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Chinese Medical Journal ; (24): 2214-2222, 2021.
Article in English | WPRIM | ID: wpr-887598


BACKGROUND@#Accumulating evidence suggests that lithium influences mesenchymal stem cell (MSC) proliferation and osteogenic differentiation. As decreased bone formation in femoral heads is induced by glucocorticoids (GCs), we hypothesized that lithium has a protective effect on GC-induced osteonecrosis of femoral heads (ONFH).@*METHODS@#A rat ONFH model was induced by methylprednisolone (MP) and the effect of lithium chloride on the models was evaluated. Micro-computed tomography (CT)-based angiography and bone scanning were performed to analyze the vessels and bone structure in the femoral heads. Hematoxylin and eosin and immunohistochemical staining were performed to evaluate the trabecular structure and osteocalcin (OCN) expression, respectively. Bone marrow-derived MSCs were isolated from the models, and their proliferative and osteogenic ability was evaluated. Western blotting and quantitative real-time polymerase chain reaction were performed to detect osteogenic-related proteins including Runx2, alkaline phosphatase, and Collagen I.@*RESULTS@#Micro-CT analysis showed a high degree of osteonecrotic changes in the rats that received only MP injection. Treatment with lithium reduced this significantly in rats that received lithium (MP + Li group); while 18/20 of the femoral heads in the MP showed severe osteonecrosis, only 5/20 in the MP + Li showed mild osteonecrotic changes. The MP + Li group also displayed a higher vessel volume than the MP group (0.2193 mm3vs. 0.0811 mm3, P < 0.05), shown by micro-CT-based angiography. Furthermore, histological analysis showed better trabecular structures and more OCN expression in the femoral heads of the MP + Li group compared with the MP group. The ex vivo investigation indicated higher proliferative and osteogenic ability and upregulated osteogenic-related proteins in MSCs extracted from rats in the MP + Li group than that in the MP group.@*CONCLUSIONS@#We concluded that lithium chloride has a significant protective effect on GC-induced ONFH in rats and that lithium also enhances MSC proliferation and osteogenic differentiation in rats after GC administration.

Animals , Cell Differentiation , Femur Head , Femur Head Necrosis/drug therapy , Glucocorticoids , Lithium Chloride , Mesenchymal Stem Cells , Osteogenesis , Rats , Rats, Sprague-Dawley , X-Ray Microtomography
Article in Chinese | WPRIM | ID: wpr-879417


OBJECTIVE@#To study the relationship between osteonecrosis of femoral head after internal fixation of femoral neck fracture and serum bone metabolism, vascular active factors, and analyze the risk factors.@*METHODS@#Total 150 patients with femoral neck fracture who underwent reduction and internal fixation from April 2016 to April 2019 were selected, including 83 males and 67 females. According to whether there was necrosis of femoral head after operation, they were divided into necrosis group(32 cases) and non necrosis group (118 cases). Before operation and 1, 3, 5 days after operation, the serum levels of beta-C terminal cross-linked telopeptides of typeⅠ collagen(β-CTX), N-telopeptide of typeⅠ procollagen(PINP), nitric oxide (NO), Endothelin-1 (ET-1) were measured. The clinical characteristics of the two groups were compared. The risk factors of postoperative femoral head necrosis were analyzed by logistic regression model. The value of serum indexes in predicting postoperative femoral head necrosis was analyzed by ROC curve.@*RESULTS@#There was no significant difference in the levels of serum PINP and β-CTX between necrotic group and non necrotic group before operation and 1, 3 and 5 days after operation(@*CONCLUSION@#The content of serum NO and ET-1 on the first day after operation can predict the necrosis of femoral head.

Female , Femoral Neck Fractures/surgery , Femur Head , Femur Head Necrosis/etiology , Fracture Fixation, Internal/adverse effects , Humans , Male , Osteonecrosis , Retrospective Studies , Risk Factors
Article in Chinese | WPRIM | ID: wpr-879415


OBJECTIVE@#To investigate the related factors of aseptic necrosis of femoral head after closed reduction and internal fixation of femoral neck fracture.@*METHODS@#From January 2009 to January 2016, 236 patients with femoral neck fracture were treated with closed reduction and internal fixation with 3 hollow lag screws, including 111 males and 125 females, aged from 19 to 89 (50.17±12.88) years. According to the follow-up results, the correlation of aseptic necrosis of femoral head was analyzed. Univariate analysis of age, gender, injured side, body weight, injury mechanism, preoperative waiting time, Garden classification and whether there was comminution of femoral neck cortex was conducted to obtain the independent variables with significant difference. Then binary logistic regression analysis was conducted to explore the independent risk factors of avascular necrosis of femoral head.@*RESULTS@#The average follow-up period of 236 cases was 4.58 years. There were significant differences in the range of injury (24.69% vs. 5.16%, @*CONCLUSION@#High energy injury, preoperative waiting time (>48 h) and comminution of femoral neck cortex were independent risk factors for aseptic necrosis of femoral head. In addition, cortical comminution on the pressure side and tension side of the femoral neck is a strong prognostic risk factor for aseptic necrosis of the femoral head, because it indicates a more serious and complex injury mechanism.

Aged , Female , Femoral Neck Fractures/surgery , Femur Head Necrosis/surgery , Femur Neck , Fracture Fixation, Internal/adverse effects , Fractures, Comminuted , Humans , Male , Risk Factors
Article in Chinese | WPRIM | ID: wpr-888326


OBJECTIVE@#To establish a risk assessment and prediction system for early osteonecrosis of the femoral head (ONFH) in order to predict the collapse risk.@*METHODS@#The risk assessment system for early necrosis and collapse of femoral head was established based on the combination of Steinberg stage, ABC typing and the proportion of the proximal sclerotic rim. Firstly, Steinberg stage system was applied. ABC typing was applied to predict risk in stage I, type C was risk free, type B was low risk, type A and type BC were medium risk, type A-C and type AB were high risk. The classification of proximal sclerotic rim was first applied when the Steinberg stage was Ⅱ-Ⅲ, and type 2 was expected to be low risk. If the classification of proximal sclerotic rimwas type 1, then the ABC typing was applied, type C was risk-free, type B was low risk, type A and type BC were medium risk, type A-C and type AB were high risk. According to this prediction system, the collapse risk of femoral head in 188 cases(301 hips) were predicted by retrospective analysis. All the hips were enrolled at the out-patient department of orthopedic in Guang'anmen Hospital attached to China Academy of Chinese Medical Science. The consistency of the prediction results of three doctors and one doctor at different times were evaluated.@*RESULTS@#Among them, 136 cases were male, 52 were female. 75 cases were single hip, 113 were double hip. The age of the patients wa 19 to 64(42.61±12.07) years. The natural course of disease was 0.33 to 5.00(3.62±1.93) years. 206 hips in 301 hips had collapsed, with a collapse rate of 68.44%. In the risk-free group, none hip had collapsed, with a collapse rate of 0%. In the low-risk group, 9 hip in 91 hips had collapsed, with a collapse rate of 9.89%. In the medium-risk group, 12 hip in 19 hips had collapsed, with a collapse rate of 63.16%. And in the high risk group, 185 hips in 190 hips had collapsed, with a collapse rate of 97.37%. They were significantly differences in their collapse rate (@*CONCLUSION@#The risk assessment and prediction system for early ONFH selects different methods to predict the risk of collapse according to the imaging characteristics of different stages, which is combines with the comprehensive assessment of multiple risk factors. The system is applicable to a wide range, simple operation and convenient for clinical application.

Adult , China , Female , Femur Head/diagnostic imaging , Femur Head Necrosis/epidemiology , Humans , Male , Middle Aged , Retrospective Studies , Risk Assessment , Treatment Outcome , Young Adult
Article in Chinese | WPRIM | ID: wpr-888310


OBJECTIVE@#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).@*METHODS@#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.@*RESULTS@#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(@*CONCLUSION@#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.

Adolescent , Adult , Allografts , Bone Transplantation , Decompression , Femur Head , Femur Head Necrosis , Fibula , Follow-Up Studies , Humans , Middle Aged , Treatment Outcome , Young Adult
Rev. cuba. ortop. traumatol ; 34(1): e271, ene.-jun. 2020.
Article in Spanish | LILACS, CUMED | ID: biblio-1139109


RESUMEN Objetivos: Describir el efecto terapéutico del uso de células madre en el manejo de la osteonecrosis de la cabeza femoral. Métodos: Se realizó una búsqueda en las distintas bases de datos como Pubmed/MEDLINE, BVS y Cochrane de los últimos 10 años, incluyéndose estudios relevantes de metaanálisis, ensayos clínicos y revisiones. Además, se revisó la página electrónica oficial de la Organización Mundial de la Salud para referencias adicionales. Las palabras de búsqueda fueron: "("Stem Cells" OR "Stem Cell Transplantation"[Mesh] OR "Mesenchymal Stem Cell Transplantation"[Mesh] OR Hematopoietic Stem Cell Transplantation"[Mesh] OR Cell-and Tissue-Based Therapy"[Mesh] "Multipotent Stem Cells"[Mesh] OR "Embryonic Stem Cells"[Mesh]) AND ("Osteonecrosis"[Mesh] OR "Femur Head Necrosis"[Mesh] "osteonecrosis of the femoral head" OR "Femoral head"). Incluimos un total de 7 estudios. 2 metaanálisis, 2 artículos de revisión, 2 ensayos clínicos controlados y aleatorizados y un estudio de evidencia. Resultados: Todos los estudios evidenciaron que la terapia con células madre en el manejo de la osteonecrosis de la cabeza femoral es segura y efectiva. El tratamiento combinado de descompresión central más implantación de células madre mostró mayor efectividad. Conclusiones: La terapia con células madre es una opción terapéutica para tratar la osteonecrosis de la cabeza femoral, sobre todo en etapas tempranas. La combinación de descompresión central más la infiltración de células madre en la zona necrótica produce mejoría de la sintomatología y contiene el progreso de la enfermedad(AU)

ABSTRACT Objectives: To describe the therapeutic effect of the stem cell use in managing osteonecrosis of the femoral head. Methods: A search was carried out in the different databases as Pubmed / MEDLINE, BVS and Cochrane for the last 10 years, including relevant meta-analysis studies, clinical trials and reviews. In addition, the official website of the World Health Organization was checked for additional references. The search words were: "(" Stem Cells "OR" Stem Cell Transplantation "[Mesh] OR" Mesenchymal Stem Cell Transplantation "[Mesh] OR Hematopoietic Stem Cell Transplantation" [Mesh] OR Cell-and Tissue-Based Therapy "[ Mesh] "Multipotent Stem Cells" [Mesh] OR "Embryonic Stem Cells" [Mesh]) AND ("Osteonecrosis" [Mesh] OR "Femur Head Necrosis" [Mesh] "osteonecrosis of the femoral head" OR "Femoral head"). We include a total of 7 studies, 2 meta-analyzes, 2 review articles, 2 controlled and randomized clinical trials, and one evidence study. Findings: All the studies showed that stem cell therapy in managing osteonecrosis of the femoral head is safe and effective. The combined treatment of central decompression plus stem cell implantation showed greater effectiveness. Conclusions: Stem cell therapy is a therapeutic option to treat osteonecrosis of the femoral head, especially in the early stages. The combination of central decompression plus the infiltration of stem cells in the necrotic area produces an improvement in the symptoms and contains the progress of the disease(AU)

Humans , Stem Cells , Decompression, Surgical/methods , Femur Head Necrosis/therapy
Acta ortop. mex ; 34(1): 16-21, ene.-feb. 2020. tab
Article in Spanish | LILACS | ID: biblio-1345079


Resumen: Introducción: La necrosis avascular de cabeza femoral (NACF) es una patología frecuente que en sus inicios es asintomática y se manifiesta de forma insidiosa, por lo que a menudo el diagnóstico se realiza en estadios avanzados, donde la única solución eficaz es la artroplastía total de cadera (ATC). El diagnóstico en fases precoces permitirá utilizar opciones terapéuticas que eviten o retrasen la ATC. Nuestro objetivo es valorar los resultados demográficos, clínicos y la tasa de éxito en nuestro centro de pacientes con diagnóstico de NACF y que han sido subsidiarios de cirugía de preservación de cadera. Material y métodos: Estudio clínico unicéntrico, prospectivo, no controlado de pacientes con diagnóstico de NACF entre Enero de 2012 y Septiembre de 2017 con un estadio Steinberg ≤ IIIA. La técnica quirúrgica utilizada es el forage descompresivo, asociado a relleno con aloinjerto y aspirado de médula ósea. Resultados: Se intervinieron 26 caderas con nuestra técnica quirúrgica. La tasa de éxito obtenida es de 61.54%, ya que 10 casos han precisado ATC durante el estudio (38.46%). Conclusión: El éxito terapéutico en la NACF está directamente relacionado con el grado de la enfermedad, por lo que es importante el diagnóstico precoz. El forage descompresivo con relleno de aloinjerto que asocia aspirado de médula ósea es una opción a tener en cuenta, ya que en estadios iniciales muestra una elevada tasa de éxito.

Abstract: Introduction: Avascular osteonecrosis of the femoral head (ONFH) is a frequent pathology with an insidious and asymptomatic presentation in early stages, so the diagnosis is often made in advanced stages, where the only effective solution is total hip arthroplasty (THA). Diagnosis in early stages will allow the use of therapeutic options that avoid or delay ATC. Our objective is to evaluate the demographic, clinical results and the success rate in our center of patients diagnosed with ONFH and who have been subsidiary of hip preservation surgery. Material and methods: Unicentric, prospective, uncontrolled clinical study of patients diagnosed with ONFH between January 2012 and September 2017 with a Steinberg ≤ IIIA stage. The surgical technique used is decompressive forage, associated with bone allograft and bone marrow aspiration. Results: 26 hips were operated on with our surgical technique. The success rate obtained is 61.54%, since 10 cases have required THA during the study (38.46%). Conclusions: The therapeutic success in ONFH is directly related to the degree of the disease, which is why early diagnosis is important. The decompressive forage with bone allograft that associates bone marrow aspiration is an option to be taken into account, since in early stages it shows a high success rate.

Humans , Arthroplasty, Replacement, Hip , Femur Head Necrosis/surgery , Femur Head Necrosis/epidemiology , Prospective Studies , Treatment Outcome , Femur Head/surgery
Article in Chinese | WPRIM | ID: wpr-879350


OBJECTIVE@#To observe the clinical effect of platelet rich plasma (PRP) combined with β tricalcium phosphate bioceramic bone in the treatment of non traumatic necrosis of the femoral head in ARCO stageⅡ.@*METHODS@#From January 2017 to December 2018, 100 patients (160 hips) with ARCO stageⅡnon traumatic necrosis of the femoral head were divided into PRP group and control group. In PRP group, 50 patients (80 hips), 22 males and 28 females, aged from 18 to 65 (43.47± 7.23) years, with a course of 4 to 18 (15.8±2.9) months, underwent core decompression and bone grafting combined with PRP implantation. There were 50 cases (80 hips) in the control group, including 27 males and 23 females, aged 20 to 63 (45.72± 7.43) years, and the course of disease was 6 to 19 (14.9±3.8) months. Hip X-ay film was followed up after operation. Harris score and VAS score were used to evaluate the curative effect, and the survival rate of hip joint was recorded.@*RESULTS@#All patients had good wound healing, no infection, thrombosis and other complications. All patients were followed up for 12 to 14 (12.0±0.4) months. Twelve months after operation, the image expression of PRP group was better than that of control group(@*CONCLUSION@#Platelet-rich plasma(PRP) combined with artificialbone for core decompression and bone grafting can change the situation of simple artificial bone implantation and uncertain curative effect, improve the success rate of this operation, effectively reduce the collapse rate of femoral head necrosis in the early and middle stage, delay or even avoid hip replacement.

Adolescent , Adult , Aged , Artemisinins , Bone Transplantation , Decompression, Surgical , Female , Femur Head/surgery , Femur Head Necrosis/surgery , Humans , Male , Middle Aged , Naphthoquinones , Platelet-Rich Plasma , Treatment Outcome , Young Adult
Rev. MVZ Córdoba ; 24(3): 7372-7377, sep.-dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1115264


RESUMEN Se reporta el caso de una cabra macho de raza alpina de 7 meses de edad, que presentaba claudicación del miembro posterior derecho sin causa definida. Se realizaron los exámenes clínicos y radiográficos, sugiriendo luxación traumática o necrosis avascular de cabeza femoral con consecuente enfermedad degenerativa articular. Se realizó tratamiento quirúrgico mediante artroplastia por excisión de cabeza y cuello femoral. El estudio histopatológico mediante la coloración de hematoxilina y eosina describió: hueso necrótico, lagunas conteniendo osteocitos necróticos, además de médula ósea necrótica. Esta información comprobó el diagnóstico de necrosis avascular de la cabeza y cuello femoral. En el post quirúrgico, la recuperación clínica del paciente se consideró buena, mitigando el dolor y mejorando la función del miembro afectado. El presente caso se trata del primer reporte de esta enfermedad en caprinos en el Perú.

ABSTRACT It is reported the case of a 7-month-old male goat of alpine race, who presented claudication of the right hind limb without definite cause. Clinical and radiographic examinations were performed, suggesting traumatic dislocation or avascular necrosis of the femoral head with consequent degenerative joint disease. It was performed a surgical treatment by an arthroplasty by excision of the head and neck of femur. The histopathological study by staining hematoxylin and eosin described: necrotic bone, lacunae containing necrotic osteocytes, as well as necrotic bone marrow. This information proved the diagnosis of avascular necrosis of the femoral head and neck. In the post-surgical period, the clinical recovery of the patient was considered good, the pain was mitigated and the function of the affected limb was improved. The present case is the first report of this disease in goats in Peru.

Animals , Goats , Osteoarthritis , Osteonecrosis , Femur Head Necrosis
Rev. bras. ortop ; 54(4): 408-415, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042432


Abstract Objectives To evaluate the factors that influence the outcome of osteosynthesis after closed reduction of the fracture of the femoral neck in young adult patients. Methods A retrospective study was conducted, reviewing the data of patients operated in a large orthopedic hospital from 2003 to 2011; a total of 81 patients met the inclusion criteria. The time interval between the fracture and the surgery, the initial fracture deviation, the quality of the reduction, and the placement of the implant were evaluated. Results The present study observed a strong relationship between the quality of the reduction and therapeutic success. The degree of the initial deviation and the time elapsed between the initial trauma and the osteosynthesis did not influence the surgical outcome regarding bone consolidation. The correct positioning of the implants was associated with a satisfactory evolution in the postoperative period. Conclusion The quality of the reduction and the positioning of the implants are factors that influence the results of osteosynthesis in fractures of the femoral neck in young adult patients.

Resumo Objetivos Avaliar os fatores que influenciam o resultado da osteossíntese pela redução fechada da fratura do colo femoral nos pacientes jovens. Métodos Foi feito um estudo retrospectivo com revisão dos dados dos pacientes operados em um hospital ortopédico de grande porte, de 2003 a 2011, com um total de 81 pacientes que atenderam aos critérios de inclusão. O intervalo de tempo entre a fratura e a cirurgia, o desvio inicial da fratura, a qualidade da redução e o posicionamento dos implantes foram os fatores avaliados. Resultados O estudo encontrou forte relação entre a qualidade da redução e o sucesso terapêutico. O grau de desvio inicial e o tempo entre o trauma inicial e a osteossíntese não influenciaramo desfecho cirúrgico emrelação à consolidação óssea. O correto posicionamento dos implantes mostrou relação com a evolução satisfatória no pós-operatório dos pacientes. Conclusão A qualidade da redução e o posicionamento dos implantes são fatores que influenciamoresultadodaosteossíntesenafraturadocolodofêmurnopacienteadultojovem.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Pseudarthrosis , Femoral Neck Fractures , Femur Head Necrosis , Femur Neck
Article in Chinese | WPRIM | ID: wpr-776121


OBJECTIVE@#To compare computer measurement semi automatic quantitative detection software system with ultra thin layer pathological section to confirm the avascular necrosis percentage of the femoral head, and provide reference for clinical treatment options.@*METHODS@#From June 2012 to December 2013, the X-ray and MRI of 24 patients(24 hips on unilateral) were reviewed, who had avascular necrosis of the femoral head at late stage (stage III and IV) according to the ARCO international staging system, and performed by total hip arthroplasty. There were 15 males and 9 females, with an average age of (65.1±8.8) years old ranging 33 to 74 years old. Based on imaging system combined with computer aided technology(CAD) system and postoperative ultrathin slice, the volume of the area of femoral head necrosis were calculated. Then combining with the total volume of the femoral head was calculated by X-ray, the percentage of each femoral head necrosis area was calculated as a percentage of the whole ball head in both methods.@*RESULTS@#For 24 hips, the normal femoral head volume was (39.58±3.29) cm³ on average of X-ray film, the necrotic volume was (20.00±3.04) cm³ on average of MRI by the calculation of computer. The necrotic volume occupying in the volume of the normal femoral head was (42.92±6.09)% on average ranged. The necrotic lesion size was larger than 40% in 16 hips, 30% to 40% in 8 hips, 1 ess than 30% in 0 hip. Under the pathological section, the necrosis volume was (19.89±3.17) cm³, the necrotic volume occupying in the volume of the normal femoral head was (40.33±6.36)%. The necrotic lesion size was larger than 40% in 12 hips, 30% to 40% in 11 hips, 1 ess than 30% in 1 hip. In computer and general measurement, the two entire femoral head volume difference was (0.113±0.466) cm³, there was no significant difference using these measurements(=-1.186, =0.248). After the linear correlation statistics analysis, there was a positive correlation relationship in necrotic volume between computer software and pathology measurement(γ=0.980, =0.000).@*CONCLUSIONS@#The severity of the necrotic femoral head is closely related to the percentage of necrotic area. When the ratio of necrotic lesions and the whole femoral head is greater than 30%, the patients' clinical symptoms tend to aggravate, the probability of total hip arthroplasty increased significantly. It have great significances in femoral head necrosis installment, judge the prognosis, guide the selection of treatment and monitoring curative effect.

Adult , Aged , Arthroplasty, Replacement, Hip , Female , Femur , Femur Head , Femur Head Necrosis , Diagnostic Imaging , Follow-Up Studies , Hip , Humans , Male , Middle Aged
Article in Chinese | WPRIM | ID: wpr-813236


To explore the effect of application of soft tissue loosening and acetabular reconstruction in hip replacement for patients with severe femoral head necrosis on joint function.
 Methods: From June 2012 to August 2016, 68 patients with severe femoral head necrosis (Ficat III, IV) underwent total hip replacement with soft tissue release and acetabular reconstruction at the Second Xiangya Hospital of Central South University. Total hip replacement is performed by the posterolateral approach. The acetabulum was rebuilt and the length of the affected limb was prolonged after clearing the scar tissue, proliferating the epiphysis, releasing the abductor muscle group and the adductor muscle group, dissecting the soft tissue around the acetabulum. One year after surgery, Harris score, X-ray positive lateral radiograph for the affected side and full-length X-ray examination for both lower extremities were performed to evaluate the curative effect.
 Results: The postoperative follow-up time ranged from 1.0 to 5.5 years. All patients' femoral heads returned to normal anatomical position and the affected limb length was restored to 1.5-3.5 cm; all patients did not damage the sciatic nerve. The Harris scores for 68 patients increased from 38.6±7.5 to 78.2±5.7 (P=0.029) in the first year after surgery.
 Conclusion: During hip replacement surgery for severe femoral head necrosis, soft tissue dissection and acetabular reconstruction can be used to ensure anatomical reconstruction for the acetabular fossa and to improve abductor function.

Acetabulum , Arthroplasty, Replacement, Hip , Femur Head , Femur Head Necrosis , General Surgery , Follow-Up Studies , Humans , Radiography , Treatment Outcome
Hip & Pelvis ; : 120-123, 2019.
Article in English | WPRIM | ID: wpr-763962


Except when caused by direct and definite mechanisms (e.g., injury of the vessels to the femoral head), the pathophysiology of avascular necrosis of the femoral head has not yet been fully elucidate. While non-traumatic avascular necrosis of the femoral head is known to be caused by alcohol, steroids and various diseases, it may also occur without such events in a patient's history. Herein, a case of bilateral avascular necrosis of the femoral head caused by asymptomatic adrenal cortex incidentaloma which was initially misdiagnosed as idiopathic is reported along with a literature review.

Adrenal Cortex , Adrenal Gland Neoplasms , Cushing Syndrome , Femur Head Necrosis , Head , Humans , Necrosis , Steroids
Rev. bras. ortop ; 53(6): 773-777, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-977906


ABSTRACT Objective: Avascular necrosis of the hip is a common debilitating disease during the fourth and fifth decades of life. This study attempted to evaluate quality of life in patients with avascular necrosis of the hip joint before and after surgery. Methods: In this study, 40 patients with avascular necrosis of the hip who underwent total hip arthroplasty, bipolar surgery, or cord compression were examined during 2006-2013. Harris Hip Score was used to assess the hip joint function and quality of life before and after surgery. The mean scores and standard deviation were used to describe data for quantitative variables, while frequency percentage was used to describe qualitative variables. Data were analyzed through SPSS v.19 and paired t-test. p < 0.05 was considered significant. Results: This study involved 40 subjects with a mean age of 32 ± 7.38 years, ranging from 21 to 45 years old. The mean Harris Hip Score for patients before and after surgery were 20.36 and 96.15, respectively, showing a statistically significant difference (p < 0.001). The average patient activity scores before and after surgery (8.9 and 44.2, respectively), non-deformity (1.6 and 3.9), and movement (3.6 and 4.9) indicated significant differences (p < 0.001). Furthermore, 80% of patients felt no hip joint pain six months after surgery, while 92.5% patients did not use any assistive device to walk. Conclusions: The results of this study demonstrated that surgery substantially contributed to relieving pain and improving hip function in patients with osteonecrosis of the hip joint in the short term.

RESUMO Objetivo: A necrose avascular do quadril é uma doença debilitante comum durante a quarta e quinta décadas de vida. O presente estudo tentou avaliar a qualidade de vida em pacientes com necrose avascular da articulação do quadril antes e após a cirurgia. Métodos: Entre 2006 e 2013, o estudo avaliou 40 pacientes com necrose avascular do quadril que foram submetidos a artroplastia total do quadril, cirurgia bipolar ou descompressão do núcleo. O Harris Hip Score foi empregado para avaliar a função da articulação do quadril e a qualidade de vida antes e após a cirurgia. Os escores médios e o desvio padrão foram usados para descrever dados para variáveis quantitativas, enquanto a porcentagem de frequência foi usada para descrever variáveis qualitativas. Além disso, os dados foram analisados com o SPSS v.19 e o teste t pareado; p < 0,05 foi considerado significativo. Resultados: Este estudo envolveu 40 indivíduos com média de 32 ± 7,38 anos, variação de 21 a 45. Os escores médios no Harris Hip Score para pacientes antes e após a cirurgia foram 20,36 e 96,15, respectivamente, apresentaram diferença estatisticamente significante (p < 0,001). Diferenças significativas (p < 0,001) foram observadas na atividade média do paciente antes e após a cirurgia (8,9 e 44,2, respectivamente), sem deformidade (1,6 e 3,9) e movimento (3,6 e 4,9). Além disso, 80% dos pacientes não sentiram dor nas articulações do quadril seis meses após a cirurgia, enquanto 92,5% dos pacientes não usaram dispositivo auxiliar para deambulação. Conclusões: Os resultados do presente estudo demonstraram que a cirurgia contribui substancialmente para aliviar a dor e melhorar em curto prazo a função do quadril em pacientes com osteonecrose da articulação do quadril.

Humans , Male , Female , Adult , Quality of Life , Arthroplasty, Replacement, Hip , Femur Head Necrosis
Rev. bras. ortop ; 53(5): 537-542, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-977883


ABSTRACT Objectives: This study is aimed at evaluating whether core decompression of the femoral head in the early stages of femoral head osteonecrosis improves patients' subjective perception of pain and avoids the progression of the disease to a femoral head collapse and a final indication of total hip arthroplasty. Methods: Eighteen patients (30 hips) in the early stages of the disease (Ficat and Arlet 1 and 2A) were evaluated through clinical, radiological, risk factor maintenance, and by the functional Merle D'Aubigné, and Postel score before and after core decompression of the femoral head. Results: There was an improvement of symptoms up to the sixth month in 83.3% of the hips evaluated through the Merle D'Aubigné and Postel score. However, 73.3% of the cases evolved with femoral head collapse, and in 50%, total hip arthroplasty was indicated regardless of whether or not the risk factors were maintained. Conclusions: Core decompression of the femoral head improves patients' pain early in the initial stages of the pathology. However, it does not alter the prognosis and the ultimate indication of total hip arthroplasty in the final stages of the disease.

RESUMO Objetivos: O presente estudo tem como objetivo avaliar se a descompressão simples da cabeça femoral nos estágios iniciais da osteonecrose da cabeça femoral melhora a percepção subjetiva da dor dos pacientes e se evita a progressão da doença para o colapso da cabeça femoral e a indicação final de artroplastia total do quadril. Métodos: Foram avaliados 18 pacientes (30 quadris) em estágios iniciais da doença (Ficat e Arlet 1 e 2 A) por critérios clínicos, radiológicos, manutenção dos fatores de risco e pela escala funcional de Merle D'Aubigné e Postel antes e após a descompressão simples da cabeça femoral. Resultados: Houve melhoria dos sintomas precocemente (até o sexto mês) em 83,3% dos quadris avaliados pela escala de Merle D'Aubigné e Postel. No entanto, 73,3% dos casos evoluíram com colapso da cabeça femoral e em 50% deles foi indicada artroplastia total do quadril, independentemente da manutenção ou não dos fatores de risco. Conclusões: A descompressão simples da cabeça femoral melhora a dor dos pacientes precocemente nos estágios iniciais da patologia. Entretanto, não altera o prognóstico da doença e a indicação final de artroplastia total do quadril nos estágios finais da doença.

Humans , Male , Female , Treatment Outcome , Femur Head Necrosis/diagnosis , Femur Head Necrosis/physiopathology , Femur Head Necrosis/pathology
Article in English | WPRIM | ID: wpr-71104


BACKGROUND: Transtrochanteric rotational osteotomy (TRO) is a controversial hip-preserving procedure with a variable success rate. The healing process of femoral head osteonecrosis after TRO has been poorly explained till now. This study aimed to evaluate the healing process of previously transposed necrotic lesion after a TRO for nontraumatic osteonecrosis of the femoral head using computed tomography (CT). METHODS: Among 52 patients (58 hips) who had preserved original femoral head after TRO, we retrospectively reviewed 27 patients (28 hips) who had undergone sequential CT scans and had no major complication following TRO. The average age was 34 years (range, 18 to 59 years). The mean follow-up period was 9.1 years. We evaluated the reparative process of the transposed osteonecrotic lesion with CT scans. RESULTS: Plain radiographs of the osteonecrotic lesion revealed sclerotic and lucent changes in 14 hips (50%) and normal bony architecture in the other 14 hips (50%) at the final follow-up. CT scans of the osteonecrotic lesions showed cystic changes with heterogeneous sclerosis in 13 hips (46%), normal trabecular bone with or without small cysts in 9 hips (32%), and fragmentation of the necrotic lesion in 6 hips (22%). Seventeen hips (60%) showed minimal (13 hips) to mild (4 hips) nonprogressive collapse of the transposed osteonecrotic area. The collapse of the transposed osteonecrotic area on the CT scan was significantly associated with the healing pattern (p = 0.009), as all 6 patients (6 hips) with fragmentation of the necrotic lesion had minimal (5 hips) to mild (1 hip) collapse. Furthermore, a significant association was found between the collapse of the transposed osteonecrotic area on the CT scan of 17 hips (60%) and postoperative Harris hip score (p = 0.021). We observed no differences among the healing patterns on CT scans with regard to age, gender, etiology, staging, preoperative lesion type, preoperative intact area, percentage of necrotic area, direction of rotation and immediate postoperative intact area. CONCLUSIONS: The majority of the hips showed incomplete regeneration of the transposed osteonecrotic lesion with cysts, sclerosis, and fragmentation, whereas repair with normal trabecular bone was observed only in one-third of the hips that were preserved after Sugioka TRO.

Femur Head Necrosis , Follow-Up Studies , Head , Hip , Humans , Osteonecrosis , Osteotomy , Regeneration , Retrospective Studies , Sclerosis , Tomography, X-Ray Computed
Article in English | WPRIM | ID: wpr-229506


<p><b>OBJECTIVES</b>To observe the regulation of Chinese herbal medicine, Modifified Qing'e Pill (, MQEP), on the expression of adiponectin, bone morphogenetic protein 2 (BMP2), osteoprotegerin (OPG) and other potentially relevant risk factors in patients with nontraumatic osteonecrosis of the femoral head (ONFH).</p><p><b>METHODS</b>A total of 96 patients with nontraumatic ONFH were unequal randomly divided into treatment group (60 cases) and control group (36 cases). The treatment group were treated with MQEP while the control group were treated with simulated pills. Both groups were given caltrate D. Six months were taken as a treatment course. Patients were followed up every 2 months. The levels of plasma adiponectin, BMP2, OPG, von Willebrand factor (vWF), von Willebrand factor cleaving protease (vWF-cp), plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (tPA), C-reactive protein (CRP), blood rheology, bone mineral density (BMD) of the femoral head and Harris Hip Score were measured before and after treatment.</p><p><b>RESULTS</b>After 6 months of treatment, compared with the control group, patients in the treatment group had signifificantly higher adiponectin and BMP2 levels (P<0.01 and P=0.013, respectively), lower vWF, PAI-1 and CRP levels (P=0.019, P<0.01 and P<0.01, respectively), and lower blood rheology parameters. BMD of the femoral neck, triangle area and Harris Hip Score in the treatment group were signifificantly higher than those in the control group. Moreover, plasma adiponectin showed a positive association with BMP2 (r=0.231, P=0.003) and a negative association with PAI-1 (r=-0.159, P<0.05).</p><p><b>CONCLUSION</b>MQEP may play a protective role against nontraumatic ONFH by increasing the expression of adiponectin, regulating bone metabolism and improving the hypercoagulation state, which may provide an experimental base for its clinical effects.</p>

Adiponectin , Metabolism , Adult , Blood Coagulation Factors , Metabolism , Bone Density , Bone Morphogenetic Protein 2 , Metabolism , Drugs, Chinese Herbal , Pharmacology , Therapeutic Uses , Female , Femur Head Necrosis , Blood , Drug Therapy , Humans , Male
Article in English | WPRIM | ID: wpr-21257


Osteonecrosis of the femoral head (ONFH) can cause femoral head depression and cortical discontinuity. Treatment for ONFH remains challenging. We performed botulinum toxin type A injection to psoas major muscle in five patients with radiological femoral head collapse (Association Research Circulation Osseus classification stage III) who were non-responsive after two years of conservative treatment (tramadol 200 mg/day, mefenamic acid 1,000 mg/day). At two weeks after the procedure, their mean hip pain was decreased from 88 ± 0.4/100 mm to 22 ± 0.4/100 mm based on visual analogue scale (VAS). The pain was maintained at a minimum of 20/100 mm and a maximum of 30/100 mm in VAS for at least six weeks after the procedure. These values were mean ± SD. These patients were followed-up for 6 months. There was no exacerbation of pain from repeated (three times) botulinum toxin type A injection to the psoas major muscle.

Botulinum Toxins , Botulinum Toxins, Type A , Classification , Depression , Femur Head Necrosis , Head , Hip , Humans , Mefenamic Acid , Osteonecrosis , Psoas Muscles
Clinics ; 71(2): 110-113, Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-774536


The purpose of this study was to evaluate the clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation. We searched the PubMed, Embase and Web of Science databases and included all case-control trials that reported on the clinical outcomes of osteonecrosis progression, incidence of total hip arthroplasty and improvement in Harris hip scores. Overall, seven case-control trials were included. Compared with the controls, patients treated with the bone marrow stem cells implantation treatment showed improved clinical outcomes with delayed osteonecrosis progression (odds ratio = 0.17, 95% CI: 0.09 - 0.32; p <0.001), a lower total hip arthroplasty incidence (odds ratio = 0.30, 95% CI: 0.12 - 0.72; p <0.01) and increased Harris hip scores (mean difference = 4.76, 95% CI: 1.24 - 8.28; p<0.01). The heterogeneity, publication bias, and sensitivity analyses showed no statistical difference significant differences between studies. Thus, our study suggests that autologous bone marrow stem cells implantation has a good therapeutic effect on osteonecrosis of the femoral, resulting in beneficial clinical outcomes. However, trials with larger sample sizes are needed to confirm these findings.

Humans , Bone Marrow Transplantation/methods , Femur Head Necrosis/surgery , Osteonecrosis/surgery , Follow-Up Studies , Treatment Outcome