomechanics and physiology. The set includes 3 types of exercises. The first type is based on the principle of autogravity burden. The second type consists of the exercises with an accelerated rhythm of small amplitude. Type 3 is based on the muscles post-isometric relaxation principle.
 In this article the recommendations are given regarding the exercises use depending on disease stage.

The role of internal fixation in the treatment of femoral head necrosis with ipsilateral hip fracture.

Whether internal fixation or hip arthroplasty is the most appropriate initial treatment for patients with ipsilateral hip fracture and osteonecrosis of the femoral head remains unknown. In this study, the prognoses of patients who underwent internal fixation or hip arthroplasty were analyzed and compared to explore the role of internal fixation in treating such patients.We retrospectively reviewed 69 patients diagnosed with osteonecrosis of the femoral head and ipsilateral hip fracture from 1999 to 2018. They were divided into the hip arthroplasty or internal fixation group. The visual analog scale and Harris score were used. The incidence of complications and the conversion to arthroplasty were also investigated to further explore the role of internal fixation.Male patients (male/female: 25/31 vs 20/38, P = .015), younger patients (average age: 46.80 ± 13.14 vs 61.07 ± 15.61, P < .001), and patients with femoral neck fractures (fracture type, femoral neck/trochanter: 21/31 vs 12/38, P = .003) were more likely to receive 1-stage hip arthroplasty. Of 38 patients undergoing internal fixation, fracture nonunion was identified in 9, and progression of osteonecrosis was identified in 16. Meanwhile, conversion to secondary hip arthroplasty occurred in 13 patients. Four independent risk factors for conversion to secondary hip arthroplasty were identified: age of ≤60 years (odds ratio [OR] = 9.786, 95% confidence interval [CI] = 2.735–35.015), male sex (OR = 6.790, 95% CI = 1.718–26.831), collapse of the femoral head before injury (OR = 7.170, 95% CI = 2.004–25.651), and femoral neck fracture (OR = 8.072, 95% CI = 2.153–30.261). A new scoring system was constructed for predicting conversion to hip arthroplasty in patients undergoing internal fixation treatment. A cutoff of ≤2 points indicated low risk for conversion, 3 to 4 points indicated moderate risk, and ≥5 points indicated high risk.Patients who underwent internal fixation had worse prognoses than those who underwent 1-stage hip arthroplasty. However, in this study, hip arthroplasty conversion did not occur in most patients who received internal fixation. Using the new scoring system to identify patients who may require conversion to replacement may help make appropriate patient management and clinical decisions.

Efficacy of robot-assisted core decompression combined with human umbilical cord-derived mesenchymal stem cell transplantation for osteonecrosis of the femoral head.

The aim of this paper was to evaluate the effects of robot-assisted core decompression combined with human umbilical cord-derived mesenchymal stem cell (hUC-MSC) transplantation for early-stage osteonecrosis of the femoral head (ONFH). A retrospective analysis was performed on 18 patients with a total of 26 hips who were diagnosed with Association Research Circulation Osseous stage 2 avascular necrosis of the femoral head and who received core decompression combined with hUC-MSC transplantation. All surgeries were completed under robotic assistance. Preoperative and postoperative visual analogue scale (VAS) scores and the Harris Hip Score (HHS) were recorded to assess clinical function. A Magnetic Resonance Imaging (MRI) examination was performed at the last follow-up. The mean follow-up was 18.6 months (12-28 months), the VAS score (4.5±0.8 vs. 0.9±0.2, t=12.6, p≤0.001) and HHS (79.5±5.8 vs. 60.5±4.6, t=14.3, p≤0.001) were significantly improved at the last follow-up, compared with preoperative value. The MRI results showed that the necrotic volume of the femoral heads was significantly reduced. Robot-assisted core decompression combined with hUC-MSC transplantation is a feasible and relatively safe method for the treatment of femoral head necrosis.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ НЕКРОЗА ГОЛОВКИ БЕДРЕННОЙ КОСТИ С ПРИМЕНЕНИЕМ ПРЕДДИФФЕРЕНЦИРОВАННЫХ МЕЗЕНХИМАЛЬНЫХ СТВОЛОВЫХ КЛЕТОК

Objective. To study the results of pre-differentiated MSCs application in the treatment of femoral head necrosis in young patients. Methods. The developed high-tech approach included: exfusion of 50-70 ml of patient’s bone marrow 4 weeks prior to implantation; osteogenic differentiation and obtaining a biomedical cell product; surgical decompression and introduction of pre-differentiated MSCs in fibrin gel; postoperative rehabilitation. Surgeries were performed in 25 patients at stages I and II according to the ARCO classification. The average age of patients is 34 [29; 45], men - 20 (80%), women - 5 (20%). Theassessment scaleis avisual analogue scale (VAS), Harris scale, radiography, MRI. Results. Observation period was 41 [19; 59] month. Average Harris score before surgery was 76 [68.8; 79] points, after treatment - 90 [78.9; 92] points. In 15 (60%) cases an excellent results were obtained, in 5 (20%) - good, in 3 (12%) - satisfactory, in 2 (8%) - unsatisfactory (collapse progression). The level of pain syndrome was reduced from 40 [30; 50] to 10 [5; 25] points. There were no complications. Preservation of the femoral head sphericity and the width of the joint space, relief of bone marrow edema, reduction of the necrosis zone size and synovitis according to MRI data were found in 92% of cases. Conclusion. The treatment method of femoral head necrosis with the use of pre-differentiated MSCs in the absence of infectious triggers in the lesion focus made it possible to preserve 95 % of cultured cells in the cell product composition and to introduce it minimally invasively, avoiding the need for bone graft collection. The introduction of the cellular technologies in practice made it possible to obtain positive treatment results in 92% of cases due to an improvement clinical condition by the Harris scale and reduce of pain syndrome compared to the initial state; it did not lead to infectious, allergic or other complications within the 41 [19; 59] month follow-up. What this paper adds A method of cell therapy of femoral head necrosis affected young patients using pre-differentiated mesenchymal stem cells (MSCs) has been firstly developed. The use of a new method of treatment made it possible to obtain positive results and preserve the structures of the hip joints in 92% of cases due to the optimization of the osteoregeneration process has been demonstrated.

Curculigo orchioides polysaccharides extraction, characterization, and their protective effects against femoral head necrosis

The use of steroid drugs such as dexamethasone in long-term treatment poses a challenge called femoral head necrosis. To reduce the destructive effects of dexamethasone, the use of herbal suppressants such as Curculigo orchioides polysaccharides (COPs) is recommended despite the ambiguities in their chemical composition and the effects of each component on the anti-necrosis activity of the femoral head. In this study, after separation of COPs through hot water–ethanol precipitation method and purification through DEAE-Sepharose fast flow column, their properties were explained by FTIR, NMR, methylation and chromatography. Moreover, the COPs biocompatibility and its inhibitory effects against dexamethasone-induced cytotoxicity were evaluated by MTT assay and gene expression on human primary osteoblasts cells. The results exhibit that the 4756 Da molecular weight COPs is generally composed of Rha, Ara, Fru, Xyl, Man, Glc, Gal, Glu A and Gal A. Also, MTT results recognized high biocompatibility of COPs and suppressive effect on dexamethasone. Also, COPs significantly reduced dexamethasone-induced intracellular levels of apoptosis and ROS. Furthermore, the use of COPs has significantly increased ALP activity, collagen content and mineralization, which are very effective in differentiating HPOS cells to repair bone tissue. Meanwhile, the gene expression outcomes indicate an increase in Bcl-2 expression gene and decrease in BAX, Caspase-9 and Caspase-3 gene expression in the presence of COPs, which are important in controlling apoptotic activity and bone regeneration. Overall, this study revealed that COPs can lead to the treatment of femoral head necrosis.

The effect of Moringa oleifera polysaccharides on the regulation of glucocorticoid-induced femoral head necrosis: In vitro and in vivo

One of the common challenges in using glucocorticoid in the long term is the development of femoral head necrosis. To address this challenge, the use of glucocorticoid suppressors like plant polysaccharides has been considered. In this study, Moringa oleifera polysaccharide was isolated through hot water–ethanol precipitation method and purified by DEAE-Sepharose fast flow column. Then, they were characterized by FT-IR, NMR, methylation, and chromatography assays. The polysaccharide biocompatibility was investigated by MTT assay and its effect on osteoblasts was evaluated by controlling gene expression. Also, the effect of polysaccharide on dexamethasone-induced femoral head necrosis in rats was assessed by hydroxyproline, hexosamine and morphometric parameters. The results show that 2 Da molecular weight polysaccharide is mainly composed of Rha, Ara, Fru, Xyl, Man and Gal in the molar ratio of 1.7:2.1:3.4:5.9:5.8:1.3. Meanwhile, MTT results on osteoblasts cells showed polysaccharide biocompatibility, while significantly reducing the negative effects of glucocorticoid. Likewise, polysaccharide significantly reduced the levels of apoptosis and intracellular ROS of glucocorticoid-induced femoral necrosis. Moreover, the results of gene expression indicated a decrease in the expression of TNF-α and IL-6 genes using polysaccharide, which is very effective in preventing apoptotic activity. Also, Polysaccharide increased bone density, bone volume per tissue volume, trabecular thickness, and the hexosamine to hydroxyproline ratio in the rat serum in the presence of glucocorticoids, which are very effective in the process of femoral head necrosis. Furthermore, polysaccharide significantly increases the OCN, RUNX2 and COL-1 genes expression in cartilage tissue, which is in line with the result of morphometric parameters. Overall, this study suggests that the use of polysaccharide could result in the treatment of femoral head necrosis.

Combination use of core decompression for osteonecrosis of the femoral head: A systematic review and meta-analysis using Forest and Funnel Plots.

Objective This study evaluated the efficacy and safety of CD combined with bone marrow stem cells in the treatment of femoral head necrosis by systematic review and meta-analysis. Methodology. PubMed, The Cochrane Library, Embase, CNKI, Google Scholar and MEDLINE, etc. databases were searched for clinical randomized controlled trials (RCTs) comparing core decompression combined with autologous bone marrow mesenchymal stem cells versus core decompression alone in the treatment of femoral head necrosis. The retrieval period is from the establishment of each database to May 20, 2021. After literature was extracted and literature quality was evaluated, meta-analysis was conducted by using RevMan5.3 software. Results A total of 420 osteonecrosis of the femoral head 452 patients' data were collected from all studies. Compared with the core decompression alone group, the CD combined with bone marrow stem cell showed marked reduction in the Visual analog scale (VAS), enhanced Harris hip score (HHS) at 12 months and 24 months, slowed down the progression of the disease, decreased the number of hips conversed to total hip arthroplasty (THA) in the future. Conclusion Core decompression therapy is a very effective and safe treatment process used for ONFH. Moreover, CD combined autologous bone marrow stem cell transplantation can improve the survival rate of the necrotic head, reduce hip pain and delay the disease progression, the rate of THA postoperatively.

Recombinant Human Bone Morphogenic Protein-2 Immobilized Fabrication of Magnesium Functionalized Injectable Hydrogels for Controlled-Delivery and Osteogenic Differentiation of Rat Bone Marrow-Derived Mesenchymal Stem Cells in Femoral Head Necrosis Repair

Femoral head necrosis (FHN) is a clinically progressive disease that leads to overwhelming complications without an effective therapeutic approach. In recent decades, transplantation of mesenchymal stem cells (MSCs) has played a promising role in the treatment of FHN in the initial stage; however, the success rate is still low because of unsuitable cell carriers and abridged osteogenic differentiation of the transplanted MSCs. Biopolymeric-derived hydrogels have been extensively applied as effective cell carriers and drug vesicles; they provide the most promising contributions in the fields of tissue engineering and regenerative medicine. However, the clinical potential of hydrogels may be limited because of inappropriate gelation, swelling, mechanical characteristics, toxicity in the cross-linking process, and self-healing ability. Naturally, gelated commercial hydrogels are not suitable for cell injection and infiltration because of their static network structure. In this study, we designed a novel thermogelling injectable hydrogel using natural silk fibroin-blended chitosan (CS) incorporated with magnesium (Mg) substitutes to improve physical cross-linking, stability, and cell osteogenic compatibility. The presented observations demonstrate that the developed injectable hydrogels can facilitate the controlled delivery of immobilized recombinant human bone morphogenic protein-2 (rhBMP-2) and rat bone marrow-derived MSCs (rBMSCs) with greater cell encapsulation efficiency, compatibility, and osteogenic differentiation. In addition, outcomes of in vivo animal studies established promising osteoinductive, bone mineral density, and bone formation rate after implantation of the injectable hydrogel scaffolds. Therefore, the developed hydrogels have great potential for clinical applications of FHN therapy.

Therapeutic Study of Thermosensitive Hydrogel Loaded with Super-Activated Platelet Lysate Combined with Core Decompression Technology for the Treatment of Femoral Head Necrosis.

Super activated platelet lysate (sPL) is a derivative of platelet-rich plasma (PRP) that contains high levels of several growth factors. In this study, we synthesized a temperature-sensitive hydrogel that contained temperature-sensitive Poly(DL-lactide-glycolide-glycolide acid) (PLGA), SrCl2, and HA, and loaded it with different concentrations of sPL. The hydrogel showed satisfactory encapsulation efficiency and release of the growth factors in a sustained manner, indicating its suitability as a drug carrier. The sPL-loaded hydrogel was inserted into the necrotic femoral head of a rat model and core decompression was applied and resulted in significantly accelerated bone repair and regeneration. Therefore, encapsulation of sPL in a hydrogel scaffolding may be an effective strategy for treating femoral head necrosis.

Short term effect of double channel decompression and bone grafting via greater trochanter combined with allograft fibula propping in the treatment of femoral head necrosis

To investigate the short-term clinical effect of double channel decompression and bone grafting through the greater trochanter combined with allograft fibula propping in the treatment of osteonecrosis of femoral head (ONFH). Twenty two patients (23 hips) with osteonecrosis of the femoral head were included from November 2017 to February 2019. According to Association Research Cirulation Osseous(ARCO) staging, there were 13 hips at stageⅡgroup, aged from 20 to 48 years old with an average of(32.5±8.5)years old;10 hips at stageⅢgroup, aged from 18 to 45 years old with an average of(32.7±8.6) years old. A single approach through the greater trochanterwas used for decompression, bone grafting and fibula support. Harris scoring system was used to evaluate the function of hip joint before and after implantation, and the anteroposterior and lateral X-ray films of hip joint were taken at 3, 6, 12 and 18 months after implantation to observe and analyze the progress of femoral head necrosis and regeneration. All patients were followed up, and the duration ranged from 12 to 18 months with an average of (14.6±2.1) months. Harris score of stageⅡand stageⅢpatients increased from 73.2± 5.5 and 66.5±3.4 to 87.6±8.7(P<0.001) and 77.2±14.0 (P<0.05) respectively. After 12 months, the X-ray film of all patients showed that 12 hips were improved at stageⅡgroup and 7 hips were improved at stageⅢgroup. The effect of double trochanteric decompression and bone grafting combined with fibular allograft propping in the treatment of early and middle stage avascular necrosis of the femoral head is good, especially suitable for young and middle aged patients with ARCOⅡstage avascular necrosis of the femoral head.

Clinical study on minimally invasive treatment of femoral head necrosis with two different bone graft materials.

To investigate the clinical efficacy and safety of two different bone graft materials in the minimally invasive treatment of early and middle stage femoral head necrosis. A total of 36 patients (39 hips) with avascular necrosis of the femoral head were divided into autologous iliac bone group (ABG) and bioceramics bone group (BBG). Both groups were treated with minimally invasive thick channel decompression to remove dead bone of femoral head. The ABG was treated with autologous iliac bone graft, and BBG was treated with β-tricalcium phosphate bone graft. The operation time, intra-operative blood loss, haemoglobin, and haematocrit were recorded at three and seven days post-operatively. The clinical efficacy and safety were evaluated by Harris score and imaging examination before, and after treatment and at follow-up stages. The patients were followed up for 24 to 45 (average 29.27 ± 3.56) months. The BBG was significantly better than the ABG in terms of operation time, intra-operative blood loss, haemoglobin, and haematocrit value at three days. Compared with pre-operative, theHarris score of the two groups at 12months after operation was significantly improved. The Harris score and the imaging evaluation of the last follow-up exhibited significantly better outcome in BBG than those of ABG. Bioceramics and autologous iliac bone minimally invasive treatment of early and medium-term femoral head necrosis exhibited satisfactory clinical efficacy in the short and medium-term. The bioceramics graft materials have the advantages of reducing trauma, bleeding, operation time, and quick recovery of post-operative functions.

Hyper-Activated Platelet Lysate Prevents Glucocorticoid-Induced Femoral Head Necrosis Through Autophagy

Background: Studies have shown that platelet lysate (PL) stimulates resting osteoblasts to resume proliferation, activates the angiogenesis induction pathway, secretes factors that promote angiogenesis, accelerates osteoblast differentiation and bone formation, and can treat Avascular necrosis. Glucocorticoids(GCs) can induce osteonecrosis of the femoral head(ONFH), which is avascular osteonecrosis, which is largely related to the increase of autophagy. Super active platelet lysate (sPL) has a variety of biologically active factors, high content and strong activity. It is an upgraded version of PL and can repair ONFH. However, the relationship between sPL and glucocorticoid-related rat ONFH is still It is not clear, therefore, the purpose of our study is whether sPL can prevent and treat ONFH through autophagy. In this study, we tried to explore the role of sPL in ONFH and explore its mechanism. Methods: Through scanning electron microscopy(SEM) and enzyme-linked immunosorbent assay (ELISA) to detect the characteristics of sPL. We used methylprednisolone (MPS)-induced in vitro osteoblast necrosis model, divided into control group, MPs group, 5% group, 10% group, 15% group and 20% group, cell counting kit-8 (CCK-8), cell cycle analysis, An-nexin V And PI staining was used to diagnose its effects on cell proliferation, apoptosis, angiogenesis and osteogenesis. Using RT-PCR and western-blotting technology to analyze its molecular mechanism. Using the rat ONFH model, divided into the control group, treatment-100 group, treatment-300 group, the prevention and treatment effects of sPL on it were verified by Micro-CT and histology. Results: Increased autophagy in the ONFH model. The characterization of sPL showed that the biologically active factor was higher than that of PRP. In vitro, the results of ccK-8 showed that sPL can significantly induce the proliferation of osteoblasts and endothelial cells. Flow cytometry results also proved that sPL can inhibit cell apoptosis and promote bone formation. In addition, in the body, sPL promotes the treatment of ONFH. In order to further verify the correlation between sPL prevention and treatment of ONFH and autophagy, we found that after sPL was used to treat hormone-induced ONFH, the effect of sPL on glucocorticoid-inducedONFH by stimulating autophagy was significantly inhibited. This study reported for the first time that sPL can improve ONFH caused by glucocorticoid-activated autophagy by inhibiting the mTOR signaling pathway. which provides a research basis for the clinical application of sPL and also provides a basis for conservative treatment of femoral head necrosis. Interpretation: sPL can inhibit GC-induced ONFH through autophagy. This simple treatment brings good news for patients with femoral head necrosis. Funding: This work is supported by the Postgraduate Research & Practice Innovation Program of Harbin Medical University (No. YJSKYCX2019- 39HYD). Declaration of Interests: The authors have declared that there are no competing interests. Ethics Approval Statement: All experimental and animal care procedures were approved by the Ethics Committee of Laboratory Animal Ethics Committee of the First Affiliated Hospital of Harbin Medical University and performed under the guidelines of the National Institutes of Health Guidelines for the Care and Use of Laboratory Animals.

Accuracy and Safety of Robot‐Assisted Drilling Decompression for Osteonecrosis of the Femoral Head

ObjectiveTo investigate the safety and superiority of robot‐assisted femoral head drilling decompression in the treatment of femoral head necrosis.MethodsA total of 63 patients who underwent borehole decompression of the femoral head in our hospital from January 2016 to March 2019 were recruited. Patients were divided into two groups for comparison according to surgical methods. In the robot‐assisted surgery group, there were 30 cases with 41 femoral heads. The conventional group had 33 cases and 46 femoral heads. All patients signed the consent form before the operation. The follow‐up time was 6 months. The incision lengths, operation times, intraoperative blood loss, intraoperative fluoroscopies, guide needle punctures, postoperative Harris scores, and postoperative complications of the two groups were compared.ResultsThe incision length of the robot surgery group was 5.16 ± 0.41 cm, while that of the traditional surgery group was 7.42 ± 0.50 cm. The operation time of the robot surgery group was 46.99 ± 4.94 min, while that of the traditional surgery group was 55.01 ± 6.19 min. The fluoroscopy frequency of the robot surgery group was 10.50 ± 1.78 times, while that of the traditional surgery group was 17.91 ± 2.20 times. The intraoperative blood loss in the robotic surgery group was 20.62 ± 2.52 mL, while that in the conventional surgery group was 52.72 ± 3.39 mL. In the robot operation group, each femoral head guide needle was punctured three times, and the puncture was successful one time. The number of guided needle punctures in the traditional group was 8.02 ± 1.73. The difference between the two groups was statistically significant (P < 0.05). The Harris score was 69.53 ± 7.51 in the robot surgery group and 68.38 ± 7.26 in the traditional surgery group one month after surgery, 78.52 ± 6.49 in the robot surgery group and 76.41 ± 7.95 in the traditional surgery group three months after surgery, and 83.32 ± 8.62 in the robot surgery group and 81.74 ± 6.20 in the traditional surgery group six months after surgery. There was no significant difference between the two groups (P > 0.05). In the traditional group, there was one case of incision infection and one case of femoral head collapse during follow‐up. In the robot group, there were no complications, such as incision infection and deep vein thrombosis. No collapse of the femoral head was found in the robot group during follow‐up.ConclusionThe positioning system of the orthopaedic robot is an ideal method for the treatment of femoral head necrosis. This method has the advantages of simple operation, accurate drilling, a short operation time, less surgical trauma, less radioactivity, and good recovery of hip joint function.