Epidemiological investigation and diagnostic analysis of osteonecrosis of the femoral head in three northeastern provinces of China.

BACKGROUND: In this retrospective case investigation, we analysed the data of patients with osteonecrosis of the femoral head (ONFH) to reveal demographic and clinical diagnostic features of ONFH in three northeastern provinces of China and provide a reference for its prevention, diagnosis, and treatment. METHODS: We collected data from patients in Beijing Orthopaedic Hospital of Liaoning, focusing on the aetiology and diagnosis of ONFH. Medical records and self-designed questionnaires were used to collect information for statistical analysis, including age, aetiology, reason for glucocorticoid use, hospital level at first visit, and diagnosis. RESULTS: In total, 906 patients with complete medical records were included in the analysis. The mean patient age was 47.65 ± 12.12 years. The peak age distribution was in the 40s for men and the 50s for women. Among the total cohort, 72 patients (7.95%; 40 men and 32 women) had traumatic ONFH, 198 (21.85%; 131 men and 67 women) had steroid-induced ONFH, 230 (25.39%; 121 men and 109 women) had idiopathic ONFH, and 406 (44.81%; 397 men and 9 women) had alcohol-induced ONFH. Six hundred and twenty patients were diagnosed with ONFH at the first visit, while 286 patients were misdiagnosed, with a diagnosis rate of 68.43%. The diagnosis rate at the first visit in tertiary hospitals was 76.14%. The diagnosis rate at the first visit in second-class hospitals was 52.07%.ONFH was most likely to be misdiagnosed as lumbar disc herniation. CONCLUSIONS: Most patients with ONFH in three northeastern provinces of China were middle-aged, male, and had alcohol-induced ONFH. The misdiagnosis rate of ONFH at the first visit was very high, especially for misdiagnosis of lumbar disc herniation, indicating that the diagnosis of ONFH requires further improvement.

Reliability and repeatability of 2021 ARCO classification and its guiding significance in treatment of nontraumatic osteonecrosis of the femoral head.

BACKGROUND: The study was designed to evaluate the interobserver reliability and intraobserver repeatability of the 2021 Association Research Circulation Osseous (ARCO) classification and explore its guiding significance in the treatment of nontraumatic osteonecrosis of the femoral head (ONFH). METHODS: In this retrospective study, we randomly selected and investigated 50 sets of preoperative computed tomography or magnetic resonance imaging scans from 96 patients (139 hips) to validate the reliability and repeatability of the 2021 ARCO classification. Patients with a nano-hydroxyapatite/polyamide-66 support rod were included in the clinical efficacy study. The Harris hip score (HHS) was used to assess hip function. Femoral head collapse of > 2 mm was considered radiological failure. Total hip arthroplasty (THA) was performed for clinical failure, and follow-up was discontinued. RESULTS: The average kappa value of interobserver consistency was 0.652. The average rate of consistency was 90.25%, and the average kappa value of intraobserver consistency was 0.836. Eighty-two patients (122 hips) were enrolled and followed up for a mean of 43.57 ± 9.64 months. There was no significant difference in the HHS among the three groups before surgery, but the difference was statistically significant at the last follow-up. Among them, types 1 and 2 had significantly higher scores at the last follow-up than preoperatively (P < 0.05), whereas type 3 had a lower score at the last follow-up than preoperatively, although the difference was not statistically significant (P > 0.05).According to the imaging evaluation, the failure rate of type 1, 2, and 3 at the last follow-up was 0%, 19%, and 87%, respectively. Univariate analysis showed that the femoral head survival rate of radiography was significantly affected by the new classification system (P = 0.00). At the last follow-up, the incidence rate of THA in type 1, 2, and 3 was 5%, 7%, and 31%, respectively. Univariate analysis showed that the femoral head survival rate was significantly affected by the new classification system (P = 0.001). CONCLUSIONS: The 2021 ARCO classification for early-stage ONFH shows substantial consistency and repeatability. We do not recommend femoral head-preserving surgery for patients with type 3 ONFH.

Preliminary report of the outcomes and indications of single approach, double-channel core decompression with structural bone support and bone grafting for osteonecrosis of the femoral head.

BACKGROUND: To report the outcomes of the single approach to double-channel core decompression and bone grafting with structural bone support (SDBS) for osteonecrosis of the femoral head (ONFH) and define the indications. METHODS: One-hundred-and-thirty-nine hips in 96 patients (79 males, 17 females; mean age 37.53±10.31 years, range 14-58 years; mean body mass index 25.15±3.63 kg/m2) were retrospectively analysed. The Harris hip score (HHS) was used to assess hip function, and radiographs were used to assess the depth of femoral head collapse. Treatment failure was defined as the performance of total hip arthroplasty (THA). The variables assessed as potential risk factors for surgical failure were: aetiology, Japanese Osteonecrosis Investigation Committee (JIC) type, age, and Association Research Circulation Osseous (ARCO) stage. Complications were recorded. RESULTS: The mean follow-up time was 29.26±10.02 months. The HHS increased from 79.00±13.61 preoperatively to 82.01±17.29 at final follow-up (P=0.041). The average HHS improvement was 3.00±21.86. The combined excellent and good rate at final follow-up (65.6%) was significantly higher than that before surgery (34.5%) (P<0.05). On radiographic evaluation, 103 (74.1%) hips remained stable, while 36 (25.9%) had femoral head collapse or aggravation of ONFH. THA was performed in 18 hips. Thus, the overall femoral head survival rate was 87.05% (121/139). The success rate was adversely affected by JIC type, but not by aetiology, age, or ARCO stage. The only complication was a subtrochanteric fracture in one patient. CONCLUSION: The SDBS may be an effective method to delay or even terminate the natural progression of ONFH, especially for patients with JIC types B and C1. The SDBS represents a new option for treating early-stage ONFH.

Fibula allograft propping as an effective treatment for early-stage osteonecrosis of the femoral head: a systematic review.

BACKGROUND: Osteonecrosis of the femoral head (ONFH) causes severe hip dysfunction. Left untreated, 80% of patients experience femoral head collapse, and 65-70% of patients require total hip arthroplasty (THA). Therefore, effective treatment is very important for ONFH. OBJECTIVE: To examine the effectiveness of fibula allografting for the treatment of early-stage ONFH METHODS: A systematic review was conducted by searching PubMed, EMBASE, and Web of Science databases using "avascular necrosis" or "ischemic necrosis" or "osteonecrosis" and "femoral head" and "fibula*," and checking the references of primary articles and reviews. Two independent authors completed the study selection separately. We extracted the following details from each article: characteristics of the patients, clinical efficacy evaluation (Harris hip score [HSS], radiographic outcomes, the rate of conversation to total hip arthroplasty [THA], and adverse effects). RESULTS: A total of 213 articles were selected from PubMed (n = 45), EMBASE (n = 77), Web of Science (n = 203), and other sources (n = 10). After checking the articles, five articles were included in the final analysis. The average age of patients involved in this review was 34.48 years. The studies investigated fibula allografts to treat ONFH in 394 hips with a mean follow-up of 49.06 months. HHS was improved from 62.73 to 86.94. Radiographic progression was found in 33.66% of hips. The failure rate of head-saving surgery by THA was 14.5%. No patients had serious postoperative complications. LIMITATIONS: The number of articles included in the study was small, and all studies were single-center studies. Most studies were retrospective with a low level of evidence. Surgical procedures were not identical with different follow-up times. CONCLUSION: Although there are some limitations to our approach, this systematic review supports fibula allografting as a simple, effective treatment for early-stage ONFH, which presents less postoperative complications, and has a satisfactory clinical effect. We consider it to be worthy of promotion as a therapy for ONFH.

Searching for valuable differentially expressed miRNAs in postmenopausal osteoporosis by RNA sequencing.

AIM: Postmenopausal osteoporosis is a systemic and chronic bone disease in women. In order to understand the pathological mechanism of postmenopausal osteoporosis, we aimed to find the potential differentially expressed miRNAs in the disease. METHODS: Firstly, RNA sequencing was used to identify differentially expressed miRNAs, followed by the construction of the miRNA-target mRNA regulatory network. Then, Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes were used to analyze the biological function of target mRNAs. Finally, electronic validation of identified differentially expressed miRNAs and target mRNAs was performed. RESULTS: A total of 33 differentially expressed miRNAs (18 upregulated and 15 downregulated miRNAs) and 6820 miRNA-mRNA pairs were identified. Among which, seven miRNAs with high degree including hsa-miR-17-5p, hsa-miR-1-3p, hsa-miR-193b-3p, hsa-miR-125b-5p, hsa-miR-10b-5p, hsa-miR-100-5p and hsa-miR-30a-3p were obtained in the miRNA-mRNA regulatory network. TGF-beta was the most significantly enriched signaling pathway of target mRNAs. The electronic validation result of hsa-miR-1-3p, hsa-miR-193b-3p, hsa-miR-10b-5p, hsa-miR-100-5p, hsa-miR-133b, hsa-miR-708-5p, CRK, RAB5C, CCND1 and PCYOX1 was consisted with the RNA sequencing analysis. CONCLUSION: Dysfunctional miRNAs may play significant roles in postmenopausal osteoporosis.

Single approach to double-channel core decompression and bone grafting with structural bone support for treating osteonecrosis of the femoral head in different stages.

BACKGROUND: We created a novel method-single approach to double-channel core decompression and bone grafting with structural bone support (SDBS)-to treat early-stage osteonecrosis of the femoral head (ONFH) by improving the Phemister technique. This study aimed to evaluate the results of SDBS for early-stage ONFH. METHODS: Altogether, 53 patients (73 hips) were treated using SDBS during 2016-2018. Bilateral (20 patients) and unilateral (33 patients = 18 left hips, 15 right hips) ONFH was diagnosed. According to the Association Research Circulation Osseous classification stages, the femoral heads were staged as IIB (n = 15), IIC (n = 19), IIIA (n = 34), IIIB (n = 4), and IIIC (n = 1). The Harris hip score was used to evaluate the hips' clinical function, computed tomography to evaluate subchondral fractures, and plain radiography to assess the extent of femoral head collapse. RESULTS: The average follow-up was 20.71 ± 6.65 months (6-36 months). At the patients' last follow-up, 4 hips were found to require arthroplasty. Thus, the overall femoral head survival rate was 94.52% (69/73). Also, the overall Harris score (84.44 ± 14.57) was significantly higher than that preoperatively (77.67 ± 14.37) (P = 0.000). The combined excellent and good rate (76.71%) was significantly higher than that preoperatively (38.36%) (P = 0.000). Imaging showed that 16 femoral heads had some ONFH progression. The average length of stay was 6.15 ± 0.86 days. The average incision measured 2.69 ± 0.30 cm. Intraoperative blood loss was 61.20 ± 4.81 ml. There were no complications during or after the operation. CONCLUSION: SDBS is an effective method for treating early-stage ONFH. It is a hip-preserving surgical approach to slow/prevent ONFH progression.

[Study on the relationship between sclerosis rim and bone morphogenetic proteins of osteonecrosis of the femoral head].

OBJECTIVES: To analyze retrospectively the formation and histological changes of sclerosis rim in patients with osteonecrosis of the femoral head (ONFH), and to study the relationship between bone morphogenetic proteins (BMP4) and sclerosis rim, so as to acquire experimental and theoretical basis on individualized treatment for ONFH patients. METHODS: From November 2005 to November 2007, 184 hips of steroid-induced ONFH inpatients were collected. The mean age was (47 ± 7) years, the patients were divided into high (more than 54 years old), middle (40 - 54 years old) and low (less than 40 years old) age groups. Their clinical data were analyzed retrospectively according to gender and age. Parts of the femoral heads were selected for the study, including 18 hips in high age group, 11 hips in low age group and 20 hips in middle age group. Each 10 hips were selected with or without sclerosis rim. The femoral heads were cut along middle coronal plane, their weight-bearing and non-weight-bearing areas were used for the study. The specimens were processed by routine HE staining and picric acid-Sirius red staining and electron microscopy preparation and immunohistochemistry stain. The average optical density of BMP4 protein was calculated by image analysis software. RESULTS: The trabecular of sclerosis rim was thickening and disorder. But its osteocytes were normal and with high secretion. The ratio of sclerosis rim was 71.4% (105/147) in middle age ONFH patients, which was significantly higher than the low age group patients (45.5%, 5/11) and high age group patients (38.5%, 10/26) (P < 0.01). The optical density of BMP4 in middle age ONFH patients was 0.32 ± 0.14, which was significantly higher than the low age group 0.20 ± 0.17 and high age patients 0.19 ± 0.27 (P < 0.05). The optical density was 0.16 ± 0.11 in ONFH patients without sclerosis rim, which was significantly lower than with sclerosis rim (0.28 ± 0.13) (P < 0.01). The time from hip pain to joint replacement in patients with sclerosis rim was (49 ± 11) months, and (15 ± 2) months without sclerosis rim. There was significant difference between the two groups (P < 0.01). CONCLUSIONS: The formation of sclerosis rim is positively related to the expression of BMP4, and high expression of BMP maybe promote the formation of sclerosis rim.

[The effect of subchondral bone defect in femoral head on structure and metabolism of article cartilage].

OBJECTIVE: To investigate the changes of structure and metabolism of the cartilage of femoral head overlying the bone defect in animal model and analyse the possible effect of the necrotic area of the femoral head on the cartilage overlying there. METHODS: 18 adult hybrid dogs was applied for bone defect model of femoral head. Of the femoral heads, the left was applied for bone defect model, the right for shame-operation. 5, 5, and 8 animals were sacrificed respectively 4, 12 and 24 weeks after operation and the femoral heads were received for examinations. The X-rays films were taken just before the animals were sacrificed. After the cartilage specimens were decalcified, dehydrated and embedded, sections 6, u thick were made. They were stained with hematoxylin-eosin, sirius-red and toilude blue. The biochemical assay were performed. RESULTS: 12 and 24 weeks after operation of bone defect, cartilage histology and biochemistry demonstrated the signs of articular cartilage pathological changes. The arrangement of chondrocytes were disorder. The number of chondrocytes decreased. The cartilage surface lost its smoothness, and these kinds of changes were more severe in the area next to the bone defect. Fibrosis and vasi formation were found. Tidemark had the changes of discontinuation and veil. Glycosaminoglycans decreased. CONCLUSION: The bone defect, whose damaged structure strength and decreased blood supply is similar, had effect on the structure and metabolism of the articular cartilage near the bone defect, and suggest osteonecrosis at the stage of pro-collapse may affect the cartilage overlying it.

[In vitro study of combination rhOPG-Fc and alendronate on inhibition osteoclast].

OBJECTIVE: To study the effect of combination rhOPG-Fc and alendronate on mature osteoclasts. METHODS: Recombinant human osteoprotegerin secretory expression in P. pastoris was performed. Osteoblasts were got from new born mouse skeletal bone and proved by ALP staining and incubated together with osteoclasts precursor cell line Raw 264.7 in 96 well plate. After 9 d, 10 micromol/L ALN, 10(-5) g/L rhOPG-Fc, 10 micromol/L ALN + 10(-5) g/L rhOPG-Fc, 5 micromol/L ALN + 5 x 10(-6) g/L rhOPG-Fc were added to these coculture systems. Osteoblasts cultured without the drugs mentioned above served as controls. TRAP stain positive cells counting and cortical bone pit formation counting were preformed in the following the 3rd and 7th d. RESULTS: SDS-PAGE and Western blot showed that molecular weight of the expressed protein was about 55 KD, and it could reach specifically with anti-IgG antibody. Many multi-nuclear TRAP stain positive cells were found in the coculture control group after 9 d incubation, and proved to be mature osteoclasts by TRAP stain. In the 3rd and 7th d after the addition of rhOPG-Fc, ALN or both, TRAP stain positive cells counting and cortical bone pit formation counting decreased significantly in the rhOPG-Fc, ALN or both groups than in the control group, and the combine group (10(-5) g/L rhOPG-Fc + 10 micromol/L ALN) decreased most significantly when compared with rhopG-FC or ALN single. CONCLUSIONS: rhOPG-Fc can decrease the number of osteoclasts and inhibit their function. The combination of both rhOPG-Fc and ALN shows the significant inhibition effect on mature osteoclasts.