[Comparative effectiveness of complex physiotherapeutic treatment of patients in the early stages of avascular necrosis of the femoral head]. / Sravnitel'naya effektivnost' kompleksnogo fizioterapevticheskogo lecheniya bol'nykh na rannikh stadiyakh asepticheskogo nekroza golovki bedrennoi kosti.

INTRODUCTION: In the late stages of avascular necrosis of the femoral head (ANFH), total hip arthroplasty (THA) is a non-alternative treatment method. In the early stages, methods of conservative treatment show some effectiveness. Among them, most often there is evidence of the effectiveness of physiotherapy options. AIM: Of this study is the development and study of a method of complex non-surgical treatment of ANFH based on a combination of physiotherapy and phytotherapy methods. MATERIAL AND METHODS: We examined 60 patients with early stages of ANFH, who underwent courses of complex treatment. Patients of the primary group received a complex, including: exposure to acupuncture points in the area of hip joint (HJ) with low-frequency currents using the Osteon-1 apparatus in combination with phytoapplications, HJ massage, special physiotherapy exercises. Unloading the HJ (walking on crutches) was mandatory component. Patients in the control group were treated using a complex including: manual massage of HJ, the use of sinusoidally modulated currents and ultraphonophoresis of hydrocortisone on the affected joint. In order to assess the dynamics of the clinical and functional state of HJ before and after the treatment, Harris questionnaire, radiography, ultrasound densitometry, and laser Doppler imaging were used. Quality of life was assessed using the SF36 questionnaire. The full course of treatment was 1 month. Long-term results were studied after 1 year by the questionnaire method. RESULTS: In patients of both groups, a positive dynamics of the clinical and functional state of the joints was registered, but higher statistically significant indicators were obtained in the primary group. Moreover, in a significant number of patients (in 95% of cases), positive clinical results persisted throughout the year. CONCLUSION: The use of a complex of treatment based on physiotherapy and a combination of physiotherapy and phytotherapy makes it possible for us to obtain positive clinical and functional dynamics of the state of the joints and an increase in the quality of life in patients with ANFH.

[Comparison of early rehabilitation effects of total hip arthroplasty with direct anterior approach versus posterior approach].

Objective: To compare the early rehabilitation effects of total hip arthroplasty (THA) with direct anterior approach (DAA) versus posterior approach (PA). Methods: A retrospective analysis was made in the data of 83 patients with unilateral osteonecrosis of the femoral head between March 2014 and May 2017. Forty-eight patients were treated with THA via PA (PA group) and 35 patients were treated with THA via DAA (DAA group). There was no significant difference in gender, age, body mass index, stage of osteonecrosis of the femoral head, and disease duration between 2 groups ( P>0.05). The length of incision, operation time, total amount of bleeding, the time of first postoperative walking with crutch, the time of first postoperative walking without crutch, the Harris scores, and the visual analogue scale (VAS) scores of 2 group were recorded and compared. Results: All incisions healed primarily and no infection, dislocation, or fracture occurred. All patients were followed up 30.2 months on average (range, 6-44 months). The numbness symptom caused by the lateral femoral cutaneous nerve injury occurred in 2 patients of DAA group and released after symptomatic treatment. The length of incision, total amount of bleeding, the time of first postoperative walking with crutch, and the time of first postoperative walking without crutch of DAA group were significantly superior to those of PA group ( P<0.05). The Harris scores of DAA group were significantly higher than those of PA group at 2 weeks and 1 month after operation ( P<0.05), while no significant difference was found between 2 groups before operation and at 3 months and 6 months after operation ( P>0.05). The VAS scores of DAA group were significantly lower than those of PA group at 1 day, 4 days, 1 week, and 2 weeks after operation ( P<0.05), while no significant difference was found between 2 groups before operation ( P>0.05). Conclusion: DAA is meaningful to enhanced recovery after THA. But it should be chosen carefully because of the disadvantages, such as long learning curve, limited indications, and requirements of specific instruments.

Successful Rehabilitation of a Young Adult With Total Hip Arthroplasty a Decade After a Girdlestone Procedure: A Case Presentation.

This is a case presentation of a female patient who underwent a Girdlestone arthroplasty at age 10 years and a total hip arthroplasty at age 21. Despite early postoperative rehabilitation, the patient experienced increasing pain, progressive gait deviations, and functional limitations during the year after surgery. This course of care was initiated 1 year after surgery and focused on motor retraining to address pain and gait deviations. This case demonstrates that positive outcomes can be achieved after longstanding musculoskeletal dysfunction is corrected, but that prolonged rehabilitation may be necessary to produce changes in movement patterns at both the local (joint and muscle) and central (cortical) levels. Correction of both the structural problem and the learned movement patterns is necessary for a successful outcome.

Interventional Catheterization Combined with Staphylococcin Aureus Injection in 112 Cases of Ischemic Necrosis of Femoral Heads.

The objective of this study was to investigate the effectiveness of interventional catheterization with staphylococcin aureus injection on ischemic necrosis of the femoral heads. By percutaneous catheterization of the femoral artery, papaverine, urokinase, compound Danshen, and anisodamine were injected intravenously into the arteries of the femoral head. Staphylococcin aureus injection was injected into the hit joint capsule on the side of the lesion to compare the conditions before and after surgery. The patients did the rehabilitation exercises of the hit joint 48 h after the surgery and had double crutches for 3-6 months. Of the 112 cases, 39 cases (34.8 %) were cured, 51 cases (45.6 %) were markedly effective, and 22 cases (19.6 %) were effective. Interventional catheterization combined with staphylococcin aureus injection given into the hit joint capsule is an effective way to treat ischemic necrosis of the femoral head by influencing the internal and external environments of the femoral head.

Rehabilitation program after mesenchymal stromal cell transplantation augmented by vascularized bone grafts for idiopathic osteonecrosis of the femoral head: a preliminary study.

OBJECTIVE: To determine the feasibility and safety of implementing a 12-week rehabilitation program after mesenchymal stromal cell (MSC) transplantation augmented by vascularized bone grafting for idiopathic osteonecrosis (ION) of the femoral head. DESIGN: A prospective case series. SETTING: University clinical research laboratory. PARTICIPANTS: Participants (N=10) with ION who received MSC transplantation augmented by vascularized bone grafting. INTERVENTION: A 12-week exercise program, which included range-of-motion (ROM) exercises, muscle-strengthening exercises, and aerobic training. MAIN OUTCOME MEASURES: Measures of ROM, muscle strength, Timed Up and Go test, and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were collected before surgery and again at 6 and 12 months after surgery. RESULTS: All participants completed the 12-week program. External rotation ROM as well as extensor and abductor muscle strength significantly improved 6 months after treatment compared with that before treatment (P<.05). Significant improvements were also seen in physical function, role physical, and bodily pain subgroup scores of the SF-36 (P<.05). No serious adverse events occurred. CONCLUSIONS: This study demonstrates the feasibility and safety of a multiplex rehabilitation program after MSC transplantation and provides support for further study on the benefits of rehabilitation programs in regenerative medicine.

Free vascularized fibular grafting preserves athletic activity level in patients with osteonecrosis.

Athletic patients with osteonecrosis of the femoral head have few desirable therapeutic options that preserve athletic ability. Because these patients are usually young and healthy, any procedure that avoids total hip arthroplasty would be most desirable. This study prospectively evaluated 15 patients (19 hips) who presented with an average age of 28.5 (range, 12 to 46) years and stages 2 (6/19), 3 (2/19), 4 (9/19), and 5 (2/19) of osteonecrosis of the femoral head. All patients were treated with free vascularized fibular autografting (FVFG) to the femoral head. Postoperative evaluations of pain symptoms and functional activity showed improvements in all patients. The average follow-up time was 8 years. Harris hip scores significantly increased from an average preoperative score of 75.3 to an average postoperative score of 94.8. Seventy-five percent of patients were able to return to their sport after recovery and all patients reported being satisfied with the procedure and would repeat their decision to have surgery. Three patients' hips were converted to arthroplasty at 3, 11, and 17 years post-FVFG. The results demonstrate that FVFG is a successful therapeutic treatment in athletes with osteonecrosis of the femoral head. It reduces pain, increases activity, and allows most patients to return to their sport, an achievement often not possible with other treatment options.

Necrosis avascular de la cabeza femoral tras el uso del arnés de Pavlik / Femoral head avascular necrosis after the use of Pavlik harness

No disponible

Arthroscopic mobilization of the hip joint in children with aseptic necrosis of the femur head.

The purpose of the study was to evaluate the ability of arthroscopic mobilization of the hip to improve restricted range of motion after failed conservative therapy (level IV) of patient with aseptic necrosis of the femoral head. We examined 11 patients (eight male, three female). The average age at follow-up was 13 years (8-17 years). All 11 patients suffered from idiopathic femur head necrosis (M. Perthes). A minimum 1-year follow-up revealed an average increase of hip motion of 20 degrees of flexion, 15 degrees of abduction (P=0.007), 30 degrees of adduction (P=0.03), 15 degrees of external rotation, and 20 degrees of internal rotation. Arthroscopic hydraulic hip distension with postoperative physiotherapy in a brace under epidural anesthesia of the hip joint leads to an increased range of motion of the affected hip and allows additional intraarticular assessment of the joint. Whether the arthroscopic findings will alter the treatment and prognosis of future patients has to be established with further studies.

Necrosis avascular de cadera asociada al consumo de alcohol en un portador heterocigoto de la mutación C282Y/H63D de hemocromatosis / Hip avascular necrosis associated to alcohol consumption in a heterocygous carrier of the hemochromatosis mutations C282Y and H63D

Se presenta el caso de un paciente de 45 años de edad afecto de coxalgia izquierda de varios meses de evolución y una hepatopatía aguda. En las pruebas realizadas se observa una necrosis avascular de cadera (NAC) y en el estudio genético una mutación en el gen HFE implicado en la mayoría de los casos de hemocromatosis hereditaria (HH). En la bibliografía revisada, la HH no aparece como factor etiológico de la NAC, aunque de manera poco frecuente está descrita su asociación. Por este motivo, ante la presencia de una NAC se deben valorar los factores etiológicos conocidos y la posibilidad de asociación con la HH para poder realizar el diagnóstico y tratamiento precoz de esta enfermedad potencialmente grave

A case of a 45-year old male patient suffering left coxalgia of several month evolution and acute hepatopathy is presented. Hip avascular necrosis (HAN) was observed in the tests performed. The genetic study showed a mutation in the HFE gene involved in most of the cases of hereditary hemochromatosis (HH). In the literature reviewed, HH does not appear as an etiological factor of HAN, although this association has been described in rare cases. Thus, when HAN is present, the known etiological factors and the possibility of association with HH should be evaluated to be able to make the diagnosis and perform an early treatment of this potentially serious disease

Course of avascular necrosis of femoral head without collapse of femoral head at first examination: minimum 8-year follow-up.

Disruption of the femoral head contour by collapse of necrotic segments is considered to be an important turning point in the history of avascular necrosis of the femoral head, and in many cases, surgical treatment is required soon after the onset of symptoms. However, in a few cases, conservative treatment is sufficiently effective to avoid surgical procedures for long periods. For patients with early-stage avascular necrosis, it is important to accurately predict its natural course. This article documents the characteristics of patients who can be treated without surgery for long periods. Seventeen hips in 13 patients with avascular necrosis of the femoral head without collapse of the femoral head at first examination were followed for at least 8 years of conservative treatment. Long-term outcomes of hips with avascular necrosis were divided into 3 groups: (1) hips without collapse, (2) hips with progression but cessation of collapse, and (3) hips with progression of collapse. In groups 1 and 2, good clinical results are expected. Hips with femoral head collapse .3 mm at 3 years from the onset of hip pain progressed to osteoarthritis. Our analysis indicated that collapse of the femoral head does not necessarily indicate a poor prognosis, and even after collapse occurs, subsequent cessation of collapse can be expected in a certain percentage of hips.

Tratamento da Osteonecrose da Cabeça Femoral com celulas progenitoras autólogas em anemia falciforme / Femoral Head Necrosis treatment with autologous stem cells in sickle cell disease

OBJETIVO: Avaliação da segurança e eficácia do uso de células progenitoras autólogas da medula óssea (CMMO) no tratamento da Osteonecrose da Cabeça Femoral (OCF) de pacientes portadores de anemia falciforme. MÉTODOS: Foram estudados 8 pacientes portadores de anemia falciforme, com OCF nos estágios I e II (classificação de Ficat e Arlet). As CMMO retiradas da crista ilíaca posterior foram concentradas e reinfundidas na área central da osteonecrose. Os principais parâmetros avaliados foram segurança, sintomas clínicos e progressão da doença, através da avaliação clínica (Harris Hip Score) e radiológica. RESULTADOS: A maior parte dos pacientes (7 em 8) referiu melhora dos sintomas após o tratamento. Não houve complicações durante o procedimento anestésico e cirúrgico. A medida do escore (Harris Hip Score) no pré-operatório foi 78,5 +/- 6,2 pontos, com aumento significativo destes valores no pós-operatório (98,3 +/- 2,5 pontos) (p< 0,001). As avaliações radiográficas e os parâmetros celulares foram favoráveis. CONCLUSÃO: O implante autólogo de CMMO parece ser seguro e eficaz no tratamento dos estágios iniciais da OCF em pacientes falciformes. Embora os resultados iniciais sejam promissores, sua interpretação é limitada pelo número de pacientes avaliados e o período curto de duração do seguimento pós-operatório. Necessita-se estender o grupo em estudo e os parâmetros celulares avaliados.

PURPOSE: To assess the efficacy and safety of autologous bone-marrow mononuclear cells (BMMC) implantation in necrotic lesions of the femoral head in patients with sickle cell disease. METHODS: We studied eight patients with stage-I or -II femoral head osteonecrosis according to the system by Ficat and Arlet. BMMCs were harvested and re-infused into the necrotic zone. The primary endpoints studied were safety, clinical symptoms and disease progression, these being assessed according to the Harris hip score (HHS) and to X-ray studies. RESULTS: After eight months, seven of the eight patients reported improvement from symptoms. There were no complications during anesthetic and surgery procedures. There was a significant postoperative increase in the HHS (98.3 +/- 2.5 points) compared to preoperative HHS (78.5 +/- 6.2 points) (p< 0.001). X-ray evaluation and cell parameters were found to be favorable. CONCLUSION: The autologous bone-marrow mononuclear cells implantation seems to be a safe and effective treatment for early stages of femoral head osteonecrosis in patients with sickle cell disease. Although promising, the interpretation of these early results is limited due to the small sample and to the short duration of follow-up. Further studies and advanced cellular assays are required to confirm the results.

Clinical evaluation of avascular necrosis in patients with sickle cell disease: Children's Hospital Oakland Hip Evaluation Scale--a modification of the Harris Hip Score.

OBJECTIVE: To establish the validity and reliability of the Children's Hospital Oakland Hip Evaluation Scale (CHOHES), a modification of the Harris Hip Score, for the evaluation of avascular necrosis (AVN) in sickle cell disease (SCD). DESIGN: Nonrandomized test-retest. SETTING: Outpatient clinic. PARTICIPANTS: Forty patients with SCD and 3 healthy controls participated. Twenty-six SCD patients (15 males, 11 females; mean age, 25 y) had been diagnosed with AVN. This group was compared with 14 SCD patients without AVN and 3 healthy controls (8 males, 9 females; mean age, 16 y). INTERVENTION: On average, subjects were assessed by 2 physical therapists by using the CHOHES on 3 separate outpatient visits within a 2-week period. MAIN OUTCOME MEASURES: A mixed model with random effects was constructed to compare patient scores on the CHOHES with disease severity as estimated by Ficat staging on plain radiographs. Correlations between and within physical therapists using the CHOHES were calculated to assess intra- and interrater reliability. RESULTS: From the random effects model, the CHOHES mean score was 88 for Ficat stage 0, 75 for Ficat stage I or II, and 61 for Ficat stages III or IV (P < .05). Intrarater reliability estimates for the total CHOHES score were very good (r > or = .87) as were interrater reliability estimates (r > or = .90) between therapists who measured hips with a wide range of CHOHES scores. CONCLUSIONS: The CHOHES appears to be an easy-to-use, valid, and reliable assessment tool and should be considered for use in the routine clinical evaluation of SCD patients with AVN.

[Using the Lequesne questionnaires for patients with hip and knee disabilities in daily routine to reflect the quality of outcome in rehabilitation]. / Der routinemässige Einsatz des Lequesne-Index zur Ergebnismessung in der orthopädischen Rehabilitation bei Hüft- und Knieerkrankungen.

AIM: Studies in rehabilitation research put great value on patients' self-assessment. Patients with hip or knee diseases who need an orthopaedic rehabilitation suffer mainly pain, reduction of walking distance and other disabilities that impact on the activities of daily life. The Lequesne scores for the hip and knee are an indicator to show the degree of disabilities. The aim of the study was to prove that the Lequesne indices are reliable instruments for the individual to express the outcome of rehabilitation. We tested the Lequesne indices in daily clinical work, in the handling and in the acceptance. METHOD: Since May 1999 the rehabilitation center Bad Eilsen uses the Lequesne questionnaires as self-report questionnaire instruments for patients with hip and knee disabilities. 145 patients with hip and 122 patients with knee diseases filled in the questionnaires correctly and handed them back. RESULTS: The Lequesne indices are able to show developments in both directions; improvement as well as change for the worse. The Lequesne questionnaires are helpful to complete the common clinical parameters. CONCLUSION: Using the Lequesne questionnaires as a self-report instrument in our daily routine we are able to obtain a good reflection of individual health condition and the quality of outcome in rehabilitation.

Core decompression with bone grafting for osteonecrosis of the femoral head.

Although core decompression is one of the more popular procedures for treating avascular necrosis, considerable controversy exists concerning its safety and effectiveness. The current authors review the results of a prospective study of 406 hips in 285 patients treated by one surgeon with core decompression and bone grafting. Patients were followed up for 2 to 14 years. The outcome was determined by the change in the Harris hip score, quantitative radiographic measurements, and need for total hip replacement. These hips were compared with 55 hips in 39 patients treated non-operatively and with historic controls. Five complications occurred after 406 procedures including two fractures that resulted from falls during the first postoperative month. Of the 312 hips in 208 patients with a minimum 2-year followup, 36% of hips (113 hips in 90 patients) required hip replacement at a mean of 29 months: 18 of 65 hips (28%) with Stage I disease; 45 of 133 hips (34%) with Stage II disease; three of 13 hips (23%) with Stage III disease; and 45 of 92 hips (49%) with Stage IV disease. Before femoral head collapse (Stages I and II combined) hip replacement was performed in 10 of 77 hips (14%) with small lesions (A), 33 of 68 hips (48%) with intermediate lesions (B), and 20 of 48 hips (42%) with large lesions (C). Results as determined by changes in Harris hip scores and radiographic progression were similar. Patients who underwent core decompression and bone grafting have a very low complication rate. In patients treated before femoral head collapse, the outcome is significantly better than in patients who received symptomatic treatment. The results are correlated with the stage and the size of the necrotic lesion.

Plastía acetabular de aumento ranurado (Técnica de Staheli) / Acetabular plasty of augmentation groove (Staheli technique)

La displasia acetabular lleva a la artrosis degenerativa en personas jóvenes. Se han descrito múltiples osteotomías del iliaco en un intento de aumentar la cobertura de la cabeza femoral. Este es un informe preliminar de seis pacientes, con edades que oscilaron de 11 a 26 años tratados con una plastía acetabular de aumento ranurado. Todos con displasia acetabular, ángulo de Wiber menor de 20 grados, y cabeza femoral muy grande o extruída, pero concéntrica. Se valoró la presencia de dolor, rigidez articular, estabilidad de la cadera, aumento del techo acetabular. Tuvimos cuatro resultados excelentes y dos buenos. Requerimos de un mayor número de pacientes y más tiempo de seguimiento para tener los resultados finales.

[Early diagnosis and management of femur head necrosis in young adult age]. / A fiatal felnöttkori combfejelhalás korai felismerése és gyógyítása.

There are a lot factors in the genesis of the ischemic femoral head necrosis. In the early stage the intraosseous pressure increases without any clinical or radiological sign. The disease is often bilateral. The early diagnosis (NMR) is essential in the treatment. In the case of a severe femoral head necrosis the radiological investigation of the other side is obligatory, in order to diagnose the early stage of the disease and to prevent the progression of the collapse with core decompression. The object of the adequate treatment of the collapsed femoral head is to release the pain and to avoid the total destruction of the femoral head. The untreated femoral head necrosis results in a painful, arthritic hip, where spontaneous regeneration is limited, and takes 8-10 years. With osteotomy and revascularisation the results are good, and the regeneration takes about 2-3 years. As a result of this treatment, the patients have a moderately limited function, and minimal limping. Rehabilitation is possible into the original profession, or into a somewhat easier job. Remodellation of the femoral head in younger patients following the revascularisation procedure has been observed in our experience in the last few years.

[Femur head necrosis in the adult. Diagnosis, therapy, legal aspects for insurance medicine]. / Hüftkopfnekrose des Erwachsenen. Diagnostik, Therapie, versicherungsrechtliche Aspekte.

Early recognition and adequate therapy of necrosis of the head of the femur in adult patients in increasingly gaining importance since they considerably influence the permanent loss of function and reduction of the earning capacity of people of working age. Presently, MRT examination is the most conclusive method for the early stage of necrosis of the head of the femur. After the introduction of microsurgical methods, new therapeutic measures for avascular necrosis of the head of the femur are available, apart from conventional surgical methods to relieve the necrotic areas and the so-called metabolic irritation drilling. Direct vascular-supply, autologous, heterotopic, corticospongiose transplants in the necrotic head of the femur are suited to re-establish circulation in the necrotic area. This involves a considerable operative scope of work.

Necrosis avascular atraumática de la cabeza femoral. Descompresión más injerto de peroné (Resultados preliminares) / Atraumatic necrosis of the femoral head. Core descompression and fibular bone grafting: preliminary results

Se realizó un estudio prospectivo, longitudinal, no comparativo en 11 pacientes (13 caderas con necrosis) de noviembre de 1993 a febrero de 1995. Los criterios de inclusión fueron: pacientes en estadios I, II o III de la clasificación de Ficat y Arlet. Fueron excluidos los pacientes en estadios IV O III en quienes una prótesis total pudo estar disponible. El examen físico fue ralizado de acuerdo con la escala funcional de Harris. Los cambios estructurales fueron determinados por radiografías y RMN. En todos los pacientes se realizó descompresión de la cabeza del fémur y se utilizó peroné para dar soporte estructural. Los resultados fueron evaluados clínicamante de acuerdo con la escala funcional de Harris, con radiografías simples y con RMN, en esto último sólo en 5 casos (38 por ciento). Los mejores resultados se obtuvieron en los estadios I (100 por ciento) y II (80 por ciento). Todos los casos en estadio III terminaron en reemplazo total de cadera. La importancia de un diagnóstico temprano es enfatizada para lo cual la resonancia magnética nuclear (RMN) es muy importante. Esta técnica es efectiva para el tratamiento de la necrosis avascular de la cabeza femoral en estadios tempranos