Unicompartmental Knee Arthroplasty for Knee Osteoarthritis With the Pellegrini-Stieda Lesion: A Case Report.

Pellegrini-Stieda lesion is described as ossification on the origin of medial collateral ligament. We present a case of end-stage knee osteoarthritis with the Pellegrini-Stieda lesion treated by unicompartmental knee arthroplasty (UKA). During the postoperative follow-up, an interesting change occurred such that the ossification lesion disappeared gradually and did not relapse. It is supposed that the disappearance was caused by UKA changing the abnormal biomechanics of the varus osteoarthritic knee.

Combined Therapy with Shock Wave and Retrograde Bone Marrow-Derived Cell Transplantation for Osteochondral Lesions of the Talus.

Multiple treatment strategies have been developed for osteochondral lesions (OCLs) of the talus. The purpose of this retrospective study was to assess retrograde autologous bone marrow cell (BMC) transplantation via core drilling (CD) combined with focused extracorporeal shock wave treatment (ESWT) in undisplaced OCL of the talus. A total of 69 patients with unilateral osteochondral lesions of the talus (Hepple grade I-III) were divided into two groups: 41 patients received combined therapy of ESWT and BMC transplantation (group A), while 28 were administered BMC transplantation alone (group B). The patients were followed up clinically and radiographically for a minimum of 2 years. Mean follow-up was 4.1 ± 2.8 years. AOFAS scores increased more significantly while pain intensity levels decreased in group A after treatment, compared with group B values (P < 0.001). In MRI follow-up, a more remarkable improvement of OCLs of the talus was observed in group A compared with group B (P = 0.040). Therefore, the combined technique reported here is a highly effective therapeutic option in OCLs of the talus with intact cartilage. It promotes patient recovery with pain control, and improves clinical outcome for more than 2 years after surgery.

[EFFECTIVENESS OF BONE GRAFTING THROUGH WINDOWING AT FEMORAL HEAD-NECK JUNCTION FOR TREATMENT OF OSTEONECROSIS WITH SEGMENTAL COLLAPSE OF FEMORAL HEAD].

OBJECTIVE: To analyze the effectiveness of bone grafting through windowing at the femoral head-neck junction for the treatment of osteonecrosis with the segmental collapse of the femoral head. METHODS: The clinical data were retrospectively analyzed from 106 patients (131 hips) with osteonecrosis with the segmental collapse of the femoral head who underwent bone grafting through windowing at the femoral head-neck junction between March 2011 and December 2013. There were 78 males and 28 females, with an average age of 31.3 years (range, 17-43 years). The body mass index ranged from 16.5 to 36.5 (mean, 24.2). There were 53 cases of corticosteroid-induced osteonecrosis of the femoral head (ONFH), 18 cases of alcohol-induced ONFH, and 35 cases of idiopathic ONFH. According to Association Research Circulation Osseous (ARCO) classification system, 105 hips were rated as stage IIIa, and 26 hips as stage IIIb; according to the China-Japan Friendship Hospital (CJFH) classification system, 41 hips were classified as C+L1 type, 13 hips as L2 type, and 77 hips as L3 type. Harris score was used for the effectiveness evaluation. The clinical failure cases were defined as patients who need total hip arthroplasty, or had a Harris score of less than 70 points. The Cox risk model analysis and Kaplan-Meier survival curves were used for multivariate analysis and univariate analysis. RESULTS: The average follow-up period was 27.9 months (range, 4-51 months). Solid fusions of bone graft were observed at 1.0-1.5 years after operation. The Harris score at last follow-up was 81.41 ±11.93, showing significant difference when compared with preoperative score (63.24 ± 9.98) (t = 13.710, P = 0.000). The results were excellent in 5 hips, good in 41 hips, fair in 57 hips, and poor in 28 hips, with an excellent and good rate of 35.1%. Thirty-three hips were classified as clinical failure. A progressive collapse of the femoral head was observed in 22 hips. The single factor analysis showed that preoperative ARCO stage, preoperative CJFH type, and preoperative Harris hip score were risk factors for clinical failure (P<0.05). The Cox risk model showed that ARCO stage IIIb was independent risk factor for clinical failure (P < 0.05). The Kaplan- Meier survival curves showed that ARCO stage IIIa patients had a better effectiveness than ARCO stage IIIb patients. CONCLUSION: Bone grafting through windowing at the femoral head-neck junction has a good effectiveness in patients at ARCO stage IIIa, while patients at ARCO stage IIIb and patients of CJFH types L2 and L3 have high clinical failure rates.

The pathogenesis of multifocal osteonecrosis.

Our objective was to study the incidence, etiology, and diagnosis of multifocal osteonecrosis (MFON) and its treatment options to facilitate an earlier diagnosis and to optimize treatment. A radiological investigation was performed in osteonecrosis patients with a high risk of MFON for a more accurate diagnosis between January 2010 and June 2015. For patients with osteonecrosis of both the hip and knee joints or for patients with a history of corticosteroid use or alcohol abuse who had osteonecrosis of one or more joints in the shoulder, ankle, wrist or elbow, magnetic resonance imaging (MRI) was also performed on other joints, regardless of whether these joints were symptomatic. Furthermore, we performed a radiological screening of 102 patients who had a negative diagnosis of MFON but were at a high risk; among them, another 31 MFON cases were successfully identified (30.4%). Thus, the incidence of MFON during the study period increased from 3.1% to 5.2%. Patients diagnosed with osteonecrosis and who are at a high risk of MFON should have their other joints radiologically examined when necessary. This will reduce missed diagnosis of MFON and facilitate an earlier diagnosis and treatment to achieve an optimal outcome.

[Risk factors for lateral compartmental cartilage wear in varus knee osteoarthritis].

OBJECTIVE: To analyze the gross features of articular cartilage wear in varus knee osteoarthritis, and discuss the risk factors for lateral compartmental cartilage erosion. METHODS: Data prospectively collected from the dissection of 286 total knee arthroplasties (223 patients) with varus knee osteoarthritis from January 2013 to December 2013 were analyzed. At the operation, the gross assessments of articular cartilage, ligament and meniscus were recorded, and then the slices were evaluated for histologic analysis. Parameters of the patients with lateral compartmental cartilage erosion were compared with those without lateral compartmental cartilage erosion using the univariate analysis. Logistic regression analysis was used to analyze the risk factors associated with lateral compartmental cartilage erosion. RESULTS: There were 223 patients with 286 knees were included,including 37 male patients (47 knees) and 189 female patients (239 knees), with an average age of (66±8) years (range 50-86 years), body mass index (BMI) was (27±5) kg/m2 (18.0-40.0 kg/m2). Varus degree was 8°±4° (1°-34°). Range of motion was 103°±21° (0°-143°), and Hospital for Special Surgery (HSS) score was 53±12 (29-76). Seventy-five knees (60 patients) showed lateral compartmental cartilage wear (26.2%). Environmental factors showed no differences in age, side, gender, BMI, range of motion,and HSS score (P>0.05). Factors significantly increasing the risk of lateral compartmental cartilage wear by univariate analysis included varus degree, activity level, duration of onset, meniscus, Weidow grade, Kellgren-Lawrence grade, collateral ligament and anterior cruciate ligament (P<0.05). Multiple Logistic regression analysis revealed the factors most highly associated with the increase risk for lateral compartmental wear were high activity level (OR=2.843, 95% CI: 1.010-8.002) and longer duration of onset (OR=1.216, 95% CI: 1.115-1.325). However, intact lateral meniscus (OR=0.012, 95% CI: 0.003-0.048) and anterior cruciate ligament (OR=0.406, 95% CI: 0.192-0.857) were associated with the protection of lateral compartmental. CONCLUSIONS: In varus knee osteoarthritis, the wear incidence of lateral compartmental is low. High activity and increased duration of onset are risk factors of lateral compartmental wear, and intact meniscus and anterior cruciate ligament are protective factors.

Ability of lower teardrop edge to restore anatomical hip center height in total hip arthroplasty.

BACKGROUND: The acetabular teardrop is often used to guide acetabular component placement in total hip arthroplasty (THA). Placing the lower acetabular component aspect at the same level as the lower teardrop edge was assumed to restore the hip center of rotation. Here we radiographically analyzed the relationship between cup center and normal contralateral acetabulum center height on unilateral THA using this placement method. METHODS: A total of 106 unilateral THA cases with normal contralateral acetabula were reviewed and the vertical and horizontal distances in relation to the lower acetabular teardrop edge from both hip joint centers, cup inclination, and anteversion were measured radiographically. The paired t-test was used to compare left and right hip center heights. Scatter plots and Pearson's correlation coefficients were used to evaluate differences in hip center heights, cup anteversion, inclination angles, and medialized cup center distance compared to the contralateral hip joint. RESULTS: Cup center height was significantly greater (P < 0.01) than contralateral hip joint center height (93.4% in the 0-5 mm range, 6.6% >5 mm). There was a weak correlation between hip center height difference and inclination (r = 0.376, P < 0.01) and between difference and anteversion (r = 0.310, P < 0.01) but no correlation between difference and outer cup diameter (r = 0.184, P = 0.058) or difference and medialized cup center distance (r = -0.098, P = 0.318). CONCLUSIONS: Although this method did not exactly replicate anatomic hip center height, the clinical significance of cup center height and anatomic hip center height differences is negligible. This acetabular component placement method has high simplicity, reliability, and stability.

[Treatment of patellofemoral osteoarthritis with patello-femoral joint arthroplasty].

OBJECTIVE: To study the outcome and surgical technique of patello-femoral joint arthroplasty (PFJ) for osteoarthritis of the knee. METHODS: From January 2010 to June 2012, 17 patients (24 knees) with patello-femoral compartmental osteoarthritis treated by PFJ were reviewed retrospectively. There were 2 male patients (4 knees) and 15 female patients (15 knees), with an average age of (64 ± 9) years (52-77 years) . The mean body mass index was (24 ± 3) kg/m² (18.0-30.1 kg/m²) . Patients were asked to return for follow-up examinations at 3, 6 months and at every year after PFJ. The range of motion (ROM), visual analogue scale(VAS), Hospital for Special Surgery score (HSS score) , Feller patella score, quadriceps muscle strength were evaluated before and after PFJ. The paired sample t-test and one-way analysis of variance (ANOVA) with replicate measures were used to determine whether there were statistically significant differences between the mean data. RESULTS: All of the patients were followed up for 18-47 months, with a mean time of (29 ± 10) months, 75.0% patients were satisfied with the outcome of this surgical procedure 1 year postoperative, and 87.5% were satisfied 2 years postoperative. HSS score was increased from 61 ± 11 to 90 ± 6 at the final follow-up (t = 12.24, P = 0.000). VAS score was reduced from 6.7 ± 1.0 to 2.4 ± 1.0 (t = 15.84, P = 0.000). The mean post-operative ROM of the knees was 126° ± 7° (t = 3.25, P = 0.003). Feller patella scores were 18.0 ± 3.2 before operation, and 18.5 ± 4.5, 19.7 ± 3.4, 24.0 ± 3.8, 26.0 ± 3.3, 26.6 ± 2.5 at 3, 6, 12, 24 months after operation, final follow-up, respectively. Quadriceps muscle strength were 3.9 ± 0.5 before operation, and 3.7 ± 0.5, 3.9 ± 0.5, 4.2 ± 0.5, 4.3 ± 0.5, 4.3 ± 0.5 at 3, 6, 12, 24 months after operation, final follow-up, respectively. Repeated measures ANOVA found significant time effects for Feller patella scores (F = 38.97, P = 0.000) and quadriceps muscle (F = 6.89, P = 0.000). Feller patella scores and quadriceps muscle strength were low at 3, 6 months after operation, with no significant differences compared with pre-operation data (P > 0.05). The improvements of Feller patella scores and quadriceps muscle strength after 6 months were of significant difference compared with pre-operation and postoperative 6 months data (t = 5.65-10.65 and t = 2.18-2.73, P < 0.05) . Three knee reported continuing pains with quadriceps muscle strength less than 4 level. CONCLUSIONS: PFJ is an effective method for patello-femoral compartmental osteoarthritis with less trauma. The early term outcome of PFJ is encouraging. Quadriceps muscle strength should be enhanced.

Recombinant human bone morphogenetic protein-2 in debridement and impacted bone graft for the treatment of femoral head osteonecrosis.

The purpose of this study was to compare the clinical outcomes of impacted bone graft with or without recombinant human bone morphogenetic protein-2 (rhBMP-2) for osteonecrosis of the femoral head (ONFH). We examined the effect of bone-grafting through a window at the femoral head-neck junction, known as the "light bulb" approach, for the treatment of ONFH with a combination of artificial bone (Novobone) mixed with or without rhBMP-2. A total of 42 patients (72 hips) were followed-up from 5 to 7.67 years (average of 6.1 years). The patients with and without BMP were the first group (IBG+rhBMP-2) and the second group (IBG), respectively. The clinical effectiveness was evaluated by Harris hip score (HHS). The radiographic follow-up was evaluated by pre-and postoperative X-ray and CT scan. Excellent, good, and fair functions were obtained in 36, 12, and 7 hips, respectively. The survival rate was 81.8% and 71.8% in the first and second group, respectively. However, the survival rate was 90.3% in ARCO stage IIb, c, and only 34.6% in ARCO stage IIIa (P<0.05). It was concluded that good and excellent mid-term follow-up could be achieved in selected patients with ONFH treated with impacted bone graft operation. The rhBMP-2 might improve the clinical efficacy and quality of bone repair.

Fourth-generation ceramic-on-ceramic total hip arthroplasty in patients of 55 years or younger: short-term results and complications analysis.

BACKGROUND: The incidence of total hip replacement in the younger and more active patients is ever increasing. The ceramic-on-ceramic (COC) bearing was developed to reduce wear debris-induced osteolysis and loosening and to improve the longevity of hip arthroplasties. Few studies have reported the clinical results and complications of the new zirconia-toughened ceramic total hip arthroplasty (THA). METHODS: A consecutive series of 132 young patients (177 hips) that underwent primary cementless THAs between January 2010 and December 2012 were included in this study. These arthroplasties all had fourth-generation COC bearings performed through a posterolateral approach. The average age was (41.8 ± 8.3) years (ranging from 22 to 55 years), and the mean follow-up period was (24.5 ± 9.4) months (ranging from 12 to 47 months). The results were evaluated both clinically and radiographically. Harris hip score (HHS) was determined before surgery and at the time of each follow-up. Presence of postoperative groin or thigh pain and squeaking were recorded. Other complications such as dislocations, periprosthetic fractures, and ceramic components fractures were diagnosed and treated in emergency. RESULTS: The average HHSs improved from preoperative 60.3 ± 10.7 (ranging from 29 to 76) to 91.0 ± 5.1 (ranging from 74 to 100) at the final follow-up (t = 45.064, P < 0.05), and 97.7% of cases were scored as excellent and good results. At the last follow-up, incidental inguinal pain was found in three hips (1.7%) and thigh pain in 11 hips (6.2%). Radiographs showed a high rate of new bone formation around the acetabular and stem components. No obvious osteolysis or prosthesis loosening was detected. Complications occurred in six hips (3.4%): posterior dislocation in two hips (1.1%), periprosthetic femoral fracture in one hip (0.6%), asymptomatic squeaking in two hips (1.1%), and ceramic liner fracture in one hip (0.6%). CONCLUSIONS: The fourth-generation COC THA showed excellent clinical results in younger active patients with no osteolysis-related prosthesis failure at a short-term follow-up study. Surgeons should still be aware of the potential risks of complications such as dislocation, periprosthetic fracture, squeaking, and ceramic components fracture.

Rotational acetabular osteotomy through an Ollier lateral U approach for early-stage osteoarthritis secondary to acetabular dysplasia.

OBJECTIVE: To explore the surgical technique and mid-term results of rotational acetabular osteotomy for early -stage osteoarthritis secondary to acetabular dysplasia. METHODS: Rotational acetabular osteotomies were performed on 14 hips of 12 patients from May 2000 to May 2006 and the patients followed up. All patients were female and their average age was 28.9 years (range, 13-46 years) at the time of surgery. The mean duration of clinical and roentgenographic follow-up was 6.0 years (range, 3.1-9.1 years). The lateral center-edge (CE) angle, acetabular roof angle and head lateralization index were measured on radiographs taken preoperatively, postoperatively and at the time of final follow-up. Clinical follow-up included use of the Harris hip score. The acetabular osteotomies were performed through an Ollier lateral U transtrochanteric approach and postoperative traction and cast immobilization were not used. RESULTS: All patients had satisfactory pain relief. The mean preoperative Harris score was 72 points; this had improved to a mean of 91 points at the time of last follow-up (P < 0.05). The mean CE angle improved from 0.9° preoperatively to 27° postoperatively (P < 0.05), the mean acetabular roof angle from 29° to 5° (P < 0.05) and the mean head lateralization index from 0.68 to 0.65. Solid bone-to-bone healing of the osteotomy sites and great trochanters occurred in all patients. CONCLUSIONS: Rotational acetabular osteotomy through an Ollier lateral U approach, which provides wide exposure and technical ease, for early-stage osteoarthritis secondary to acetabular dysplasia can relieve pain and delay the appearance or reduce the severity of osteoarthritis. Satisfactory mid-term results can be obtained.

Early and middle term results after surgical treatment for slipped capital femoral epiphysis.

OBJECTIVE: To evaluate the early and middle-term results of in situ single screw fixation and subtrochanteric osteotomy of the femur with external fixator for slipped capital femoral epiphysis (SCFE). METHODS: From June 1998 to July 2008, 11 patients (seven male [eight hips] and four female [four hips]) of average age 14.3 years (range, 9-18 years) were treated in our hospital. According to the Southwick measurement, seven hips were mildly affected (<30°), two moderately (30-50°), and three severely (>50°). The average body mass index (BMI) was 31.1 g/m(2) (range, 27-35 g/m(2) ). All the mild and moderate cases underwent in situ single screw fixation, and the three severe cases subtrochanteric osteotomy of femur with external fixator. All cases were evaluated both clinically and radiographically at 3 months, 6 months and every year postoperatively. RESULTS: All cases were followed up for 2-12 years (average 5.6 years). The Harris hip score increased from a mean of 74.8 (70 ∼ 85) points preoperatively to 90.6 (70 ∼ 100) points postoperatively. X-ray films showed epiphyseal closure in the in situ single screw fixation cases, and no further increase in epiphyseal-shaft angle. Partial reduction of slipped epiphysis with normal joint spaces was observed after subtrochanteric osteotomy of the femur in the external fixator cases. CONCLUSION: In situ single screw fixation for treating mild and moderate SCFE has a satisfactory clinical outcome, and the advantage of prevention of further slippage. Subtrochanteric osteotomy of the femur with external fixator is suitable for severe SCFE with late deformity; the realignment procedure can correct deformity and postpone or prevent subsequent osteoarthritis.

Experimental study on phase-contrast imaging with synchrotron hard X-ray for repairing osteonecrosis of the femoral head.

Synchrotron radiation light is 1 of 4 artificial light sources, the others being electric light, X-ray, and laser. Phase-contrast imaging with hard X-ray has achieved wide application in many scientific fields, such as biomedicine and material science. This article compares the effectiveness of nanohydroxyapatite/collagen (nHAC) and autologous mesenchymal stem cell for the repair of defects in a rabbit model with osteonecrosis of the femoral head under the monitoring of phase-contrast imaging with synchrotron hard X-ray. We established models of bilateral osteonecrosis of the femoral head defect using New Zealand rabbits and divided them into 3 groups. Imaging techniques such as phase-contrast imaging and diffraction enhanced imaging with synchrotron hard X-ray were applied to assess the degradation and repair process of nHAC and mesenchymal stem cell at 4, 8, and 12 weeks postoperatively. We found phase-contrast imaging with synchrotron hard X-ray displayed the reparative process of the bone defect, degradation of nHAC, and osteocyte substitution. There were significant differences in the repair of the bone defect and osteogenesis in groups B and C compared with group A (control). Osteogenesis was more significant in group C. We provided experimental data for the development and application of synchrotron hard X-ray imaging techniques and concluded that phase-contrast microimaging with synchrotron hard X-ray displays the reparative process of bone tissue at a micro-level and plays an important role in the development of tissue engineering.

Osteonecrosis in patients after severe acute respiratory syndrome (SARS): possible role of anticardiolipin antibodies.

OBJECTIVES: This study examined the anticardiolipin antibodies in post-SARS (severe acute respiratory syndrome) osteonecrosis patients to investigate the etiology of post-SARS osteonecrosis, and to eventually provide valuable information for the early diagnosis of nontraumatic osteonecrosis and for the susceptible population screening. METHODS: This study recruited 62 post-SARS osteonecrosis patients and 52 age- and gender-matched healthy controls. Fasting blood samples were collected from all the subjects through cubital veins. Immunoglobulins A, G and M (IgA, G and M) types of anticardiolipin antibodies were examined by enzyme-linked immunosorbent assay. The routine examinations of prothrombin time, thrombin time, prothrombin activity, and international normalized ratio were also performed. RESULTS: There were 21 of 62 post-SARS osteonecrosis patients (33.9%) who showed at least one type of anticardiolipin antibodies. The titers of specific IgA, IgG, and IgM were 11.33 +/- 11.209 APL, 5.127 +/- 5.927 GPL, and 17.821 +/- 10.606 MPL, respectively. There were only 4 of 52 subjects in the control group (7.7%) who showed positive anticardiolipin antibody with titers of IgA at 10.702 +/- 3.126 APL, IgG at 5.184 +/- 4.780 GPL, and IgM at 14.684 +/- 5.516 MPL. There were significant differences between the 2 groups confirmed by t-Test and chi(2) test (P < 0.05), while no significant differences were observed in prothrombin time, thrombin time, prothrombin activity, and international normalized ratio results between the 2 groups. CONCLUSIONS: The incidences of anticardiolipin antibodies were increased in the post-SARS osteonecrosis patients and anticardiolipin antibodies may play a role in the pathogenesis of post-SARS osteonecrosis.

Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells.

BACKGROUND: Since self-limited repair ability of the necrotic lesion may be a cause for failure of the technique, the possibility has been raised that bone marrow mononuclear cells (BMMCs) containing BMSCs implanted into a necrotic lesion of the femoral head with core decompression (CD) may be of benefit in the treatment of this condition. For this reason, we studied the implantation of the concentrated autologous bone marrow containing mononuclear cells in necrotic lesion of the femoral head to determine the effect of the method. METHODS: The study included 45 patients (59 hips, 9 females, 36 males; mean age 37.5 years, range 16-56 years) with stages I-IIIA nontraumatic avascular necrosis of the femoral head according to the system of the Association Research Circulation Osseous. Concentrated bone marrow (30-50 ml) containing mononuclear cells has been gained from autologous bone marrow (100-180 ml) obtained from the iliac crest of patient with the cell processor system. Concentrated bone marrow was injected through a CD channel into the femoral head. The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 27.6 months (range 12-40 months). RESULTS: Pre- and post-operative evaluations showed that the mean Harris hip score increased from 71 to 83. Clinically, the overall success is 79.7%, and hip replacement was done in 7 of the 59 hips (11.9%). Radiologically, 14 of the 59 hips exhibited femoral head collapse or narrowing of the coxofemoral joint space, and the overall failure rate is 23.7%. The number of BMMCs increased from 12.2 +/- 3.2 x 10(6)/ml to 35.2 +/- 12 x 10(6)/ml between pre-concentration and post-concentration. CONCLUSION: The concentrated autologous bone marrow containing mononuclear cells implantation relieves hip pain, prevents the progression of osteonecrosis. Therefore, it may be the treatment of choice particularly in stages I-II nontraumatic osteonecrosis of the femoral head.

Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window.

Nontraumatic osteonecrosis of the femoral head (non-ONFH) is a disorder that can lead to femoral head collapse and the need for total hip replacement. Various head-preserving procedures have been used for this disease to avert the need for total hip replacement. These include various vascularised and nonvascularised bone grafting procedures. We examined the effect of bone-grafting through a window at the femoral head-neck junction known as the "light bulb" approach for the treatment of osteonecrosis of the femoral head with a combination of demineralised bone matrix (DBM) and auto-iliac bone. The study included 110 patients (138 hips; 41 females, 69 males; mean age 32.36 years, range 17-54 years) with stage IIA-IIIA nontraumatic avascular necrosis of the femoral head according to the system of the ARCO (Association Research Circulation Osseous). The bone grafting procedure is called "light bulb" procedure in which the diseased bone was replaced by a bone graft substitute (combination of DBM and auto-iliac bone).The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 25.37 months (range 7-42 months). All data were processed by a statistics analysis including Cox risk model analysis and Kaplan-Meier survival analysis. Pre- and postoperative evaluations showed that the mean Harris hip score increased from 62 to 79. Clinically, 94 of 138 hips (68%) were successful at the latest follow-up, and radiological improvement was noted in 100% of patients in stage IIA, 76.67% of patients in stage IIB and 50.96% of patients in stage IIC and IIIA cases. Excellent and good results according to the Harris score were obtained in 100% of cases in stage IIA, 93.33% in stage IIB and 59.62% in stages IIIA and IIC stage, with a survivorship of 85% in stages IIA and IIB and 60% in stage IIIA and IIC cases. Cox risk model analysis showed that the clinical success rate correlated with both pre-operation stage and the necrotic area of the femoral head. The complications included ectopic ossification, lateral femoral cutaneous nerve lesion and joint infection. This procedure may be effective at avoiding or forestalling the need for total hip replacement in young patients with early to intermediate stages of osteonecrosis of the femoral head. Therefore, it may be the treatment of choice particularly in nontraumatic osteonecrosis of the femoral head of pre-collapse stage with small and middle area (<30%, or the depth of collapse <2 mm).

[Measuring blood flow change of osteonecrosis of femoral head with laser doppler flowmetry].

OBJECTIVE: To detect the blood perfusion of the necrotic area and the femoral head and neck junction in the patients diagnosed as osteonecrosis of femoral head (ONFH) with laser doppler flowmetry (LDF). METHODS: From 2007 to 2008, 50 patients with ONFH 82 hips were performed core decompression and autologous stem cells transplantation. Group A was for ARCO stage II 46 hips (IIA 6 hips, IIB 22 hips, IIC 18 hips), and Group B was for stage III 36 hips (IIIA 20 hips, IIIB 10 hips, IIIC 6 hips). Blood perfusion of necrotic area and femoral head and neck junction with LDP were detected during the operation. Statistical analysis was made. RESULTS: In Group A, the perfusion volume of necrotic area was (30.2 +/- 3.0) PU, and the perfusion volume of femoral head and neck junction was (103.4 +/- 4.4) PU. In Group B, the perfusion volume of necrotic area was (30.6 +/- 2.8) PU, and the perfusion volume of femoral head and neck junction was (103.4 +/- 3.9) PU. In Group A and Group B, the perfusion volume of necrotic area was lower than that of femoral head and neck junction, and the difference was significant (P < 0.01). CONCLUSIONS: LDF can effectively detect that the perfusion volume of ONFH decreased, which provides a theoretical basis in order to further study the pathogenesis of ONFH. Meanwhile, there is application value of LDF on the study of ONFH.

[Clinical analysis of light bulb operation with nano-hydroxyapatite/collagen for the treatment of osteonecrosis of the femoral head].

OBJECTIVE: To retrospectively analyze the clinical effect of light bulb operation with nano-hydroxyapatite/ collagen in a consecutive series of patients with osteonecrosis of the femoral head (ONFH). METHODS: From January 2001 to July 2005, 26 patients (35 hips) were treated, 16 males and 10 females, aged 19-54 years old (33.5 on average). The course of disease was 12-36 months (18 months on average). Based on the etiology, 15 cases (22 hips) were steroid induced type, 10 (12 hips) were alcohol induced type and the other one (1 hip) was idiopathic type. According to the system of Association Research Circulation Osseous (ARCO), there were 6 hips of stage IIB, 16 hips of stage IIC, 9 hips of stage IIIA, 3 hips of stage IIIB and 1 hip of stage IIIC. The Harris score was 62.2 +/- 7.5. All the patients who had undergone light bulb operation with nano-hydroxyapatite/collagen were evaluated both clinically and radiographically. The bone graft mixture rate of nano-hydroxyapatite/collagen and autogenous bone was 1 : 1, and the mixed bone graft was 6 times of the scraped osteonecrosis volume (30-48 mL). RESULTS: The incisions of all 26 patients (35 hips) obtained healing by first intention. The 2 cases, which got lateral femoral cutaneous nerve injury during the operation, recovered 3-6 months after the operation without any treatment. Another 2 cases got heterotopic ossification 3 months after operation, with no special treatment. All the 26 patients (35 hips) were followed up for 2-7 years (3.5 on average). The patients' bone healing began from the 3rd month after operation. The postoperative Harris score was 85.1 +/- 16.2, and there was significant difference compared with the preoperative one (P < 0.001). There were 15 hips of excellent, 11 of good, 5 of fair, and 4 of poor which received total hip arthroplasty at the end of the follow-up. According to imaging, 5 hips were progressed from preoperative IIC to IIIA, while the other hips were radiologically stable, with no progress of ONFH. CONCLUSION: Light bulb operation with nano-hydroxyapatite/collagen provides a surgical treatment to treat early ONFH with satisfactory clinical outcomes. Nano-hydroxyapatite/collagen is beneficial for the repair and reconstruction of ONFH and suitable for femoral-head-preserving operation for the patients with ONFH of stage II.

Decreased proliferation of mesenchymal stem cells in corticosteroid-induced osteonecrosis of femoral head.

The ability of self-repair in patients with corticosteroid-induced osteonecrosis of the femoral head is limited, and it has been suggested the cause is likely relevant to the poor proliferation activity of mesenchymal stem cells in the femoral head region. This study measured the number and proliferation activity of human mesenchymal stem cells in patients both with and without corticosteroid-induced osteonecrosis of the femoral head. Bone marrow was collected from the proximal femur in patients with steroid-induced osteonecrosis of the femoral head (osteonecrosis group, n=18) and patients with new femoral neck fractures without osteonecrosis (control group, n=11). Mesenchymal stem cells were isolated by density gradient centrifugation, and then selected by the adhesive method. The MTT reduction assay method was used to evaluate the level of proliferation. Cells from osteonecrosis patients showed reduced proliferation ability compared with the control patients. The percentage of cells in the S+G2/M phase was decreased significantly (P<.01) in the osteonecrosis group. The decreased proliferation ability of mesenchymal stem cells may play a role in the low repair capacity of steroid-induced osteonecrosis of femoral head. The altered function of mesenchymal stem cells may be responsible for the pathogenesis and progression of osteonecrosis.

[Hematological changes and related gene mutation of post-severe acute respiratory syndrome patients with osteonecrosis].

OBJECTIVE: To investigate the hematological changes and related gene mutation of post-severe acute respiratory syndrome (SARS) patients with osteonecrosis so as to find the sensitive molecular symbols for early screening of the high risk populations. METHODS: Fast peripheral venous blood samples were collected from 61 post-SARS patients with osteonecrosis, 25 males and 36 females, aged 30.4 (20 - 60), and 52 sex and age-matched healthy persons as controls. ELISA was used to detect the coagulation and fibrinolysis indicators: activated partial thromboplastin time (APTT), protein C (PC), antithrombin III (AT-III), plasminogen activator inhibitor (PAI), activated protein C resistance (APC-R), plasminogen (PLG), von Willebrand factor (VWF), D-dimer (D-D), and fibrinogen (Fib). Real-time PCR was used to detect the mutation of factor V G1601A (FV Leiden) and prothrombin G20210A. RESULTS: The levels of PC, AT-III, and PLG of the osteonecrosis group were 85% +/- 34%, 84 +/- 29%, and 69 +/- 23%, significantly lower than that of the control group (109% +/- 20%, 104% +/- 14%, and 94% +/- 15% respectively, all P < 0.01). PAI of the osteonecrosis group was 16 U/ml +/- 14 U/ml, significantly higher than that of the control group (8.0 U/ml +/- 4.3 U/ml, P < 0.01). The percentage of patients with abnormal indicators was 99.5% (54/61) in the osteonecrosis group, significantly higher than that of the control group (36.5%, 19/52, P < 0.01). The percentage of patients with 3 or more abnormal indicators was 72.1% (44/61) in the osteonecrosis group, significantly higher than that of the control group (17.3%, 9/52, P < 0.01). No mutations of F V Leiden and prothrombin G20210A was found in both groups. CONCLUSION: Trends of hypercoagulation and hypofibrinolysis exist in the post-SARS patients with osteonecrosis. APTT, PC, AT-III, and PLG can be used as sensitive indicator for screening high risk populations of osteonecrosis.

Changes in coagulation and fibrinolysis of post-SARS osteonecrosis in a Chinese population.

The purpose of this study was to detect changes in coagulation and fibrinolysis of post-severe acute respiratory syndrome (SARS) Chinese patients with osteonecrosis, investigate the aetiology of post-SARS osteonecrosis (ON), and select the sensitive molecular markers for identifying the susceptible population. For this study, blood samples were collected from 88 patients with post-SARS ON and 52 healthy people. Activated partial thromboplastin time (APTT), protein C (PC), antithrombin III (AT-III), plasminogen activator inhibitor (PAI), activated protein C resistance (APC-R), plasminogen (PLG), von Willebrand's factor(vWF), D-dimer (D-D), fibrinogen (Fib), and homocysteine (HCY) were examined by enzyme-linked immunosorbent assay (ELISA). We noted that blood agents of patients with ON changed obviously. APTT, PC, AT-III, PAI, APC-R, and PLG were significantly different between the two groups. Hypercoagulation and hypofibrinolysis were found in patients with post-SARS ON. Therefore, these examinations can be used to screen a population susceptible to ON. Measurements of APTT, PC, AT-III, PAI, APC-R, and PLG are sensitive blood tests for screening purposes.