Visual and quantitative assessment of the effectiveness of non-vascularized bone grafting in osteonecrosis of the femoral head via CT-based radiomics and clinical data / 中国修复重建外科杂志

OBJECTIVE@#To investigate the value of CT-based radiomics and clinical data in predicting the efficacy of non-vascularized bone grafting (NVBG) in hip preservation, and to construct a visual, quantifiable, and effective method for decision-making of hip preservation.@*METHODS@#Between June 2009 and June 2019, 153 patients (182 hips) with osteonecrosis of the femoral head (ONFH) who underwent NVBG for hip preservation were included, and the training and testing sets were divided in a 7∶3 ratio to define hip preservation success or failure according to the 3-year postoperative follow-up. The radiomic features of the region of interest in the CT images were extracted, and the radiomics-scores were calculated by the linear weighting and coefficients of the radiomic features after dimensionality reduction. The clinical predictors were screened using univariate and multivariate Cox regression analysis. The radiomics model, clinical model, and clinical-radiomics (C-R) model were constructed respectively. Their predictive performance for the efficacy of hip preservation was compared in the training and testing sets, with evaluation indexes including area under the curve, C-Index, sensitivity, specificity, and calibration curve, etc. The best model was visualised using nomogram, and its clinical utility was assessed by decision curves.@*RESULTS@#At the 3-year postoperative follow-up, the cumulative survival rate of hip preservation was 70.33%. Continued exposure to risk factors postoperative and Japanese Investigation Committee (JIC) staging were clinical predictors of the efficacy of hip preservation, and 13 radiomic features derived from least absolute shrinkage and selection operator downscaling were used to calculate Rad-scores. The C-R model outperformed both the clinical and radiomics models in predicting the efficacy of hip preservation 1, 2, 3 years postoperative in both the training and testing sets ( P<0.05), with good agreement between the predicted and observed values. A nomogram constructed based on the C-R model showed that patients with lower Rad-scores, no further postoperative exposure to risk factors, and B or C1 types of JIC staging had a higher probability of femoral survival at 1, 2, 3 years postoperatively. The decision curve analysis showed that the C-R model had a higher total net benefit than both the clinical and radiomics models with a single predictor, and it could bring more net benefit to patients within a larger probability threshold.@*CONCLUSION@#The prediction model and nomogram constructed by CT-based radiomics combined with clinical data is a visual, quantifiable, and effective method for decision-making of hip preservation, which can predict the efficacy of NVBG before surgery and has a high value of clinical application.

Application of fibular flap with partial continuous periosteum and cortex in hip preservation surgery for femoral head necrosis / 中华显微外科杂志

Objective:To investigate the short-term clinical effect of using fibular flap with preserving the continuity of fibula in hip preservation surgery for femoral head necrosis.Methods:From September, 2017 to November, 2020, 13 cases of femoral head necrosis were repaired with fibular flap. The fibular flaps were cut with an improved method for preserving the continuity of the fibular cortex, and the donor sites were sutured directly. The fibuls were inserted into the femoral heads with single or double segment folding support. Autogenous iliac crest combined with platelet-rich plasma(PRP) was used for impaction of bone grafting in femoral head, and the fibular flaps were anastomosed with 1 artery and 2 veins. All follow-up data were obtained, including bone union by X-ray and CT as well as the functional recovery of the hip joint and donor site. Statistical analysis was performed. P<0.05 was considered statistically significant. Results:The followed-up time ranged from 6 to 23 months. The fibular bones were significantly thicker and the incisions healed well at the donor sites. There was neither abnormal sensation in toes, dorsal foot, and lateral of the leg, nor significant influence on foot function. The hip joint activities were normal. The outcome was proved to be remarkable according to the Harris score(from 58.9±10.6 points before surgery to 81.7±10.6 points after surgery), the difference was statistically significant ( P<0.05) . Conclusion:The method of the improved fibular flap in hip preservation surgery is beneficial to the repair and reconstruction of the necrotic femoral head since the donor area is less traumatic, and a satisfactory clinical effect can be obtained.

Type L1 steroid-induced osteonecrosis of the femoral head through femoral head and neck junction decompression by fenestration: A single-center prospective clinical study / 中国组织工程研究

BACKGROUND: Osteonecrosis of the femoral head is a refractory disease in department of orthopedics. Especially with steroid-induced osteonecrosis, incidence rate is high, and it is easy to collapse. Increasing knowledge of hormone necrosis will help early identification and intervention, and choose reasonable treatment measures to improve prognosis. OBJECTIVE: To investigate the clinical effects and influencing factors in the treatment of different kinds of steroid-induced osteonecrosis of the femoral head of CJFH type L1 patients through femoral head and neck junction decompression by fenestration and bone grafting. METHODS: Clinical data of 82 patients (106 hips) with CJFH type L1 steroid-induced osteonecrosis of the femoral head, who underwent femoral head and neck junction decompression by fenestration in China-Japan Friendship Hospital, were analyzed. The clinical effect evaluation consisted of two parts: Harris hip score system, the observation of bilateral hip joint and frog position film. Clinical endpoint events were marked by poor Harris hip score < 70, progressive collapse of the femoral head with/without obvious clinical manifestation. Univariate and multivariate analyses were used to analyze the influence of gender, age, etiology, preoperative ARCO stage, onset time and preoperative Harris score on prognosis. RESULTS AND CONCLUSION: (1) All patients were followed up, and the mean duration was 3-51 months. (2) Based on Harris hip score of the last follow-up, the results were excellent in 4 hips, good in 33 hips, fair in 50 hips, and poor in 19 hips. The excellent and good rate was 34.9% (37/106). Harris hip score was higher in the final follow-up (83.1±14.3) than that before surgery (64.4±9.8) (P < 0.05). (3) Imaging results demonstrated that there were 15 hips with progressive collapse of the femoral head, and 6 hips without obvious clinical symptoms. (4) The 26 hips were classified as clinical failed. Univariate and multivariate analyses showed that preoperative Harris hip score < 70 was the independent risk factor for prognosis of osteonecrosis of the femoral head (P < 0.05). There was no significant difference among different types of steroid-induced osteonecrosis of the femoral head. (5) The method through femoral head and neck junction decompression by fenestration and bone grafting has a good effectiveness in patients with type L1 steroid-induced osteonecrosis of the femoral head in short and medium terms, but preoperative Harris hip score < 70 is a risk factor affecting the prognosis of hip preservation.

Effect of platelet-rich plasma on blood coagulation indexes after hip preserving surgery for osteonecrosis of the femoral head / 中国组织工程研究

BACKGROUND: It was found that platelet-rich plasma injection can change the coagulation function of patients with osteonecrosis of the femoral head. OBJECTIVE: To investigate the effect of platelet-rich plasma injection on coagulation parameters in patients with osteonecrosis of the femoral head after hip preserving surgery, and to evaluate the risk factors of vascular embolism after surgery. METHODS: Totally 75 cases of osteonecrosis of the femoral head treated by drilling and decompression of the femoral head, removing the dead bone in the femoral head and supporting with fibula allograft were selected in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from December 2016 to September 2018. According to whether platelet-rich plasma injection was used during the operation, the patients were divided into two groups. The platelet-rich plasma group contained 42 cases (42 hips). The control group (33 cases, 35 hips) did not use platelet-rich plasma. The other treatments in the two groups were the same. The changes of blood coagulation indexes before and after operation were continuously observed in the two groups. RESULTS AND CONCLUSION: (1) Patients in both groups were followed up for 3 months. (2) Levels of fibrinogen and D-dimer were significantly increased in both groups. However, levels of fibrinogen and D-dimer in one week after operation in the platelet-rich plasma group were 52.5% and 47.0% higher than those in the control group, indicating platelet-rich plasma led to hypercoagulability and a possible high risk of vascular embolism. (3) There were significant differences in prothrombin time, activated partial thromboplastin time and international standardized ratio, but there was no significant clinical significance in both groups. (4) The use of platelet-rich plasma had no effect on platelet level or C-reactive protein.

Hip preservation experience of avascular necrosis of femoral head according to China-Japan Friendship Hospital classification / 中国修复重建外科杂志

Objective: To sum up staging treatment experiences of hip preservation for avascular necrosis of the femoral head (ANFH) according to China-Japan Friendship Hospital Classification (CJFH Classification). Methods: The literature about hip preservation of ANFH was extensively reviewed, and a staging treatment method for ANFH was set up base on CJFH Classification and the 28 years of clinical experience in this research group. Results: According to CJFH Classification, the ANFH can be rated as types M, C, and L. And the type L is rated as L1, L2, and L3 subtypes. The staging treatment method for ANFH based on CJFH Classification is set up. Conservative treatment was selected for CJFH-M patients because the necrotic area is small and in the medial non-weight-bearing area. Minimally invasive sequestrum clearance, impacting bone graft, and supporting allogenic fibular graft is selected for CJFH-C patients because the necrotic area is also small and in the lateral non-weight-bearing area. If patients are in CJFH-L1, normal bone area is less than 1/3 on hip abduction radiograph, the sequestrum clearance and impacting bone graft via surgical hip dislocation approach can be selected. If patients are in CJFH-L1, normal bone area is more than 1/3 on hip abduction radiograph, the transtrochanteric curved varus osteotomy can be selected. The rotational osteotomy on the base of femoral neck via surgical hip dislocation approach is for CJFH-L2 patients. Total hip arthroplasty via direct anterior approach is for CJFH-L3 patients. Conclusion: The staging treatment method for ANFH according to CJFH Classification has good short-term effectiveness. But the long-term effectiveness needs further follow-up.

Development of hip preservation in treating adult hip dysplasia / 中国修复重建外科杂志

During the past decades, the field of hip preservation in China has achieved great improvements. Theoretically, the blood supply of the femoral head and the acetabulum along with the mechanism of early-stage hip osteoarthritis has been gradually cleared. The knowledge and application of the periacetabular osteotomy, surgical hip dislocation, and hip arthroscopy has been vigorously promoted. Improved understanding of the mechanism, pathology, and prevention protocols of the secondary hip dysplasia have been obtained, despite the fact that lack of awareness of some mechanism and detail, for example, hip instability or borderline dysplasia, etc. On the basis of summing up those clinical progress, this article further elaborated the historical development of hip preservation through the review of several traditional treatment, and made objective assessment about the follow-up, evaluation, minimally invasive surgery, and individualized treatment newly reported.

One-stage Hip Reconstruction for Developmental Hip Dysplasia in Children over 8 Years of Age / 대한고관절학회지

PURPOSE: This study was performed to assess the clinical and radiological outcomes following one-stage hip reconstruction, consisting of open reduction femoral shortening and pelvic osteotomy, for neglected developmental dislocation of the hip (DDH). MATERIALS AND METHODS: This is a retrospective analysis of 77 hips in 65 patients (46 females and 19 males; 12 had bilateral dislocations), operated at a Ghurki Trust Teaching Hospital in Pakistan between 2013 and 2015. The average age at surgery was 11.02±3.43 years. According to the Tönnis classification, there were 10, 14, 22, and 31 patients in grades 1, 2, 3, and 4, respectively. The pelvic procedure utilized in this study was triple osteotomy (47 hips) followed by double and Salter osteotomy (18 and 12 hips, respectively). Postoperative evaluations were conducted using the modified MacKay's scoring system (functional outcomes) and Severin's scoring method (radiological assessment). RESULTS: Postoperatively, there were 38 (49.4%), 19 (24.7%), 14 (18.2%), and 6 (7.8%) hips in Severin grade I, II, III and IV, respectively. According to the modified McKay criteria, there were 22 hips (28.6%) in excellent condition, 44 (57.1%) in good condition, 9 (11.7%) in fair condition and 2 (2.6%) in poor condition. Both patients with poor outcomes had an unstable, painful hip with evidence of avascular necrosis of the femoral head. CONCLUSION: Based on the results presented here, we recommend the single stage procedure of open reduction, femoral shortening and pelvic osteotomy for treatment of DDH in older children with good to excellent functional and radiological outcomes.