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Cheon JE, Kim JY, Choi YH, Kim WS, Cho TJ, Yoo WJ. MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI. PLoS One 2021; 16:e0248701. [PMID: 33735261 PMCID: PMC7971487 DOI: 10.1371/journal.pone.0248701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/03/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The purpose of this study was to identify imaging risk factors on contrast-enhanced hip MRI after closed reduction of developmental dysplasia of the hip (DDH) that could predict future development of avascular necrosis (AVN) of the femoral head. Materials and methods Fifty-eight infants (F: M = 53: 5, aged 3–18 months) who underwent immediate postoperative contrast-enhanced hip MRI after closed reduction of DDH were included in this study. Quality of reduction (concentric vs eccentric reduction with or without obstacles), abduction angle of the hip, presence of ossific nucleus, and pattern of contrast enhancement of the femoral head were retrospectively evaluated on MRI. Interobserver agreement of contrast enhancement pattern on MRI were evaluated by two radiologists. Development of AVN was determined through radiographic findings at 1 year after reduction. Results AVN of the femoral head developed in 13 (22%) of 58 patients. Excessive abduction of the hip joint (OR 4.65, [95% CI 1.20, 18.06] and global decreased enhancement of the femoral head (OR 71.66, [95% CI 10.54, 487.31]) exhibited statistically significant differences between the AVN and non-AVN groups (P < 0.05). Eccentric reduction (P = 0.320) did not show statistically significant difference between two groups and invisible ossific nucleus (P = 0.05) showed borderline significance. Multi-variable logistic regression indicated that global decreased enhancement of the femoral head was a significant risk factor of AVN (OR 27.92, 95% CI [4.17, 350.18]) (P = 0.0031). Interobserver agreement of contrast enhancement pattern analysis and diagnosis of AVN were good (0.66, 95% CI [0.52, 0.80]). Conclusion Contrast-enhanced hip MRI provides accurate anatomical assessment of the hip after closed reduction of DDH. Global decreased enhancement of the femoral head could be used as a good predictor for future development of AVN after closed reduction of DDH.
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Napora JK, Morris WZ, Gilmore A, Hardesty CK, Son-Hing J, Thompson GH, Liu RW. Purposeful Closed Reduction and Pinning in Unstable Slipped Capital Femoral Epiphysis Results in a Rate of Avascular Necrosis Comparable to the Literature Mean. Orthopedics 2021; 44:92-97. [PMID: 33561873 DOI: 10.3928/01477447-20210201-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The standard treatment of stable slipped capital femoral epiphysis (SCFE) is generally accepted to be in situ pinning. Controversy exists regarding the treatment of unstable SCFE, including the role of a purposeful closed reduction or open reduction. The objective of this study was to investigate the rate of avascular necrosis (AVN) with purposeful closed reduction and in situ pinning of unstable SCFE. The authors retrospectively reviewed 221 patients with 302 SCFE hips treated with in situ pinning between 2000 and 2014. Forty-eight patients (50 hips) presented with an unstable SCFE. All unstable SCFEs were treated by a gentle reduction method with traction and hip internal rotation followed by pinning. Southwick angles were measured prior to reduction and at the first postoperative visit. No stable SCFEs developed AVN. Thirteen (26%) unstable SCFEs developed AVN. Avascular necrosis developed in 7 of 17 (41%) hips screened with magnetic resonance imaging vs 6 of 33 (18%) hips screened with plain radiographs alone. Mean change in Southwick angle was 28°±8° in the AVN group vs 18°±18° in the no AVN group (P=.18). Despite potentially inflating the rate with the use of early detection magnetic resonance imaging, the authors found an AVN rate comparable to that in the published literature with the use of gentle purposeful reduction on a fracture table, and no statistical differences in reduction amount between patients with and without AVN. Gentle purposeful reduction appears to be a reasonable low morbidity option in the treatment of unstable SCFE without a clear increase in risk of AVN. [Orthopedics. 2021;44(2):92-97.].
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Boontanapibul K, Steere JT, Amanatullah DF, Huddleston JI, Maloney WJ, Goodman SB. Response to Letter to the Editor on "Diagnosis of Osteonecrosis of the Femoral Head: Too Little, Too Late, and Independent of Etiology". J Arthroplasty 2021; 36:e12-e13. [PMID: 33446355 DOI: 10.1016/j.arth.2020.09.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 02/02/2023] Open
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Parsa A, Mirzaie M, Omidi-Kashani F, Ariamanesh AS. Letter to the Editor on "Diagnosis of Osteonecrosis of the Femoral Head: Too Little, Too Late, and Independent of Etiology". J Arthroplasty 2021; 36:e11. [PMID: 33446354 DOI: 10.1016/j.arth.2020.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/21/2020] [Indexed: 02/02/2023] Open
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Zhang G, Li M, Qu X, Cao Y, Liu X, Luo C, Zhang Y. Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis. J Orthop Surg Res 2020; 15:579. [PMID: 33267908 PMCID: PMC7709328 DOI: 10.1186/s13018-020-02098-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the efficacy of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups. METHODS The study retrospectively included 110 patients and 138 hips with DDH diagnosis that underwent closed reduction between February 2012 and November 2015 in our single tertiary medical institution. The failure rate of CR and the underlying risk factors were evaluated. Meanwhile, the incidence of AVN and the related risk factors among the successful CR cases were assessed. RESULTS The overall failure rate of DDH treated by CR in the present study was 31.16% (43/138). Risk factors for the CR failure were older age at the time of CR (≥ 18.35 month), large medical interval before CR (≥ 35.35 mm), and severer dislocation of the affected hip (IDHI grades III and IV). The incidence of AVN was 8.33% (6/72) in patients with successful CR at the last follow-up. No significant risk factors had been established in the present study that associated with the AVN occurrence. CONCLUSIONS For the treatment of DDH with CR, patients with younger age might achieve better outcomes; early diagnosis and early treatment might be the key point in the DDH treatment.
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Khan Y, Arora S, Gupta S, Mahajan N, Sural S, Dhal A. Electrocuted Hip: Late Consequences of Electrical Shock Injuries of Orthopaedic Relevance: A Case Report and Review of Literature. JBJS Case Connect 2020; 10:e1900632. [PMID: 32910607 DOI: 10.2106/jbjs.cc.19.00632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 43-year-old man suffered household electric shock from 220 V alternating current when he accidently touched a live wire with his left hand. Subsequently, he was diagnosed to have osteonecrosis of the left femoral head and underwent total hip arthroplasty. CONCLUSION We suggest that the electric current could have thrombosed the terminal subsynovial vessels of the femoral head, leading to osteonecrosis. To the best of authors' knowledge, only 2 cases of osteonecrosis of the hip after electric shock have been reported in the literature. A literature review of the delayed consequences of electric shock injuries pertaining to orthopaedics is also presented.
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Rossi G, Maffulli N, Lombardo MDM, Manfroni F, Bassani R, Petrachi BV, Sirtori P, Brugnoli A, Cuccuru T, Brambilla L, Domenicucci M, Marmotti A, Dzissah OEK, Mangiavini L, Kombate NK, Peretti GM. Total hip arthroplasty for osteonecrosis of the femoral head in sickle cell disease: a case series from our African experience. J BIOL REG HOMEOS AG 2020; 34:219-222. Congress of the Italian Orthopaedic Research Society. [PMID: 33261281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sickle cell disease causes osteonecrosis (20% to 50% of patients) and collapse of the femoral head that result in secondary osteoarthritis. Total hip arthroplasty (THA) is a valid alternative for these patients. We define the difficulties that can be encountered when undertaking THA in sickle cell disease patients and give advice on how to deal with these technically demanding procedures. We undertook total hip arthroplasty procedures on 12 patients (4 females and 8 males) with osteonecrosis of the femoral head. Two bilateral prostheses were performed. We had only one type of stem, only one type of acetabular cup and only 28 mm cobalt chrome heads. The procedures were performed through either an anterior or a direct lateral approach. The average size of the Cup was 46 (Versafit, Medacta), the average size of the femoral stem was 0 (Amistem, Medacta), the most used size of the modular head was a S. Standard stem that was used in nine patients, while three patients received a lateralizing stem. Three patients had periprosthetic fracture, treated by cerclage. Total hip replacement is an excellent alternative for patients with osteonecrosis from sickle cell disease. The preparation of the acetabulum and the femur is difficult and requires attention, time and appropriate equipment.
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Lombardo MDM, Maffulli N, Bassani R, Petrachi BV, Rossi G, Manfroni F, Sirtori P, Brambilla L, Agnoletto M, Marmotti A, Edem Kwashivi Dzissah O, Mangiavini L, Kombate NK, Peretti GM. Bilateral THA in the same sitting for avascular necrosis of the head of the femur in sickle cell patient: our African experience. J BIOL REG HOMEOS AG 2020; 34:111-114. Congress of the Italian Orthopaedic Research Society. [PMID: 33261264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sickle cell anemia is protective against the malaria protozoan. The heterozygous form of the disease is not fatal, and may cause musculoskeletal disorders when sickling occurs, and small vessels are occluded. When the head of the femur is involved, this may result in hip arthritis, often bilateral, at a young age. This article describes three patients in whom bilateral total hip arthroplasty (THA) was performed in the context of a humanitarian mission in Togo, Africa.
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Hancıoğlu S, Tosyalı HK, Erkan S, Yercan HS. Clinical and radiological outcomes of chronic severe slipped capital femoral epiphysis patients treated by surgical dislocation and modified Dunn osteotomy: Case series. Jt Dis Relat Surg 2020; 31:599-604. [PMID: 32962595 PMCID: PMC7607949 DOI: 10.5606/ehc.2020.75101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the clinical and radiological outcomes of patients with chronic severe slipped capital femoral epiphysis (SCFE) treated by surgical dislocation and modified Dunn osteotomy (MDO). PATIENTS AND METHODS This retrospective study, conducted between January 2010 and December 2017, included nine patients (8 males, 1 female; mean age 12.6 years; range, 7 to 16 years) with nine hips. The degree of corrections in Southwick angle and alpha angle were measured on frog-leg views. Range of motion (ROM) of the hips was measured at each follow-up visit. Heyman and Herndon classification system and Harris Hip Score (HHS) were evaluated for clinical and functional outcomes at the latest follow-up visit. RESULTS The mean follow-up time was 34.8 months. Avascular necrosis complication was observed in one hip. Except two patients with lateral femoral cutaneous neuropathy, none of the patients suffered from any other complications. Mean preoperative Southwick angle of 59.1° was corrected to an angle of -0.8° postoperatively. Alpha angles were calculated as 44.6° postoperatively. Modified Dunn osteotomy resulted in marked improvement in hip ROM in all directions and increased HHS. CONCLUSION Our results encourage us to use this method in treating SCFE patients with chronic severe slips.
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Gallart Úbeda V, Elía Martínez JM, Puerta de Diego R, Elía Martínez I, Valero Inigo JC. [Multiple osteonecrosis. Update and case report]. Rehabilitacion (Madr) 2020; 54:63-67. [PMID: 32007184 DOI: 10.1016/j.rh.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/28/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
Multifocal osteonecrosis is defined as the presence of osteonecrosis in three or more osseous sites. It is an infrequent entity representing less than 3% of cases among osteonecrosis patients. Multifocal osteonecrosis has been associated with systemic diseases, with patients at highest risk being those with lupus erythematosus, transplant recipients and those with haematological disorders or prolonged high-dose glucocorticoid treatment. The area most prone to disturbances is the femoral head. The pathogenesis of this particular disorder has not been fully defined, although several risk factors have been identified. We report the case of a young woman with abnormal hemostatic factors and a history of glucocorticoid and oral contraceptive therapy who developed bilateral hip osteonecrosis, followed by shoulder ON. The present article also provides an extensive literature review of the aetiology and treatment of multifocal ON.
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Stirling P, Moran M. Now you see it: progressive radiographic findings in avascular necrosis of the hip. Lancet 2019; 394:e38. [PMID: 31789221 DOI: 10.1016/s0140-6736(19)32687-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/26/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022]
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Briceño-Souza E, Méndez-Domínguez N, Cárdenas-Dajdaj R, Chin W, Huchim-Lara O. Dysbaric osteonecrosis associated with decompression sickness in a fishing diver. Undersea Hyperb Med 2019; 46:217-220. [PMID: 31051069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Diving as a method of fishing is used worldwide in small-scale fisheries. However, one of the main causes of morbidity and mortality among fishermen is decompression sickness (DCS). We report the case of a 46-year-old male fisherman diver who presented with chronic inguinal pain that radiated to the lower left limb. Living and working in a fishing port in Yucatan, he had a prior history of DCS. A diagnosis of avascular necrosis in the left femoral head secondary to DCS was made via analysis of clinical and radiological findings. The necrosis was surgically resolved by a total hip arthroplasty. Dysbaric osteonecrosis is a more probable diagnosis. In this region fishermen undergo significant decompression stress in their daily fishing efforts. Further studies regarding prevalence of dysbaric osteonecrosis among small-scale fisheries divers are needed. In a community where DCS is endemic and has become an epidemic, as of late, the perception of this health risk remains low. Furthermore, training and decompression technique are lacking among the fishing communities.
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Sultan AA, Mohamed N, Samuel LT, Chughtai M, Sodhi N, Krebs VE, Stearns KL, Molloy RM, Mont MA. Classification systems of hip osteonecrosis: an updated review. INTERNATIONAL ORTHOPAEDICS 2019. [PMID: 29916002 DOI: 10.1007/s00264-018-4018-4/tables/4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE Osteonecrosis of the femoral head (ONFH) typically impacts middle-aged patients who are typically more active and in whom many surgeons would try to delay performing a total hip arthroplasty (THA). This poses a clinical decision-making challenge. Therefore, several options for joint preservation have been advocated, but varying indications and success rates have led to debate on when to use the various procedures. This is due in part to the lack of a generalized system for assessing ONFH, as well as the absence of a standardized method of data collection for patient stratification. Due to the paucity of studies, in this review, we aimed to provide an up-to-date review of the most widely utilized classification systems and discuss the characteristics of each system. METHODS A comprehensive literature review was conducted. Studies published between January 1st, 1975 and March 1st, 2018 were reviewed. The following key words were used in combination with Boolean operators AND or OR for the literature search: "osteonecrosis," "avascular necrosis," "hip," "femoral head," "classification," "reliability," and "validity." We defined the inclusion criteria for qualifying studies for this review as follows: (1) studies that reported on the classification systems for hip osteonecrosis, (2) studies that reported on the inter-observer reliability of the classification systems, and (3) studies that reported on the intra-observer reliability of any ONFH classification systems. In addition, we employed the following exclusion criteria: (1) studies that assessed classification systems for traumatic osteonecrosis, (2) Legg-Calvé-Perthes disease, or (3) Developmental Dysplasia of the Hip. Additionally, we excluded case reports and duplicate studies among searched databases. RESULTS The following classification systems were the most commonly utilized: The Ficat and Arlet, Steinberg, the Association Research Circulation Osseous (ARCO), and the Japanese Investigation Committee (JIC) classification systems. The details of each system have been discussed and their inter- and intra-observer reliability has been compared. CONCLUSION To this date, there is a lack of consensus on a universal and comprehensive system, and the use of any of the previous classification systems is a matter of dealer's choice. The Ficat and Arlet system was the earliest yet remains the most widely utilized system. Newer classification systems have been developed and some such as the JIC shows promising prognostic value while maintaining simplicity. However, larger validating studies are needed. While all of these systems have their strengths, the lack of a unified classification and staging system is still a problem in the diagnosis and prognosis ONFH. Further multi-center collaborative efforts among osteonecrosis experts are needed to adopt a universal classification system that may positively reflect on patient's outcomes.
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Pavelka T, Salášek M, Bárta P, Fridrich F, Džupa V. [Avascular Necrosis of Femoral Head and Coxarthrosis Progression after Acetabular Fractures]. ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE CECHOSLOVACA 2019; 86:381-389. [PMID: 31941564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF THE STUDY Non-operative and operative treatment of acetabular fractures is associated with a risk of development of posttraumatic avascular necrosis of femoral head or with the development of posttraumatic coxarthrosis. The purpose of the study was to identify the occurrence of these two complications in patients in our group and to determine the risk factors for the development of these complications. MATERIAL AND METHODS The retrospective study was conducted in two Level I trauma centres in the period from 2009 to 2014. The group included patients with an acetabular fracture. The inclusion criteria were the following: outpatient follow-up for the period of 3 years after the injury, full radiology and CT documentation. The exclusion criteria were the following: pathological fractures, missing documentation after the union, insufficient follow-up period or dissent of the patient. The inclusion criteria were met by 192 patients, 48 women and 144 men, with the mean age of 48.9 years. The following basic epidemiological data were monitored: age, sex, cause of injury, type of fracture according to the Letournel classification, occurrence of associated injuries and type of therapy. The patients undergoing non-operative treatment as well as patients undergoing operative treatment underwent clinical and radiological examinations at 3 and 6 weeks after the injury, then at 3, 6 and 12 months after the injury, subsequent follow-up checks were done at a year-interval up to 3 years after the injury. RESULTS The posttraumatic avascular necrosis of femoral head developed in 22 patients (11.7%, 17 men, 5 women, p = 0.1159), with the mean age of 55.3 years (STDEVP 15.5, range from 22 to 82). The average time to the development of femoral head necrosis was 13.1 months (STDEVP 17.0, range from 1 to 80), median 6 months, 95% percentile 34 months. In a total of 16 patients necrosis developed within 18 months after injury, while in 6 patients after a longer period of time. Progression of coxarthrosis was observed in 63 patients (33.5%, 44 men and 19 women, p = 0.0447). Within 24 months progression was seen in 55 patients, beyond 2 years in 8 patients. Confirmed as risk factors for the development of posttraumatic avascular necrosis of femoral head and progression of posttraumatic coxarthrosis were the age 60 years and above (p = 0.0023), posttraumatic medialisation of the femoral head greater than 2 mm (p < 0.0001), displacement in the weight bearing area within the acetabulum greater than 2 mm (p < 0.0001), operative treatment (p = 0.0014), combined surgical approach (p = 0.0044), and higher caput-collum-diaphyseal (CCD) angle of proximal femur (p = 0.0142). At risk for the development of avascular necrosis were the A5 type fractures (p = 0.0214) and B2 type fractures (p = 0.0218), at risk for the development of coxarthrosis were the C1 type fractures (p = 0.0122). The isolated fractures of the anterior column were by contrast associated with a significantly lower risk for development of both the AVN (p = 0.0052) and posttraumatic coxarthrosis (p = 0.0006), the isolated fractures of the posterior wall were associated only with a higher risk for AVN and coxarthrosis summation (p = 0.0399), and the same applies to the T fractures (B3, p = 0.0200). DISCUSSION Majority of current studies regarding acetabular fractures focuses on operative treatment, short-term complications and comparison of outcomes of operative and non-operative treatment. Only a few studies are dedicated to epidemiological data, or risk factors for the development of medium-term and long-term complications. In the presented study attention was paid to two main complications arising from these fractures and requiring subsequent operative treatment: posttraumatic avascular necrosis of femoral head and posttraumatic coxarthrosis. The limitations of the study are its retrospective nature, summation of groups from two trauma centres (potential bias in patient enrolment or in assessing radiographs), lower frequency of clinical surveillance in non-operatively treated patients after healing, a fairly low number of non-operatively treated patients - especially those with osteoporosis-related insufficiency fractures. Ranking among the relative limitations is also the Letournel classification which, though most commonly used at present, shows a low level of correlation in comparisons by more evaluators. CONCLUSIONS Confirmed as significant risk factors for the development of posttraumatic avascular necrosis of the femoral head and posttraumatic coxarthrosis progression were the age of 60 and above, posttraumatic medialisation of the femoral head greater than 2 mm, displacement involving the weight bearing area of the acetabulum greater than 2 mm, operative treatment, combined operative approach. At risk are also the transverse fractures (A5 according to the Letournel classification), transverse posterior wall fractures (B2 according to the Letournel classification) and at risk for the development of coxarthrosis are both-column fractures with the high fracture line of the anterior column (C1 according to the Letournel classification). Femoral neck valgosity was a risk factor for the development of femoral head necrosis. Conversely, sex and instability of osteosynthesis detected on the radiograph within 3 months postoperatively were not confirmed as the risk factors for the development of aforementioned complications. To verify the results of this retrospective study other multicentric and prospective studies should be conducted. Key words: complications of treatment of acetabular fractures, risk factors for avascular necrosis of femoral head, risk factors for coxarthrosis.
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Kuo YR, Chen CC, Wang JW, Chang JK, Huang YC, Pan CC, Lin YC, Wu RW, Lee CH. Bone infarction of the hip after hand allotransplantation: A case report. Microsurgery 2018; 39:349-353. [PMID: 30481394 DOI: 10.1002/micr.30375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/11/2018] [Accepted: 08/07/2018] [Indexed: 11/07/2022]
Abstract
Vascularized composite allotransplantation represents as an emerging field in reconstructive surgery. However, some complications can be associated with the procedure. The authors describe a case of bone infarctions of the bilateral hip joints following the first hand allotransplantation in Taiwan. A 45-year-old man who experienced a traumatic amputation of the distal third of his forearm received a hand transplantation from a brain-dead donor. Immunosuppression included antithymocyte globulins, and bolus methylprednisolone (Solu-Medrol) was used for the induction. The maintenance therapy protocol included systemic tacrolimus, mycophenolate mofetil, and prednisone. The patient discontinued the systemic steroid 15 months after surgery. Two episodes of acute rejections were observed at 105 and 810 days after surgery. These signs disappeared after pulse therapy with Solu-Medrol, titration with tacrolimus, and topical immunosuppressive creams (tacrolimus and clobetasol). However, the patient felt pain in both hips after long periods of standing 30 months after the transplantation. A pelvic radiograph and magnetic resonance imaging revealed avascular necrosis (AVN) in both hip joints. Because of the progressive worsening of the pain, the patient underwent a decompression surgery on the left hip involving a fibula bone graft. The patient underwent a right hip hemi-arthroplasty with a bipolar prosthesis 3 months later. The patient remained in good health without major complications. These findings indicate that systemic steroids and tacrolimus might be the major predisposing factors for the induction of AVN after hand allotransplantation.
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Siddiqui N, Khan BA. A case of Avascular Necrosis in a patient with Adrenocortical Carcinoma and Disseminated Metastasis. J PAK MED ASSOC 2018; 68:1267-1269. [PMID: 30108401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
28 years old, male patient was diagnosed with Metastatic Adrenocortical Carcinoma after extensive investigation. Patient's primary concern was only his right hip and right shoulder pain. On imaging investigations, the patient was diagnosed with Avascular Necrosis of the right hip joint. Further laboratory work-up for avascular necrosis showed Primary Hypercortisolism and eventually patient was found to have Adrenocortical Carcinoma base on CT and bone scan results, Avascular Necrosis usually presents with pain in the affected area, mostly involving shoulder, knee or hip joint. Among many of the causes of Avascular necrosis, one rare cause is hormone secreting Adreno cortical Carcinoma, a rare and a highly malignant tumour. Patients can present with Cushing's syndrome or can have atypical presentation like this patient. This patient did not have any symptoms related to malignancy such as loss of appetite and weight loss.
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Ulici A, Carp M, Tevanov I, Nahoi CA, Sterian AG, Cosma D. Outcome of pinning in patients with slipped capital femoral epiphysis: risk factors associated with avascular necrosis, chondrolysis, and femoral impingement. J Int Med Res 2018; 46:2120-2127. [PMID: 29210310 PMCID: PMC6023047 DOI: 10.1177/0300060517731683] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/24/2017] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to assess the principal risk factors that could lead to the most common long-term complications of slipped capital femoral epiphysis, such as avascular necrosis, chondrolysis, and hip impingement. Methods We conducted a single-centre, retrospective study and evaluated patients (70 patients, 81 hips) who were treated for slipped capital femoral epiphysis from 2010 to 2015 and who underwent pinning. We measured the severity of displacement radiologically using the Southwick angle. Postoperative radiographs were evaluated for the most frequent long-term complications of avascular necrosis (AVN), chondrolysis, and femoral acetabular impingement (FAI). Results We found seven cases of AVN, 14 cases of chondrolysis, and 31 hips had an α angle of 60°. Sex, ambulation, and symptoms did not affect development of these complications. Patients with a normal weight were almost two times more likely to develop FAI. Patients with moderate and severe slips had a similar percentage of AVN. In severe slips, 85.7% of patients had an α angle higher than 60°. Conclusions This study shows that severe slips have a higher risk of developing AVN and hip impingement. Every patient who suffers from SCFE (even the mildest forms) should be regularly checked for FAI.
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Sionek A, Czwojdziński A, Kowalczewski J, Okoń T, Marczak D, Sibiński M, Złotorowicz M, Czubak J. Hip osteonecroses treated with calcium sulfate-calcium phosphate bone graft substitute have different results according to the cause of osteonecrosis: alcohol abuse or corticosteroid-induced. INTERNATIONAL ORTHOPAEDICS 2018; 42:1491-1498. [PMID: 29550914 DOI: 10.1007/s00264-018-3892-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/12/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of the study was to assess the factors influencing the final results of treatment of the femoral head osteonecrosis (ONFH) with core decompression and bone substitute grafting. The special interest was focused on comparison between alcohol- and steroid-induced ONFHs. MATERIAL AND METHODS In this prospective study, a total of 53 patients (58 hips) in the mean age of 35.5 years were included: 29 had a history of alcohol use (32 hips) and 24 of steroid use (26 hips). The mean follow-up was 4.2 years (minimum 3 years). RESULTS At last follow-up, significant improvements were noted in the Harris Hip Score (HHS) (mean 44.0 vs 55.9 points, p < 0.00002) and VAS scores (mean 7.0 vs 5.8 points, p < 0.0002) for the whole ONFH cohort, comparing to pre-operative status. The degree of improvement did not differ between Ficat and Arlet grade II and grade III (mean 14.9 vs 6.2 points, respectively, p = 0.1). No change was found between the final and initial results in this group in the steroid group (HHS mean 42.2 vs 45.5 points, p = 0.5 and VAS mean 6.8 vs 6.5 points, p = 0.5), but the improvement was noted in the alcohol group (HHS mean 45.5 vs 64.4 points, p < 0.0001; VAS mean 7.1 vs 5.2 points, p < 0.0001) comparing to pre-operative status. CONCLUSIONS Presented treatment of ONFH significantly improves hip function, offers pain reduction, and gives similar functional improvement for hips scoring grade II and III on the Ficat and Arlet scale. A good response to operative treatment is seen in patients with alcohol-induced ONFH, but not in those with steroid-induced ONFH.
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de Sautu de Borbón EC, Morales Conejo M, Guerra Vales JM. Prevalence of risk factors for the development of avascular hip necrosis in a third-level hospital. REUMATOLOGIA CLINICA 2018; 14:122-123. [PMID: 28551174 DOI: 10.1016/j.reuma.2017.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/07/2017] [Accepted: 04/20/2017] [Indexed: 06/07/2023]
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Huang D, Li Z, Chen B, Fang G, Sun X, Li F, Xu H, Chen Y, Ding W. Naringin protects against steroid‑induced avascular necrosis of the femoral head through upregulation of PPARγ and activation of the Notch signaling pathway. Mol Med Rep 2018; 17:3328-3335. [PMID: 29257271 DOI: 10.3892/mmr.2017.8247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 06/01/2017] [Indexed: 02/05/2023] Open
Abstract
Naringin, a flavonoid, is the effective pharmaceutical ingredient of drynaria, with the effects of healing fractures, strengthening bones and promoting kidney function. The aim of the present study was to investigate the potential effect of naringin on steroid‑induced avascular necrosis of the femoral head (SANFH). Treatment with naringin markedly protected against the steroid‑induced decrease in serum osteocalcin levels, and the rate of osteonecrosis in a model of SANFH. In addition, naringin decreased the total cholesterol and low density lipoprotein/high density lipoprotein ratio in the SANFH rabbit. It was observed that naringin markedly inhibited caspase‑3 activity, increased runt‑related transcription factor 2 and transcription factor sp7 mRNA expression, promoted alkaline phosphatase activity and upregulated collagen I, peroxisome proliferator‑activated receptor (PPAR) γ2, neurogenic locus notch homolog protein (Notch), β‑catenin and phosphorylated‑Rac‑α serine/threonine protein kinase protein expression in the SANFH rabbit. The results of the present study demonstrated that naringin protects against SANFH through upregulation of PPARγ2 and activation of the Notch signaling pathway, and may be a useful addition to the treatment options for diseases of the femoral head.
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Gangji V, Soyfoo MS, Heuschling A, Afzali V, Moreno-Reyes R, Rasschaert J, Gillet C, Fils JF, Hauzeur JP. Non traumatic osteonecrosis of the femoral head is associated with low bone mass. Bone 2018; 107:88-92. [PMID: 29154968 DOI: 10.1016/j.bone.2017.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/12/2017] [Accepted: 11/13/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Osteoporosis (OP) and osteonecrosis of the femoral head (ONFH) share common clinical and pathophysiological features we sought to determine whether ONFH was associated with an increased prevalence of OP and whether the increased prevalence of OP was related to the stage of ONFH at diagnosis. METHODS We included 243 patients with ONFH and 399 age and sex-matched healthy controls. Data was gathered including demography, risk factors, ARCO staging of ONFH and bone mineral density (BMD). RESULTS Overall, BMD (defined by the T-score) was significantly lower in the ONFH group at both the femoral head (-0.96±1.11) and the lumbar spine (-1.22±1.47) compared to the control group (-0.55±0.97 and -0.73±1.31) (p<0.01). The ONFH group depicted a significantly higher proportion of osteopenia (50.39% vs 40.87%, p=0.027) and of OP (18.78% vs 7.33%, p<0.001) relative to the control group. Stage 1 and 2 ONFH patients (53.86%, p=0.0203; OR=1.54 (95% CI: [1.04; 2.29])) were at a higher risk of osteopenia than the control group (40.88%), but not stages 3 or 4 (48.47%, p=0.2569; OR=1.27 (95% CI: [0.78; 2.06]). Patients with stage 3 or 4 ONFH (25.31%, p<0.001; OR=3.93 (95% CI: [1.63; 10.96])) were at a higher risk of osteoporosis than patients in the stage 1 and 2 ONFH (7.24%), and compared to the control group (7.33%, adj. p-value<0.001; OR=4.89 (95% CI: [2.77; 8.76]). CONCLUSIONS Non-traumatic osteonecrosis of the femoral heads is associated with low bone mineral density. This study showed that fractural stages ONFH were associated with a 5-fold risk of osteoporosis.
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Camporesi E, Vezzani G, Zanon V, Manelli D, Enten G, Quartesan S, Bosco G. Review on hyperbaric oxygen treatment in femoral head necrosis. Undersea Hyperb Med 2017; 44:497-508. [PMID: 29281187 DOI: 10.22462/11.12.2017.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Femoral head necrosis (FHN) is a common invalidating disease with an unclear etiology and pathophysiology that affects middle-aged people. FHN may lead to joint collapse and require invasive treatments. Because of its clinical and socioeconomic significance, an early diagnosis, staging and appropriate treatment are required. Unfortunately, to date a unique algorithm for the treatment of FHN has not been defined. OBJECTIVE In this report we summarize the Tenth European Consensus Conference on hyperbaric medicine (April 2016, France), during which experts from Europe revised the list of accepted indications for hyperbaric oxygen (HBO₂) treatment, including FHN. METHODS In this report all aspects of osteonecrosis discussed during the meeting have been considered: pathophysiology,clinical presentation, standard management, HBO₂ therapy and evidence-based review of its efficacy. All observations are based on a thorough review of the best available research and evidence-based medicine. CONCLUSIONS The Consensus Conference in Lille established FHN as an indication for HBO₂ therapy and suggested a protocols guideline to adopt for this pathology.
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Chinese Guideline for the Diagnosis and Treatment of Osteonecrosis of the Femoral Head in Adults. Orthop Surg 2017; 9:3-12. [PMID: 28371498 DOI: 10.1111/os.12302] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/04/2016] [Indexed: 01/15/2023] Open
Abstract
The treatment of adult osteonecrosis of the femoral head (ONFH), with 8.12 million patients in China, remains a challenge to surgeons. To standardize and improve the efficacy of the treatment of ONFH, Chinese specialists updated the experts' suggestions in March 2015, and an experts' consensus was given to provide a current basis for the diagnosis, treatment and evaluation of ONFH. The current guideline provides recommendations for ONFH with respect to epidemiology, etiology, diagnostic criteria, differential diagnosis, staging, treatment, as well as rehabilitation. Risk factors of non-traumatic ONFH include corticosteroid use, alcohol abuse, dysbarism, sickle cell disease and autoimmune disease and others, but the etiology remains unclear. The Association Research Circulation Osseous (ARCO) staging system, including plain radiograph, magnetic resonance imaging, radionuclide examination, and histological findings, is frequently used in staging ONFH. A staging and classification system was proposed by Chinese scholars in recent years. The major differential diagnoses include mid-late term osteoarthritis, transient osteoporosis, and subchondral insufficiency fracture. Management alternatives for ONFH consist of non-operative treatment and operative treatment. Core decompression is currently the most common procedure used in the early stages of ONFH. Vascularized bone grafting is the recommended treatment for ARCO early stage III ONFH. This guideline gives a brief account of principles for selection of treatment for ONFH, and stage, classification, volume of necrosis, joint function, age of the patient, patient occupation, and other factors should be taken into consideration.
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Chen C, Yu L, Tang X, Liu MZ, Sun LZ, Liu C, Zhang Z, Li CZ. Dynamic hip system blade versus cannulated compression screw for the treatment of femoral neck fractures: A retrospective study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:381-387. [PMID: 28844681 PMCID: PMC6197598 DOI: 10.1016/j.aott.2017.07.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/06/2017] [Accepted: 07/30/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to compare clinical outcomes of patients with femoral neck fractures treated with the dynamic hip system blade (DHS-BLADE) or cannulated compression screws. METHODS Eighty-six patients with femoral neck fractures were treated by closed reduction internal fixation with a DHS-BLADE (n = 42; 18 males and 24 females; mean age: 56.3 years (37-87)) or cannulated compression screws (n = 44; 20 males and 24 females; mean age: 53.8 years (26-83)) between March 2011 and August 2013. The groups were compared with Harris hip score, operation time, surgical blood loss, incision size, hospital stay, and related complications. RESULTS The average follow-up time was 27 months (range, 24-36 months). There was no significant difference for the operation time, incision size, hospital stay, and Harris hip score between the groups. Also, no statistically significant differences in the rates of nonunion (4.5% vs. 0) and avascular necrosis of the femoral head (9.1% vs. 7.1%) were observed. However, the screw group experienced significantly less surgical blood loss (32.4 ± 24.7 ml) than the blade group (87.2 ± 46.6 ml; P = 0.041). The incidence of femoral neck shortening above 10 mm in the screw group was significantly higher than that in the blade group (15.9% vs. 2.4%, P = 0.031). The blade group had a significantly lower incidence of screw migration than the screw group (4.8% vs. 22.7%, P = 0.016). CONCLUSION The DHS-BLADE and cannulated compression screws might be equally effective in terms of postoperative fracture union. However, the DHS-BLADE has advantages over cannulated compression screws for preventing femoral neck shortening, screw migration, and cut-out. LEVEL OF EVIDENCE Level III, Therapeutic study.
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