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D'Ambrosi R, Biancardi E, Massari G, Ragone V, Facchini RM. Survival Analysis after Core Decompression in Association with Platelet-Rich Plasma, Mesenchymal Stem Cells, and Synthetic Bone Graft in Patients with Osteonecrosis of the Femoral Head. JOINTS 2018; 6:16-22. [PMID: 29675502 PMCID: PMC5906108 DOI: 10.1055/s-0038-1626740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/02/2018] [Indexed: 01/14/2023]
Abstract
Purpose The aim of this study was to report the rate of survivorship in patients with osteonecrosis of the femoral head treated with core decompression in association with mesenchymal stem cells (MSCs) implantation, platelet-rich plasma (PRP) injection, and synthetic bone graft. Methods We evaluated 24 hips in 16 patients, according to Ficat classification, treated by core decompression, injection of PRP and MSCs, and backfilling of the core tract with synthetic bone graft. Survivorship was estimated using Kaplan-Meier curves. Results The survivorship of core decompression in association with the procedure is 50% at 75 months of follow-up. The survival rate was 80% for patients in early stage and 28.6% for patients in advanced stage at 75 months. When we compared Kaplan-Meier survival curves of patients in stage III + IV and patients in stage I + II, we noticed that the survival functions are statistically different ( p < 0.05, log-rank test), particularly in stage I + II where we had a greater surviving core decompression, in comparison to patients in stage III + IV. Conclusion This technique is safe and good preliminary results were obtained in patients with early stages of the disease with no reported complications. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Riccardo D'Ambrosi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.,Centro Traumatologico Ortopedico, U.O. Clinica Ortopedica e Traumatologica, Milan, Italy
| | - Elena Biancardi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.,Centro Traumatologico Ortopedico, U.O. Clinica Ortopedica e Traumatologica, Milan, Italy
| | | | | | - Renato Mario Facchini
- Centro Traumatologico Ortopedico, U.O. Clinica Ortopedica e Traumatologica, Milan, Italy
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252
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The biological basis for concentrated iliac crest aspirate to enhance core decompression in the treatment of osteonecrosis. INTERNATIONAL ORTHOPAEDICS 2018; 42:1705-1709. [PMID: 29435623 DOI: 10.1007/s00264-018-3830-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 02/01/2018] [Indexed: 12/20/2022]
Abstract
Core decompression is a surgical procedure that is capable of salvaging the patient's own natural joint, if the operation is performed in the early stages of osteonecrosis, in which the articular surface has not collapsed. The addition of concentrated cells, aspirated from the iliac crest, to the core tract has been shown to enhance the viability of the femoral head, although large, prospective, randomized, blinded multicentre studies are lacking. The rationale for adding these cells to the core decompression tract is to provide osteoprogenitor and vascular progenitor cells to the area of decompressed dead bone, in order to facilitate tissue regeneration and repair. It has become increasingly evident that vast discrepancies exist in different series in regard to the criteria for patient selection, the surgical technique of core decompression, the methods for harvesting, processing, and injecting the cells, and the methodology for determining success or failure in a specific patient cohort. This paper reviews the salient points relevant to the treatment of osteonecrosis by core decompression with addition of concentrated iliac crest aspirates and poses important questions regarding the future successful application of this technique.
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253
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Abstract
About 250000 patients are operated on annually for hip arthroplasty in the USA alone. Of this number, about 10% the cause of their osteoarthritis is the avascular necrosis of the femoral head. But the causes of necrosis are multiple and many of them are still unknown. That is why small advances in etiopathogenesis, diagnosis and treatment of different causes are very important in order to reduce the number of affected patients. It may seem that small changes, studies focused on the details of different diseases do not bring great changes to science, but it is these small changes that end up adding great evolutions in our knowledge. In addition, the changes of recent years, are not focused on our specialty in technical or anatomical evolutions exclusively, but are often based on biological bases, which is the branch that evolves more within trauma and orthopedics. That is why open and constant minds are what help us move forward.
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Affiliation(s)
- Roberto Seijas
- a Orthopaedic Surgery, Artroscopia G.C., Fundación García-Cugat , Hospital Quirón Barcelona , Spain.,b Universitat Internacional Catalunya , Barcelona , Spain
| | - Andrea Sallent
- c Orthopaedic Department , Hospital Vall d'Hebron , Barcelona , Spain
| | - Eila Rivera
- a Orthopaedic Surgery, Artroscopia G.C., Fundación García-Cugat , Hospital Quirón Barcelona , Spain
| | - Oscar Ares
- b Universitat Internacional Catalunya , Barcelona , Spain.,d Orthopaedic Department , Hospital Clínic Barcelona , Spain.,e Hospital Quirón-Teknon , Barcelona , Spain
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254
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Huang L, Wang Y, Jiang Y, Wu Y, Hu C, Ouyang H. High levels of GSK-3β signalling reduce osteogenic differentiation of stem cells in osteonecrosis of femoral head. J Biochem 2017; 163:243-251. [DOI: 10.1093/jb/mvx076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/18/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Lu Huang
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jie Fang Road, Hangzhou 310009, PR China
| | - Ying Wang
- Department of Radiation Oncology, Zhejiang Provincial People’s Hospital, #158 Shang Tang Road, Hangzhou 310014, PR China
| | - Yangzi Jiang
- Center for Stem Cell and Tissue Engineering, Department of Sports Medicine, School of Medicine, Zhejiang University, #866 Yu Hang Tang Road, Hangzhou 310058, PR China
| | - Yan Wu
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jie Fang Road, Hangzhou 310009, PR China
| | - Changchang Hu
- Center for Stem Cell and Tissue Engineering, Department of Sports Medicine, School of Medicine, Zhejiang University, #866 Yu Hang Tang Road, Hangzhou 310058, PR China
| | - Hongwei Ouyang
- Center for Stem Cell and Tissue Engineering, Department of Sports Medicine, School of Medicine, Zhejiang University, #866 Yu Hang Tang Road, Hangzhou 310058, PR China
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255
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Weinstein RS, Hogan EA, Borrelli MJ, Liachenko S, O’Brien CA, Manolagas SC. The Pathophysiological Sequence of Glucocorticoid-Induced Osteonecrosis of the Femoral Head in Male Mice. Endocrinology 2017; 158:3817-3831. [PMID: 28938402 PMCID: PMC5695837 DOI: 10.1210/en.2017-00662] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/11/2017] [Indexed: 11/19/2022]
Abstract
In search of the sequence of pathogenic events leading to glucocorticoid-induced osteonecrosis, we determined the molecular, biomechanical, cellular, and vascular changes in the femur of C57BL/6 mice receiving prednisolone for 14, 28, or 42 days. The femoral head, but not the distal femur, of mice treated for 14 days showed a decrease in the expression of the hypoxia-inducible factor (Hif)-1α and vascular endothelial growth factor (VEGF), the number of osteoblasts, and bone formation rate and strength and showed an increase in osteoclasts. These changes were accompanied by conversion of the normal dendritic vasculature to pools of edema as detected by magnetic resonance imaging, providing robust diagnostic evidence of early osteonecrosis. At that time point, there were no detectable changes in bone density, cortical or cancellous bone architecture, midshaft or distal cancellous bone, or osteocyte apoptosis. In mice treated for 28 days, femoral head cancellous density, cortical width, and trabecular thickness decreased, and by 42 days the femoral heads had full-depth cortical penetrations and cancellous tissue osteonecrosis. These results indicate that the femoral head is a particularly sensitive anatomical site to the adverse effects of glucocorticoid excess on bone and that decreases of Hif-1α and VEGF expression, bone vascularity, and strength precede the loss of bone mass and microarchitectural deterioration, thus rendering the femoral head vulnerable to collapse.
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Affiliation(s)
- Robert S. Weinstein
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Erin A. Hogan
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Michael J. Borrelli
- Department of Radiology, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Serguei Liachenko
- National Center for Toxicological Research/Food and Drug Administration, Jefferson, Arkansas 72079
| | - Charles A. O’Brien
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Stavros C. Manolagas
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
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256
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Basic-Kinda S, Karlak I, Durakovic N, Lubina ZI, Livaja Radman I, Dotlic S, Peric Z, Hude I, Aurer I. High incidence of aseptic hip necrosis in Hodgkin lymphoma patients treated with escalated BEACOPP receiving methylprednisolone. Intern Med J 2017; 48:523-529. [PMID: 29068514 DOI: 10.1111/imj.13653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/16/2017] [Accepted: 10/18/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Escalated BEACOPP (eBEACOPP) is an effective but fairly toxic regimen for the treatment of Hodgkin lymphoma (HL). Avascular necrosis (AVN) of femoral head was previously reported to increase in patients treated with eBEACOPP, but so far, no systematic analysis of its frequency has been published. AIMS To analyse the frequency and identify possible risk factors for AVN development in patients treated with eBEACOPP. METHODS We identified 26 patients treated with eBEACOPP for newly diagnosed high-risk advanced-stage HL, 25 of whom were alive at the time of study. All patients were invited to participate in a cross-sectional study; 17 patients responded and were evaluated by magnetic resonance imaging and orthopaedic examination. RESULTS Six patients (35.3%) were diagnosed with AVN after receiving eBEACOPP treatment. AVN was not correlated with age, gender, number of received eBEACOPP cycles, irradiation therapy or cumulative dose of steroids administered. There were significantly more cases of AVN in patients receiving methylprednisolone than prednisone (P = 0.01). CONCLUSION The use of methylprednisolone was shown to be a risk factor for the development of AVN in patients treated with eBEACOPP and should not be the corticosteroid of choice in the treatment of patients with HL.
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Affiliation(s)
- Sandra Basic-Kinda
- Department of Internal Medicine, Division of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivan Karlak
- Department of Traumatology, University Hospital Centre Sisters of Mercy, Zagreb, Croatia
| | - Nadira Durakovic
- Department of Internal Medicine, Division of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zvonimir I Lubina
- Department of Radiology, Northampton General Hospital, Northampton, UK
| | - Ivo Livaja Radman
- Department of Internal Medicine, Division of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Snježana Dotlic
- Department of Pathology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zinaida Peric
- Department of Internal Medicine, Division of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ida Hude
- Department of Internal Medicine, Division of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Igor Aurer
- Department of Internal Medicine, Division of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Phillips L, Hesketh K, Schaeffer EK, Andrade J, Farr J, Mulpuri K. Avascular necrosis in children with cerebral palsy after reconstructive hip surgery. J Child Orthop 2017; 11:326-333. [PMID: 29081846 PMCID: PMC5643925 DOI: 10.1302/1863-2548.11.170078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Progressive hip displacement is one of the most common orthopaedic pathologies in children with cerebral palsy (CP). Reconstructive hip surgery has become the standard treatment of care. Reported avascular necrosis (AVN) rates for hip reconstructive surgery in these patients vary widely in the literature. The purpose of this study is to identify the frequency and associated risk factors of AVN for reconstructive hip procedures. METHODS A retrospective analysis was performed of 70 cases of reconstructive hip surgery in 47 children with CP, between 2009 and 2013. All 70 cases involved varus derotation osteotomy (VDRO), with 60% having combined VDRO and pelvic osteotomies (PO), and 21% requiring open reductions. Mean age at time of surgery was 8.82 years and 90% of patients were Gross Motor Function Classification System (GMFCS) 4 and 5. Radiographic dysplasia parameters were analysed at selected intervals, to a minimum of one year post-operatively. Severity of AVN was classified by Kruczynski's method. Bivar- iate statistical analysis was conducted using Chi-square test and Student's t-test. RESULTS There were 19 (27%) noted cases of AVN, all radio- graphically identifiable within the first post-operative year. The majority of AVN cases (63%) were mild to moderate in severity. Pre-operative migration percentage (MP) (p = 0.0009) and post-operative change in MP (p = 0.002) were the most significant predictors of AVN. Other risk factors were: GMFCS level (p = 0.031), post-operative change in NSA (p = 0.02) and concomitant adductor tenotomy (0.028). CONCLUSION AVN was observed in 27% of patients. Severity of displacement correlates directly with AVN risk and we suggest that hip reconstruction, specifically VDRO, be performed early in the 'hip at risk' group to avoid this complication.
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Affiliation(s)
- L. Phillips
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - K. Hesketh
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - E. K. Schaeffer
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada,Department of Orthopaedics, University of British Columbia and Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - J. Andrade
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - J. Farr
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - K. Mulpuri
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada,Department of Orthopaedics, University of British Columbia and Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, BC, Canada,Correspondence should be sent to: Dr K. Mulpuri, Department of Orthopaedic Surgery, BC Children’s Hospital, 1D66-4480 Oak Street, Vancouver, BC, Canada.
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258
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Song Y, Du Z, Chen B, Ren M, Yang Q, Sui Y, Wang Q, Wang A, Zhao H, Qin Y, Zhang G. Association of SREBP2 gene polymorphisms with the risk of osteonecrosis of the femoral head relates to gene expression and lipid metabolism disorders. Mol Med Rep 2017; 16:7145-7153. [PMID: 28901487 DOI: 10.3892/mmr.2017.7473] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 07/12/2017] [Indexed: 11/06/2022] Open
Abstract
Although lipid metabolism disorders have been recognized as a primary factor of osteonecrosis of the femoral head (ONFH), the molecular pathogenesis remains unclear. Sterol regulatory element‑binding protein 2 (SREBP2) specifically regulates cholesterol and fatty acid metabolism to maintain lipid homeostasis. To explore the roles of the SREBP2 gene in the development of ONFH, the authors analyzed the gene polymorphism and gene expression of three tag single nucleotide polymorphisms of the SREBP2 gene, the serum lipids levels, and their associations with ONFH development in 182 ONFH patients and 179 healthy controls. The results demonstrated that the stage IV proportions of ONFH patients carrying the rs2267439CT or CC genotype were significantly higher and lower than the stage III proportions of ONFH patients (P=0.039), respectively. The serum triglyceride, low‑density lipoprotein (LDL)‑c levels, and LDL‑C/high‑density lipoprotein (HDL)‑C ratio in the ONFH group were significantly increased compared to those in the control group (P=0.01, P=0.005, P=0.0001) while the HDL‑C level of ONFH group was remarkably lower than that of the control group (P=0.0001). Association analysis further revealed that the LDL‑c levels of the rs226744 GG and AG genotype carriers were statistically higher than that of the AA genotype carriers (P=0.039, P=0.05). These results demonstrated that the gene polymorphism of SREBP2 not only significantly associated with the clinical phenotypes of ONFH but also closely related to lipid metabolism disorder. The results indicated that SREBP2 gene polymorphism and function may play key roles in the development of ONFH.
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Affiliation(s)
- Yang Song
- Department of Orthopedics of the Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Zhenwu Du
- Department of Orthopedics of the Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Bingpeng Chen
- Department of Orthopedics of the Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Ming Ren
- Department of Orthopedics of the Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Qiwei Yang
- Department of Orthopedics of the Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Yujie Sui
- The Engineering Research Center of Molecular Diagnosis and Cellular Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, Jilin 130041, P.R. China
| | - Qingyu Wang
- Department of Orthopedics of the Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Ao Wang
- Department of Orthopedics of the Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Haiyue Zhao
- The Engineering Research Center of Molecular Diagnosis and Cellular Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, Jilin 130041, P.R. China
| | - Yanguo Qin
- Department of Orthopedics of the Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Guizhen Zhang
- Department of Orthopedics of the Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
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Theruvath AJ, Ilivitzki A, Muehe A, Theruvath J, Gulaka P, Kim C, Luna-Fineman S, Sakamoto KM, Yeom KW, Yang P, Moseley M, Chan F, Daldrup-Link HE. A PET/MR Imaging Approach for the Integrated Assessment of Chemotherapy-induced Brain, Heart, and Bone Injuries in Pediatric Cancer Survivors: A Pilot Study. Radiology 2017; 285:971-979. [PMID: 28777701 DOI: 10.1148/radiol.2017170073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose To develop a positron emission tomography (PET)/magnetic resonance (MR) imaging protocol for evaluation of the brain, heart, and joints of pediatric cancer survivors for chemotherapy-induced injuries in one session. Materials and Methods Three teams of experts in neuroimaging, cardiac imaging, and bone imaging were tasked to develop a 20-30-minute PET/MR imaging protocol for detection of chemotherapy-induced tissue injuries of the brain, heart, and bone. In an institutional review board-approved, HIPAA-compliant, prospective study from April to July 2016, 10 pediatric cancer survivors who completed chemotherapy underwent imaging of the brain, heart, and bone with a 3-T PET/MR imager. Cumulative chemotherapy doses and clinical symptoms were correlated with the severity of MR imaging abnormalities by using linear regression analyses. MR imaging measures of brain perfusion and metabolism were compared among eight patients who were treated with methotrexate and eight untreated age-matched control subjects by using Wilcoxon rank-sum tests. Results Combined brain, heart, and bone examinations were completed within 90 minutes. Eight of 10 cancer survivors had abnormal findings on brain, heart, and bone images, including six patients with and two patients without clinical symptoms. Cumulative chemotherapy doses correlated significantly with MR imaging measures of left ventricular ejection fraction and end-systolic volume, but not with the severity of brain or bone abnormalities. Methotrexate-treated cancer survivors had significantly lower cerebral blood flow and metabolic activity in key brain areas compared with control subjects. Conclusion The feasibility of a single examination for assessment of chemotherapy-induced injuries of the brain, heart, and joints was shown. Earlier detection of tissue injuries may enable initiation of timely interventions and help to preserve long-term health of pediatric cancer survivors. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Ashok J Theruvath
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Anat Ilivitzki
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Anne Muehe
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Johanna Theruvath
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Praveen Gulaka
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Christine Kim
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Sandra Luna-Fineman
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Kathleen M Sakamoto
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Kristen W Yeom
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Phillip Yang
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Michael Moseley
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Frandics Chan
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Heike E Daldrup-Link
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
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Piuzzi NS, Chahla J, Jiandong H, Chughtai M, LaPrade RF, Mont MA, Muschler GF, Pascual-Garrido C. Analysis of Cell Therapies Used in Clinical Trials for the Treatment of Osteonecrosis of the Femoral Head: A Systematic Review of the Literature. J Arthroplasty 2017; 32:2612-2618. [PMID: 28392136 DOI: 10.1016/j.arth.2017.02.075] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is associated with regional loss of cells within bone, often resulting in pain and mechanical collapse. Our purpose was to analyze the cell-therapies used in clinical trials for the treatment of ONFH with regard to (1) cell-sources, (2) collection techniques, (3) cell-processing, (4) qualitative and quantitative characterizations, and (5) delivery methods. METHODS A systematic review of the current literature on the use of cell therapies for the treatment of ONFH was performed. Studies with a level-of-evidence III or higher were evaluated. A total of 1483 articles were screened. Eleven studies met the criteria to be included in this review. RESULTS Ten studies used bone-marrow, and 1 study used blood as the cell-source. Nine studies used freshly isolated tissue-derived nucleated cells from bone-marrow, mixed bone marrow-derived nucleated cells, 1 study used mixed blood-derived nucleated cells, and 1 study used culture-expanded cells derived from bone marrow aspirate. Cell dose varied from 2-million to 3-billion cells. Qualitative cell characterization of injected cells using surface markers was done by 5 studies using CD34. Two studies assayed the cell-population using a colony-forming-unit assay. CONCLUSION There is a lack of standardization with respect to the quantitative and qualitative characterization of methods for cell-harvest, cell-processing, and cell-transplantation/delivery. Cell-therapy holds promise as a means of restoring local cell populations that are made deficient because of injury or disease. However, the orthopedic community and patients will benefit greatly by a greater investment in blinded, randomized, controlled trials and clinical effectiveness trials that embrace rigorous standards.
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Affiliation(s)
- Nicolas S Piuzzi
- Department of Orthopaedic Surgery and Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio; Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado
| | - Hao Jiandong
- Department of Orthopaedic Surgery, University of Colorado Denver, Denver, Colorado
| | - Morad Chughtai
- Department of Orthopaedic Surgery and Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado; Department of Orthopaedic Surgery, The Steadman Clinic, Vail, Colorado
| | - Michael A Mont
- Department of Orthopaedic Surgery and Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - George F Muschler
- Department of Orthopaedic Surgery and Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
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Song Y, Du Z, Ren M, Yang Q, Wang Q, Chen G, Zhao H, Li Z, Wang J, Zhang G. Association of gene variants of transcription factors PPARγ, RUNX2, Osterix genes and COL2A1, IGFBP3 genes with the development of osteonecrosis of the femoral head in Chinese population. Bone 2017; 101:104-112. [PMID: 28476574 DOI: 10.1016/j.bone.2017.05.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/28/2017] [Accepted: 05/01/2017] [Indexed: 02/06/2023]
Abstract
The molecular pathogenesis of osteonecrosis of the femoral head (ONFH) has been remained obscure so that its prevalence has been increasing in recent decades. Different transcription factors play critical roles in maintaining the balance between osteogenesis and adipogenesis. However, it has been unclear that the genes variants of the transcription factors exert the effects on the imbalance between steogenesis and adipogenesis during the development of ONFH. Here, we selected the 11SNPs from steogenesis, adipogenesis-specific transcription factors RUNX2, Osterix, and PPARγ genes, chondrogenesis or adipogenesis key factors COL2A1, IGFBP3 genes and analysed the genotypes, alleles, haplotypes and their association with the risk and clinical phenotypes of ONFH through Mass ARRAY® platformin in 200 ONFH patients and 177controls. The patients with ONFH (132 males, 68 females; age: 53.46±11.48yr) were consecutively enrolled at the Department of Orthopedics, the Second Clinical College of Jilin University, from March 2014 to June 2015 and were diagnosed and classified into 10 cases of stage II (5.6%), 54 cases of stage III (30.2%) and 115 cases (64.2%) of stage IV and alcohol-induced (71 cases (39.7%)), idiopathic (64 cases (34.0%)), and steroid-induced osteonecrosis (47 cases (26.3%)) subgroup, respectively. Our results showed that all models of logistical regression analysis, the co-dominants, dominants, and recessives of PPARγrs2920502, significantly associated with the increased risk of ONFH (p=0.004, p=0.013, p=0.016), respectively. Both the minor homozygous CC genotype and the allele C of rs2920502 were evidently correlated with the enhanced risk of ONFH (p=0.005, p=0.0005),respectively. The recessives models of IGFBP3rs2132572 (G/A) as well as RUNX2 rs3763190(G/A) were statistically associated with the higher ONFH risk, p=0.030, p=0.029, respectively; the minor homozygous(AA) of IGFBP3rs2132572 (G/A) was also related to the increased risk of bilateral hips lesions, p=0.039. Moreover, the ages on set of major homozygous(GG) and heterozygous(GT) of COL2A1rs2070739(G/A) were significantly younger than that of the minor homozygous(AA) of the SNP(p=0.008) while the A-T-G-A haplotype of COL2A1 gene revealed significant association with the decreased the risk of bilateral hip lesions, p=0.01, OR:0.258. More important, the serum HDL-c level and the ratio of LDL-c/HDL-c in the ONFH group were significantly decreased and increased compared with those of the control group (p=0.02, p=0.0001), respectively. Particularly, the CC genotype of PPARγ rs2920502 was statistically correlated with the enhanced serum TG level, p=0.011.These results suggest that the variants of PPARγ, RUNX2, COL2A1, and IGFBP3 genes closely associated with the development of ONFH.
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Affiliation(s)
- Yang Song
- Department of Orthopedics of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; The Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Ziqiang Street 218, Changchun 130041,PR China
| | - Zhenwu Du
- Department of Orthopedics of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; Research Centre of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; The Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Ziqiang Street 218, Changchun 130041,PR China
| | - Ming Ren
- Department of Orthopedics of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; The Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Ziqiang Street 218, Changchun 130041,PR China
| | - Qiwei Yang
- Research Centre of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; The Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Ziqiang Street 218, Changchun 130041,PR China
| | - Qingyu Wang
- Research Centre of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; The Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Ziqiang Street 218, Changchun 130041,PR China
| | - Gaoyang Chen
- Research Centre of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; The Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Ziqiang Street 218, Changchun 130041,PR China
| | - Haiyue Zhao
- Research Centre of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; The Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Ziqiang Street 218, Changchun 130041,PR China
| | - Zhaoyan Li
- Department of Orthopedics of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; The Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Ziqiang Street 218, Changchun 130041,PR China
| | - Jincheng Wang
- Department of Orthopedics of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; The Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Ziqiang Street 218, Changchun 130041,PR China.
| | - Guizhen Zhang
- Department of Orthopedics of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; Research Centre of Second Clinical College of Jilin University, Ziqiang Street 218, Changchun 130041,PR China; The Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Ziqiang Street 218, Changchun 130041,PR China.
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Theruvath AJ, Sukerkar PA, Bao S, Rosenberg J, Luna-Fineman S, Kharbanda S, Daldrup-Link HE. Bone marrow oedema predicts bone collapse in paediatric and adolescent leukaemia patients with corticosteroid-induced osteonecrosis. Eur Radiol 2017; 28:410-417. [PMID: 28726121 DOI: 10.1007/s00330-017-4961-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Corticosteroid treatment of paediatric leukaemia patients can lead to osteonecrosis (ON). We determined whether bone marrow oedema (BME) is an early sign of progressive ON and eventual bone collapse. METHODS In a retrospective study, two radiologists reviewed MR imaging characteristics of 47 early stage epiphyseal ON in 15 paediatric and adolescent leukaemia patients. Associations between BME on initial imaging studies and subchondral fracture, disease progression and bone collapse were assessed by Cochran-Mantel-Haenszel tests. Differences in time to progression and bone collapse between lesions with and without oedema were assessed by log rank tests. RESULTS Forty-seven occurrences of ON were located in weight bearing joints, with 77% occurring in the femur. Seventeen lesions progressed to collapse, two lesions worsened without collapse, and 28 remained stable or improved. BME was significantly associated with subchondral fracture (p = 0.0014), disease progression (p = 0.0015), and bone collapse (p < 0.001), with a sensitivity and specificity of 94% and 77%, respectively, for bone collapse. Time to progression for ON with oedema was 2.7 years (95% CI: 1.7-3.4); while the majority of no-oedema ON were stable (p = 0.0011). CONCLUSIONS BME is an early sign of progressive ON and eventual bone collapse in paediatric and adolescent leukaemia patients. KEY POINTS • Bone marrow oedema in corticosteroid-induced osteonecrosis predicts progression to bone collapse. • Bone marrow oedema is associated with subchondral fractures in corticosteroid-induced osteonecrosis. • Bone marrow oedema can be used to stratify patients to joint-preserving interventions. • Absence of bone marrow oedema can justify a "wait and watch" approach.
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Affiliation(s)
- Ashok Joseph Theruvath
- Department of Radiology, Paediatric Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University, Langenbeckst. 1, Mainz, 55131, Germany
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Preeti Arun Sukerkar
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Shanshan Bao
- Department of Radiology, Paediatric Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Jarrett Rosenberg
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Sandra Luna-Fineman
- Department of Paediatrics, Paediatric Haematology/Oncology, Lucile Packard Children's Hospital, Stanford University School of Medicine , 1201 Welch Rd, Stanford, CA, 94305, USA
| | - Sandhya Kharbanda
- Department of Paediatrics, Paediatric Haematology/Oncology, Lucile Packard Children's Hospital, Stanford University School of Medicine , 1201 Welch Rd, Stanford, CA, 94305, USA
| | - Heike Elisabeth Daldrup-Link
- Department of Radiology, Paediatric Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
- Department of Paediatrics, Paediatric Haematology/Oncology, Lucile Packard Children's Hospital, Stanford University School of Medicine , 1201 Welch Rd, Stanford, CA, 94305, USA.
- Stanford Cancer Institute, Stanford University School of Medicine, 265 Campus Drive, Stanford, CA, 94305, USA.
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263
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Wei BF, Feng Z, Wei W, Chen X. Associations of TNF-α -238 A/G and IL-10 -1082 G/A Genetic Polymorphisms With the Risk of NONFH in the Chinese Population. J Cell Biochem 2017; 118:4872-4880. [PMID: 28543357 DOI: 10.1002/jcb.26167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/23/2017] [Indexed: 02/06/2023]
Abstract
The study aims to explore the roles of common polymorphisms of Tumor Necrosis Factor-α (TNF-α) (-238 A/G and -308 A/G) and IL-10 (-819 T/C and -1082 G/A) genes in the risk of non-traumatic osteonecrosis of the femoral head (NONFH). One hundred and forty-seven NONFH patients and 135 healthy individuals were selected as the case and control groups. qRT-PCR and Western blotting techniques detected mRNA as well as protein expressions of TNF-α and IL-10 of each genotype in both the case and control groups. The GA genotype and the A allele of TNF-α -238 A/G were higher in the case group than in the control group. Compared with the control group, AA, GA, and AG + AA genotypes as well as the A allele of IL-10-1082 G/A were all lower in the case group. In the case groups increased levels of TNF-α as well as decreased levels of IL-10 expression when compared with the control group. TNF-α expression of TNF-α-238 GA genotype was significantly higher than that in patients with GG genotype, while the IL-10 expression of GA and AA genotypes of IL-10-1082 was significantly lower than in that of patients with the GG genotype. TNF-α protein expression in the GA genotype was significantly higher than in the GG genotype. In relation to TNF-α -238, TNF-α protein expression of GA and AA genotypes had significantly reduced more so than the GG genotype in IL-10-1082. TNF-α-238 A/G and IL-10-1082 G/A may be involved as risk factors of NONFH. J. Cell. Biochem. 118: 4872-4880, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Biao-Fang Wei
- Department of Femoral Head, Linyi People's Hospital, Linyi, 276000, China
| | - Zhi Feng
- Department of Femoral Head, Linyi People's Hospital, Linyi, 276000, China
| | - Wei Wei
- Department of Orthopaedic, First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Xiao Chen
- Department of Emergency, Women and Children's Health Care Hospital of Linyi, Linyi, 276016, China
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264
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Liu Y, Zhao D, Wang WM, Wang BJ, Zhang Y, Li ZG. Hemodynamic changes in osteonecrosis treatment of the femoral head with iliac bone flaps pedicled with the lateral femoral circumflex artery ascending branch: A 10-year report. Technol Health Care 2017; 24 Suppl 2:S493-8. [PMID: 27163309 DOI: 10.3233/thc-161173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascularized bone grafting was used in the treatment of osteonecrosis femoral head, which may directly influence the pathologic event of femoral head. OBJECTIVE This paper evaluates hemodynamic changes in osteonecrosis treatment of the femoral head (ONFH) with iliac bone flaps from the lateral femoral circumflex artery ascending branches via digital subtraction angiography. METHODS A total of 48 patients, (31 males and 17 females; 38 at stage II and 10 at stage III), were treated with iliac bone flaps pedicled with the ascending branch of the lateral femoral circumflex artery. DSA was performed on all 48 patients preoperatively and 6 months postoperatively, and 10 years postoperatively on 1 patient. RESULTS Six months after surgery, femoral head blood supplies were distinctly visualized in the selective DSA in 44 cases. 4 patients showed poor or failed vessel pedicle filling in the transplanted bone flaps. Total hip arthroplasty was performed on these 4 patients. DSA was conducted 10 years post-operation in 1 case; the subject showed normal blood supply of the femoral head. CONCLUSIONS The anatomical position of the ascending branch of the lateral femoral circumflex artery was constant. Digital subtraction angiography successfully examined hemodynamic changes in osteonecrosis treatment of the femoral head with vascularized bone flaps.
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Affiliation(s)
- YuPeng Liu
- Department of Biomedical Engineering, Dalian University of Technology, Dalian, Liaoning, China.,Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - DeWei Zhao
- Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - W M Wang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - B J Wang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Y Zhang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Z G Li
- Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
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265
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Piuzzi NS, Chahla J, Schrock JB, LaPrade RF, Pascual-Garrido C, Mont MA, Muschler GF. Evidence for the Use of Cell-Based Therapy for the Treatment of Osteonecrosis of the Femoral Head: A Systematic Review of the Literature. J Arthroplasty 2017; 32:1698-1708. [PMID: 28162838 DOI: 10.1016/j.arth.2016.12.049] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/23/2016] [Accepted: 12/28/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cell-therapy has been promoted among the therapeutic arsenal that can aid in bone formation and remodeling, in early stages of osteonecrosis of the femoral head (ONFH). The purpose of this systematic review was to assess the evidence supporting the (1) clinical efficacy; (2) structural modifying effect, as evaluated radiographically; (3) revision rates; and (4) safety of cell-therapy for the treatment of ONFH. METHODS A systematic review was performed including studies with a level-of-evidence of III or higher. A total of 1483 articles were screened. Eleven studies met the criteria for inclusion in this review (level-of-evidence: 6 level-I, 1 level-II, and 4 level-III), including 683 cases of ONFH. RESULTS All 10 studies that reported patient-reported outcomes showed improved outcomes in the cell-therapy groups compared with the control group. Overall, 24.5% (93/380 hips) that received cell-therapy showed radiographic progression compared with 40% (98/245 hips) in the control group. Nine of 10 studies that reported failure rates showed a lower total hip arthroplasty conversion rate in the cell-therapy group 16% (62/380 hips) compared with the control group 21% (52/252 hips). There was a low complication rate (<3%) with no major adverse effects. CONCLUSION Cell-therapies for the treatment of ONFH have been reported to be safe and suggest improved clinical outcomes with lower disease progression rate. However, there was substantial heterogeneity in the included studies, and in the cell-based therapies used. Specific clinical indications and cell-therapy standardization are required because studies varied widely with respect to cell sourcing, cell characterization, adjuvant therapies, and assessment of outcomes.
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Affiliation(s)
- Nicolas S Piuzzi
- Department of Orthopaedics, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio; Instituto Universitario del Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Jorge Chahla
- Department of Biomedical Engineering, Steadman Philippon Research Institute, Vail, Colorado
| | - John B Schrock
- Department of Orthopaedics, University of Colorado, Aurora, Colorado
| | - Robert F LaPrade
- Instituto Universitario del Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; The Steadman Clinic, Vail, Colorado
| | | | - Michael A Mont
- Department of Orthopaedics, Cleveland Clinic, Cleveland, Ohio
| | - George F Muschler
- Department of Orthopaedics, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
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266
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Guo P, Gao F, Wang Y, Zhang Z, Sun W, Jiang B, Wang B, Li Z. The use of anticoagulants for prevention and treatment of osteonecrosis of the femoral head: A systematic review. Medicine (Baltimore) 2017; 96:e6646. [PMID: 28422866 PMCID: PMC5406082 DOI: 10.1097/md.0000000000006646] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a progressive disease, which mainly affects young adults and often necessitates total hip arthroplasty (THA), so early interventions are critical to successfully protect hip joint from THA. In this review, our purpose was to determine the effects of anticoagulants for preventing and treating the primary and secondary ONFH, respectively, before the collapse stage or before the pathology of necrosis. METHODS We searched PubMed, Embase, Web of Science databases for relevant studies. Any observational or experimental studies that evaluated anticoagulants and ONFH were our goal of searching the electric databases. RESULTS Four studies including a total of 218 hips were identified in this review, 2 of them were prospective studies which performed by 1 group, 1 was a retrospective study, and the last was a prospective comparative study. CONCLUSIONS Our findings supported that the anticoagulants could be used for primary ONFH. However, anticoagulants cannot play a protective role on secondary ONFH. Moreover, there were no serious adverse effects reported in the studies after anticoagulants treatment. Nevertheless, our present study with some limitations such as the limited sample size only provided limited quality of evidence; confirmation from further systematic review or meta-analysis with large-scale, well-designed randomized control trials is required.
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Affiliation(s)
- Peipei Guo
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, The graduate school of Peking Union Medical College
| | - Fuqiang Gao
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China
| | - Yanhua Wang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Zhenkun Zhang
- Department of Internal Medicine, Shandong Shouguang People's Hospital, Shandong Province, China
| | - Wei Sun
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China
| | - Baoguo Jiang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Bailiang Wang
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China
| | - Zirong Li
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China
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267
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Pascart T, Falgayrac G, Migaud H, Quinchon JF, Norberciak L, Budzik JF, Paccou J, Cotten A, Penel G, Cortet B. Region specific Raman spectroscopy analysis of the femoral head reveals that trabecular bone is unlikely to contribute to non-traumatic osteonecrosis. Sci Rep 2017; 7:97. [PMID: 28273910 PMCID: PMC5427816 DOI: 10.1038/s41598-017-00162-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 02/13/2017] [Indexed: 01/26/2023] Open
Abstract
Non-traumatic osteonecrosis (ON) of the femoral head is a common disease affecting a young population as the peak age of diagnosis is in the 40 s. The natural history of non-traumatic ON leads to a collapse of the femoral head requiring prosthetic replacement in a 60% of cases. Although trabecular bone involvement in the collapse is suspected, the underlying modifications induced at a molecular level have not been explored in humans. Here, we examine changes in the molecular composition and structure of bone as evaluated by Raman spectroscopy in human end-stage ON. Comparing samples from femoral heads harvested from 11 patients and 11 cadaveric controls, we show that the mineral and organic chemical composition of trabecular bone in ON is not modified apart from age-related differences. We also show that the molecular composition in the necrotic part of the femoral head is not different from the composition of the remaining ‘healthy’ trabecular bone of the femoral head. These findings support that quality of trabecular bone is not modified during ON despite extensive bone marrow necrosis and osteocyte death observed even in the ‘healthy’ zones on histological examination.
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Affiliation(s)
- Tristan Pascart
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France. .,Department of Rheumatology, Saint-Philibert Hospital, Lille University, F-59160, Lomme, France.
| | - Guillaume Falgayrac
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France
| | - Henri Migaud
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital, Lille University, F-59000, Lille, France
| | - Jean-François Quinchon
- Department of Anatomopathology, Saint-Philibert Hospital, Lille University, F-59160, Lomme, France
| | - Laurène Norberciak
- Department of biostatistics, Saint-Philibert Hospital, Lille University, F-59160, Lomme, France
| | - Jean-François Budzik
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France.,Department of Radiology,Saint-Philibert Hospital, Lille University, F-59160, Lomme, France
| | - Julien Paccou
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France.,Department of Rheumatology, Lille University Hospital, Lille University, F-59000, Lille, France
| | - Anne Cotten
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France.,Department of Radiology, Lille University Hospital, Lille University, F-59000, Lille, France
| | - Guillaume Penel
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France
| | - Bernard Cortet
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France.,Department of Rheumatology, Lille University Hospital, Lille University, F-59000, Lille, France
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268
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Significant Associations of SOX9 Gene Polymorphism and Gene Expression with the Risk of Osteonecrosis of the Femoral Head in a Han Population in Northern China. BIOMED RESEARCH INTERNATIONAL 2017; 2016:5695317. [PMID: 28090537 PMCID: PMC5174161 DOI: 10.1155/2016/5695317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/08/2016] [Indexed: 01/15/2023]
Abstract
Sex determining region Y-box 9 (SOX9) is a key transcription factor involved in cartilage formation during the embryonic development stage and cartilage growth and repair after birth. To explore the roles of polymorphism and expression of the SOX9 gene in the development of osteonecrosis of the femoral head (ONFH), we analyzed the polymorphism of rs12601701 [A/G] and rs1042667 [A/C] and the serum protein expression of the SOX9 gene in 182 patients with ONFH and 179 healthy control subjects. Results revealed that the A-A haplotype of SOX9 gene as well as the GG and AA genotypes of rs12601701 was significantly associated with increased ONFH risk (P = 0.038) and the risk of bilateral hip lesions of ONFH (P = 0.009), respectively. The C-A, A-A, and A-G haplotypes were also statistically associated with the decreased and increased risk of bilateral hip lesions of ONFH (P = 0.03, P = 0.048, and P = 0.013), respectively, while the A-A haplotype closely related to the clinical stages of ONFH (P = 0.041). More importantly, the serum SOX9 protein expression of the ONFH group was greatly decreased compared to control group (P = 0.0001). Our results first showed that the gene polymorphism and gene expression of SOX9 were significantly associated with the risk and clinical phenotypes of ONFH and also indicate that the SOX9 gene may play a key role in the development of ONFH.
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269
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Chen L, Hong G, Fang B, Zhou G, Han X, Guan T, He W. Predicting the collapse of the femoral head due to osteonecrosis: From basic methods to application prospects. J Orthop Translat 2017; 11:62-72. [PMID: 29662770 PMCID: PMC5866406 DOI: 10.1016/j.jot.2016.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/28/2016] [Accepted: 11/10/2016] [Indexed: 12/25/2022] Open
Abstract
Collapse of the femoral head is the most significant pathogenic complication arising from osteonecrosis of the femoral head. It is related to the disruption of the maintenance of cartilage and bone, and results in an impaired function of the vascular component. A method for predicting the collapse of the femoral head can be treated as a type of clinical index. Efforts in recent years to predict the collapse of the femoral head due to osteonecrosis include multiple methods of radiographic analysis, stress distribution analysis, finite element analysis, and other innovative methods. Prediction methods for osteonecrosis of the femoral head complications originated in Western countries and have been further developed in Asia. Presently, an increasing number of surgeons have chosen to focus on surgical treatments instead of prediction methods to guide more conservative interventions, resulting in a growing reliance on the more prevalent and highly effective total hip arthroplasty, rather than on more conservative treatments. In this review, we performed a literature search of PubMed and Embase using search terms including "osteonecrosis of femoral head," "prediction," "collapse," "finite element," "radiographic images," and "stress analysis," exploring the basic prediction method and prospects for new applications.
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Affiliation(s)
- Leilei Chen
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - GuoJu Hong
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China.,School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, WA, Australia
| | - Bin Fang
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Guangquan Zhou
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Xiaorui Han
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Tianan Guan
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Wei He
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
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270
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Song Y, Du ZW, Yang QW, Ren M, Wang QY, Wang A, Chen GY, Zhao HY, Yu T, Zhang GZ. Association of Genes Variants in RANKL/RANK/OPG Signaling Pathway with the Development of Osteonecrosis of the Femoral Head in Chinese Population. Int J Med Sci 2017; 14:690-697. [PMID: 28824302 PMCID: PMC5562121 DOI: 10.7150/ijms.19124] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/21/2017] [Indexed: 12/22/2022] Open
Abstract
The RANKL/RANK/OPG pathway plays an important role in regulating bone remodeling and bone turnover. However, the association of the genes variants with the risk of ONFH has rarely been reported. Here, we analyzed the correlation of the 10 SNPs polymorphisms of RANKL, RANK, OPG, TRAF6, and NFATC1 genes with the risk and development of ONFH in 200 ONFH patients and 177 health controls of Chinese population with using Mass ARRAY® platform. The results showed that the recessive model of NFATC1rs9518 was significantly associated with increased ONFH risk (OR:8.223, P=0.048); the proportion of stage Ⅳ patients in the rs9518TC genotype carriers was statistically higher than that of stage Ⅲ patients (P=0.03); in the T-C haplotype carriers of Naftac1, the proportion of bilateral hips lesions was also significantly enhanced than that of unilateral hip lesions(P=0.05). In addition, the proportion of idiopathic ONFH in the TT genotype carriers of OPGrs2073617 was significantly higher than that of steroid or alcohol-induced ONFH, respectively, while in the TC genotype carriers of the SNP, the proportion of idiopathic ONFH remarkably decreased compared with that of Alcohol-induced ONFH, P=0.021. Our results were first found that NFATC1rs9518 closely associated with the risk and the development of ONFH, while OPGrs2073617 statistically correlated with the etiological classification of ONFH.
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Affiliation(s)
- Yang Song
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Zhen-Wu Du
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Qi-Wei Yang
- Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Ming Ren
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,Research Center of Second Clinical College, Jilin University, Changchun, 130041, China
| | - Qing-Yu Wang
- Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Ao Wang
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Gao-Yang Chen
- Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Hai-Yue Zhao
- Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Tao Yu
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,Research Center of Second Clinical College, Jilin University, Changchun, 130041, China
| | - Gui-Zhen Zhang
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
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271
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Song Y, Du Z, Yang Q, Ren M, Sui Y, Wang Q, Wang A, Zhao H, Wang J, Zhang G. Associations of IGFBP3 Gene Polymorphism and Gene Expression with the Risk of Osteonecrosis of the Femoral Head in a Han Population in Northern China. DNA Cell Biol 2016; 35:836-844. [DOI: 10.1089/dna.2016.3441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Yang Song
- Department of Orthopedics, Second Clinical College of Jilin University, Changchun, People's Republic of China
- The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
| | - Zhenwu Du
- Department of Orthopedics, Second Clinical College of Jilin University, Changchun, People's Republic of China
- The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
- Research Center of Second Clinical College of Jilin University, Changchun, People's Republic of China
| | - Qiwei Yang
- The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
- Research Center of Second Clinical College of Jilin University, Changchun, People's Republic of China
| | - Ming Ren
- Department of Orthopedics, Second Clinical College of Jilin University, Changchun, People's Republic of China
- The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
| | - Yujie Sui
- The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
- Research Center of Second Clinical College of Jilin University, Changchun, People's Republic of China
| | - Qingyu Wang
- The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
- Research Center of Second Clinical College of Jilin University, Changchun, People's Republic of China
| | - Ao Wang
- Department of Orthopedics, Second Clinical College of Jilin University, Changchun, People's Republic of China
- The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
| | - Haiyue Zhao
- The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
- Research Center of Second Clinical College of Jilin University, Changchun, People's Republic of China
| | - Jincheng Wang
- Department of Orthopedics, Second Clinical College of Jilin University, Changchun, People's Republic of China
- Research Center of Second Clinical College of Jilin University, Changchun, People's Republic of China
| | - Guizhen Zhang
- Department of Orthopedics, Second Clinical College of Jilin University, Changchun, People's Republic of China
- The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
- Research Center of Second Clinical College of Jilin University, Changchun, People's Republic of China
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272
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Galluccio F, Matucci-Cerinic M. Efficacy of Short-term Teriparatide for Hip Osteonecrosis. J Rheumatol 2016; 43:2084-2085. [PMID: 27803352 DOI: 10.3899/jrheum.160190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Felice Galluccio
- Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi (AOUC), University of Florence;
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence, Florence, Italy
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273
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He D, Zhuang C, Xu S, Ke X, Yang X, Zhang L, Yang G, Chen X, Mou X, Liu A, Gou Z. 3D printing of Mg-substituted wollastonite reinforcing diopside porous bioceramics with enhanced mechanical and biological performances. Bioact Mater 2016; 1:85-92. [PMID: 29744398 PMCID: PMC5883955 DOI: 10.1016/j.bioactmat.2016.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/16/2016] [Accepted: 08/23/2016] [Indexed: 01/10/2023] Open
Abstract
Mechanical strength and its long-term stability of bioceramic scaffolds is still a problem to treat the osteonecrosis of the femoral head. Considering the long-term stability of diopside (DIO) ceramic but poor mechanical strength, we developed the DIO-based porous bioceramic composites via dilute magnesium substituted wollastonite reinforcing and three-dimensional (3D) printing. The experimental results showed that the secondary phase (i.e. 10% magnesium substituting calcium silicate; CSM10) could readily improve the sintering property of the bioceramic composites (DIO/CSM10-x, x = 0-30) with increasing the CSM10 content from 0% to 30%, and the presence of the CSM10 also improved the biomimetic apatite mineralization ability in the pore struts of the scaffolds. Furthermore, the flexible strength (12.5-30 MPa) and compressive strength (14-37 MPa) of the 3D printed porous bioceramics remarkably increased with increasing CSM10 content, and the compressive strength of DIO/CSM10-30 showed a limited decay (from 37 MPa to 29 MPa) in the Tris buffer solution for a long time stage (8 weeks). These findings suggest that the new CSM10-reinforced diopside porous constructs possess excellent mechanical properties and can potentially be used to the clinic, especially for the treatment of osteonecrosis of the femoral head work as a bioceramic rod.
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Affiliation(s)
- Dongshuang He
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou, 310058, China
| | - Chen Zhuang
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou, 310058, China
| | - Sanzhong Xu
- Department of Orthopaedic Surgery, The First Affiliated Hospital, School of Medicine of Zhejiang University, Hangzhou, 310003, China
| | - Xiurong Ke
- Rui'an People's Hospital, The 3rd Hospital Affiliated to Wenzhou Medical College, Rui'an, 325200, China
| | - Xianyan Yang
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou, 310058, China
| | - Lei Zhang
- Rui'an People's Hospital, The 3rd Hospital Affiliated to Wenzhou Medical College, Rui'an, 325200, China
| | - Guojing Yang
- Rui'an People's Hospital, The 3rd Hospital Affiliated to Wenzhou Medical College, Rui'an, 325200, China
| | - Xiaoyi Chen
- Clinical Research Institute, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, PR China
| | - Xiaozhou Mou
- Clinical Research Institute, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, PR China
| | - An Liu
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Zhongru Gou
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou, 310058, China
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274
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Villa JC, Husain S, van der List JP, Gianakos A, Lane JM. Treatment of Pre-Collapse Stages of Osteonecrosis of the Femoral Head: a Systematic Review of Randomized Control Trials. HSS J 2016; 12:261-271. [PMID: 27703421 PMCID: PMC5026659 DOI: 10.1007/s11420-016-9505-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment for osteonecrosis of the femoral head (ONFH) remains controversial. Current reviews include low-level evidence studies evaluating the treatment of both pre-collapse and collapse stages of the disease. QUESTIONS/PURPOSES The purpose of the current study is to systematically review the literature evaluating core decompression (CD) with bone marrow mesenchymal cells (BMMCs), CD alone, and bisphosphonate treatment in pre-collapse ONFH by focusing just on randomized clinical trials (RCTs) reporting functional and radiologic outcomes. We aim to determine if the literature provides evidence supporting any single approach. METHODS Using PubMed and EMBASE databases, we reviewed the clinical evidence of treatments for pre-collapse ONFH following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twelve RCTs met the inclusion criteria. RESULTS Results showed that CD with BMMCs has lower risk of femoral head collapse when compared to the CD alone excluding hips lost to follow-up (relative risk (RR) [95% CI]:0.25 [0.11, 0.60]; p = 0.002) and when assumed that hips lost to follow-up experienced collapse (RR [95% CI]: 0.11 [0.03, 0.47]; p = 0.003). Neither CD nor bisphosphonate treatments showed lower risk to femoral head collapse when compared to control treatments (p = 0.46 and 0.31, respectively). CONCLUSION Current literature shows that there is a lower risk of femoral head collapse in patients with ONFH treated with CD combined with BMMCs when compared to CD alone; however, there is no robust evidence to determine the effect on functional outcomes. More RCTs assessing new combination therapies and using standardized outcome measures are required.
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Affiliation(s)
- Jordan C. Villa
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | | | | | - Arianna Gianakos
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Joseph M. Lane
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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275
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Ünal MB, Cansu E, Parmaksızoğlu F, Cift H, Gürcan S. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: Results of 7.6-year follow-up. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:501-506. [PMID: 27865611 PMCID: PMC6197408 DOI: 10.1016/j.aott.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/19/2015] [Accepted: 01/14/2016] [Indexed: 01/30/2023]
Abstract
Objectives The aim of this study was to determine long term follow up of the patients who had femoral head osteonecrosis and had been treated with free vascularized fibular grafting. Patients and methods We retrospectively reviewed 28 hips of 21 patients who had undergone free vascularized fibular grafting for the treatment of osteonecrosis of femoral head. There were 16 male and 5 female patients. The mean age of the patients at the time of surgery was 30.7 years (between 15 and 53 years). The mean follow-up time was 7.6 years (between 5 years and 9.2 years). Results During follow-up, one patient died because of leukemia, and one patient was lost. The remaining 26 hips of 19 patients were evaluated. According to the Ficat classification, at the time of surgery, 17 hips were in grade 2 and 9 hips were in grade 3. The post-operative Harris hip scores in grade II disease were excellent in 12 patients, good in 3 patients, and fair in 1 patient. In grade III disease, 1 patient was excellent, 5 patients were good, and 1 patient was fair. There was a significant increase in HHS scores (61 ± 9.7 vs 84 ± 17.8, p < 0.001). Conclusion Free vascularized fibular grafting yields extremely good results, particularly in pre-collapse stages of disease in young patients. The operation time does not mark increased if the surgical team is “familiar” with the procedure, and the residual fibular defect of the donor site does not impair the functions of daily living. Level of Evidence Level IV, Therapeutic study.
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276
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Drelichman G, Fernández Escobar N, Basack N, Aversa L, Larroude MS, Aguilar G, Szlago M, Schenone A, Fynn A, Cuello MF, Aznar M, Fernández R, Ruiz A, Reichel P, Guelbert N, Robledo H, Watman N, Bolesina M, Elena G, Veber SE, Pujal G, Galván G, Chain JJ, Arizo A, Bietti J, Bar D, Dragosky M, Marquez M, Feldman L, Muller K, Zirone S, Buchovsky G, Lanza V, Sanabria A, Fernández I, Jaureguiberry R, Contte M, Barbieri María A, Maro A, Zárate G, Fernández G, Rapetti MC, Donato H, Degano A, Kantor G, Albina R, Álvarez Bollea M, Brun M, Bacciedoni V, Del Río F, Soberón B, Boido N, Schweri M, Borchichi S, Welsh V, Corrales M, Cedola A, Carvani A, Diez B, Richard L, Baduel C, Nuñez G, Colimodio R, Barazzutti L, Medici H, Meschengieser S, Damiani G, Nucifora M, Girardi B, Gómez S, Papucci M, Verón D, Quiroga L, Carro G, De Ambrosio P, Ferro J, Pujol M, Castella CC, Franco L, Nisnovich G, Veloso M, Pacheco I, Savarino M, Marino A, Saavedra JL. Skeletal involvement in Gaucher disease: An observational multicenter study of prognostic factors in the Argentine Gaucher disease patients. Am J Hematol 2016; 91:E448-53. [PMID: 27420181 DOI: 10.1002/ajh.24486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 12/21/2022]
Abstract
Patients with Gaucher type 1 (GD1) throughout Argentina were enrolled in the Argentine bone project to evaluate bone disease and its determinants. We focused on presence and predictors of bone lesions (BL) and their relationship to therapeutic goals (TG) with timing and dose of enzyme replacement therapy (ERT). A total of 124 patients on ERT were enrolled in a multi-center study. All six TG were achieved by 82% of patients: 70.1% for bone pain and 91.1% for bone crisis. However, despite the fact that bone TGs were achieved, residual bone disease was present in 108 patients on ERT (87%) at time 0. 16% of patients showed new irreversible BL (bone infarcts and avascular osteonecrosis) despite ERT, suggesting that they appeared during ERT or were not detected at the moment of diagnosis. We observed 5 prognostic factors that predicted a higher probability of being free of bone disease: optimal ERT compliance; early diagnosis; timely initiation of therapy; ERT initiation dose ≥45 UI/kg/EOW; and the absence of history of splenectomy. Skeletal involvement was classified into 4 major phenotypic groups according to BL: group 1 (12.9%) without BL; group 2 (28.2%) with reversible BL; group 3 (41.9%) with reversible BL and irreversible chronic BL; and group 4 (16.9%) with acute irreversible BL. Our study identifies prognostic factors for achieving best therapeutic outcomes, introduces new risk stratification for patients and suggests the need for a redefinition of bone TG. Am. J. Hematol. 91:E448-E453, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | | | | | | | - Marina Szlago
- Laboratorio de Neuroquímica “Dr. N.A Chamoles”, CABA
| | | | - Alcyra Fynn
- Hospital de Niños “Sor María Ludovica”, La Plata; Prov. Buenos Aires
| | | | - Marcela Aznar
- Hospital de Niños “Sor María Ludovica”, La Plata; Prov. Buenos Aires
- Hospital CEPSI Eva Perón; Santiago del Estero
- Hospital Provincial de Niños “Santa Trinidad”; Córdoba
- Hospital Ramos Mejía, CABA
- Hospital de Niños “Pedro de Elizalde”, CABA. Hospital “Dr. Julio C. Perrando”; Chaco. Hospital del Niño Jesús; Tucumán. Hospital Iturraspe; Santa Fe. Instituto Médico Platense; La Plata
| | - Ramiro Fernández
- Hospital de Niños “Sor María Ludovica”, La Plata; Prov. Buenos Aires
| | - Alba Ruiz
- Hospital CEPSI Eva Perón; Santiago del Estero
| | | | | | - Hugo Robledo
- Hospital Provincial de Niños “Santa Trinidad”; Córdoba
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Victoria Lanza
- Hospital Materno Infantil de Mar del Plata, Pcia. Buenos Aires
| | - Alba Sanabria
- Hospital Materno Infantil de Mar del Plata, Pcia. Buenos Aires
| | | | | | | | | | | | | | | | | | - Hugo Donato
- Hospital de Niños de San Justo, Pcia. Buenos Aires
| | | | | | - Roberto Albina
- Consultorio Particular, Mar del Plata; Prov. Buenos Aires
| | | | - María Brun
- Hospital Centenario, Gualeguaychu, Entre Ríos
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David Verón
- Hospital Nacional “Profesor Alejandro Posadas”, L
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277
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Yin H, Yuan Z, Wang D. Multiple drilling combined with simvastatin versus multiple drilling alone for the treatment of avascular osteonecrosis of the femoral head: 3-year follow-up study. BMC Musculoskelet Disord 2016; 17:344. [PMID: 27528281 PMCID: PMC4986261 DOI: 10.1186/s12891-016-1199-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/03/2016] [Indexed: 12/15/2022] Open
Abstract
Background Multiple small drilling for core decompression is widely used to preserve the femoral head in patients with avascular necrosis of the femoral head (ANFH). Nevertheless, the clinical outcome remains controversial. Simvastatin has been demonstrated to promote bone formation and reduce bone adsorption. The purpose of this study was to determine whether simvastatin enhanced the effect of multiple decompressions in preventing progression of ANFH and to identify independent risk factors associated with poor results. Methods We retrospectively analyzed 58 hips in 36 patients, with a follow-up of 36 months. 20 patients (32 hips) underwent multiple drilling combined with simvastatin treatment (SIM group); 16 patients (26 hips) underwent multiple drilling alone (MD group). We defined clinical failure as a requirement for subsequent hip surgery or Harris Hip Score < 75. New occurrence of collapse or increased collapse > 2 mm on plain radiographs was defined as radiological failure. Results Successful clinical results were achieved in 27 of 32 hips (84 %) in the SIM group compared with 15 of 26 hips (58 %) in the MD group (OR = 0.2, CI (0.1, 0.6.), P = 0.032). Successful radiological results were achieved in 27 of 32 hips (84 %) in the SIM group and in 16 of 26 hips (61.5 %) in the MD group (P = 0.048). Body mass index, disease stage and location of lesion were independent prognostic factors for overall survival. Conclusions We believe that simvastatin could enhance the effects of multiple decompressions in preventing progression of ANFH and reducing the risk of femoral head collapse.
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Affiliation(s)
- Han Yin
- Department of Orthopaedics, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, No. 67, Dongchang Road, Liaocheng, Shandong, China
| | - Zhenfeng Yuan
- Department of Orthopaedics, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, No. 67, Dongchang Road, Liaocheng, Shandong, China.
| | - Dawei Wang
- Department of Orthopaedics, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, No. 67, Dongchang Road, Liaocheng, Shandong, China
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278
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Ciapetti G, Granchi D, Fotia C, Savarino L, Dallari D, Del Piccolo N, Donati DM, Baldini N. Effects of hypoxia on osteogenic differentiation of mesenchymal stromal cells used as a cell therapy for avascular necrosis of the femoral head. Cytotherapy 2016; 18:1087-99. [PMID: 27421741 DOI: 10.1016/j.jcyt.2016.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 05/31/2016] [Accepted: 06/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AIMS Avascular necrosis of the femoral head (AVN) occurs as common result of various conditions or develops as a primary entity, with a high freqency in young adults. Because of its tendency toward osteoarthritis requiring total hip arthroplasty, alternative treatments are being advocated, including cell therapy with mesenchymal stromal cells (MSCs). Because osteonecrotic bone is a severely hypoxic tissue, with a 1-3% oxygen tension, the survival and function of multipotent cells is questionable. METHODS In this study, the proliferative, immunophenotypic and osteogenic properties of bone marrow (BM)-derived MSCs from a clinical series of patients with AVN were evaluated under in vitro conditions mimicking the hypoxic milieu of AVN to verify the rationale for cell therapy. MSCs retrieved from the iliac crest (BM-MSC) were isolated, expanded and induced to osteogenic differentiation under a 2% pO2 atmosphere (hypoxia) in comparison with the standard 21% pO2 (normoxia) that is routinely used in cell culture assays. RESULTS Both proliferation and colony-forming ability were significantly enhanced in hypoxia-exposed BM-MSCs compared with BM-MSCs under normoxia. The expression of bone-related genes, including alkaline phosphatase, Type I collagen, and osteocalcin was significantly increased under hypoxia. Moreover, mineral deposition after osteogenic induction was not hampered, but in some cases even enhanced under low oxygen tension. CONCLUSIONS These findings support autologous cell therapy as an effective treatment to stimulate bone healing in the hypoxic microenvironment of AVN.
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Affiliation(s)
- Gabriela Ciapetti
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Donatella Granchi
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Caterina Fotia
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lucia Savarino
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Dante Dallari
- Conservative Orthopaedic Surgery and Innovative Techniques, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicola Del Piccolo
- Conservative Orthopaedic Surgery and Innovative Techniques, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Maria Donati
- 3rd Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Nicola Baldini
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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279
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Arbeloa-Gutierrez L, Dean CS, Chahla J, Pascual-Garrido C. Core Decompression Augmented With Autologous Bone Marrow Aspiration Concentrate for Early Avascular Necrosis of the Femoral Head. Arthrosc Tech 2016; 5:e615-20. [PMID: 27656386 PMCID: PMC5021452 DOI: 10.1016/j.eats.2016.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/04/2016] [Indexed: 02/03/2023] Open
Abstract
Lack of necessary perfusion to the femoral head can lead to necrosis of the underlying bone (avascular necrosis) and result in femoral and acetabular surface changes in advanced stages. Numerous treatments have been reported in the literature, including nonoperative and surgical procedures. In addition to the standard core decompression, we describe the use of bone marrow aspirate to stimulate a healing response and bone grafting, allowing for immediate weight bearing postoperatively. The purpose of this article was to describe our method of core decompression augmented with bone marrow aspirate concentrate and bone grafting for the treatment of early avascular necrosis of the femoral head.
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Affiliation(s)
| | - Chase S. Dean
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Cecilia Pascual-Garrido
- Department of Orthopedics, University of Colorado, Aurora, Colorado, U.S.A.,Address correspondence to Cecilia Pascual-Garrido, M.D., Department of Orthopedics, University of Colorado, University of Colorado Hospital, Anschutz Outpatient Pavilion, 1635 N Aurora Ct, Aurora, CO 80045, U.S.A.Department of OrthopedicsUniversity of ColoradoUniversity of Colorado HospitalAnschutz Outpatient Pavilion1635 N Aurora CtAuroraCO80045U.S.A.
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280
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Stanovici J, Le Nail LR, Brennan MA, Vidal L, Trichet V, Rosset P, Layrolle P. Bone regeneration strategies with bone marrow stromal cells in orthopaedic surgery. Curr Res Transl Med 2016; 64:83-90. [PMID: 27316391 DOI: 10.1016/j.retram.2016.04.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 12/18/2022]
Abstract
Bone is the most transplanted tissue human with 1 million procedures every year in Europe. Surgical interventions for bone repair are required for varied reasons such as trauma resulting non-union fractures, or diseases including osteoporosis or osteonecrosis. Autologous bone grafting is the gold standard in bone regeneration but it requires a second surgery with associated pain and complications, and is also limited by harvested bone quantity. Synthetic bone substitutes lack the osteoinductive properties to heal large bone defects. Cell therapies based on bone marrow or ex vivo expanded mesenchymal stromal stem cells (MSCs) in association with synthetic calcium phosphate (CaP) bone substitutes may be alternatives to autologous bone grafting. This manuscript reviews the different conventional biological and synthetic bone grafting procedures as well as the more recently introduced cell therapy approaches used in orthopaedic surgery for bone regeneration. Some clinical studies have demonstrated safety and efficacy of these approaches but regeneration of large bone defects remain challenging due to the absence of rapid and adequate vascularisation. Future directions in the field of bone regeneration are presented, such as testing alternative cell sources or in situ fabrication of vascularized bone grafts in patients.
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Affiliation(s)
- J Stanovici
- Inserm, UMR 957, équipe labellisée Ligue 2012, 1, rue Gaston-Veil, 44035 Nantes, France; Laboratoire de physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives, faculté de médecine, université de Nantes, Nantes Atlantique universités, 1, rue Gaston-Veil, 44035 Nantes, France; Service de chirurgie orthopédique et traumatologique 2, hôpital Trousseau, CHRU de Tours, 37044 Tours, France
| | - L-R Le Nail
- Inserm, UMR 957, équipe labellisée Ligue 2012, 1, rue Gaston-Veil, 44035 Nantes, France; Laboratoire de physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives, faculté de médecine, université de Nantes, Nantes Atlantique universités, 1, rue Gaston-Veil, 44035 Nantes, France; Service de chirurgie orthopédique et traumatologique 2, hôpital Trousseau, CHRU de Tours, 37044 Tours, France
| | - M A Brennan
- Inserm, UMR 957, équipe labellisée Ligue 2012, 1, rue Gaston-Veil, 44035 Nantes, France; Laboratoire de physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives, faculté de médecine, université de Nantes, Nantes Atlantique universités, 1, rue Gaston-Veil, 44035 Nantes, France
| | - L Vidal
- Inserm, UMR 957, équipe labellisée Ligue 2012, 1, rue Gaston-Veil, 44035 Nantes, France; Laboratoire de physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives, faculté de médecine, université de Nantes, Nantes Atlantique universités, 1, rue Gaston-Veil, 44035 Nantes, France
| | - V Trichet
- Inserm, UMR 957, équipe labellisée Ligue 2012, 1, rue Gaston-Veil, 44035 Nantes, France; Laboratoire de physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives, faculté de médecine, université de Nantes, Nantes Atlantique universités, 1, rue Gaston-Veil, 44035 Nantes, France
| | - P Rosset
- Inserm, UMR 957, équipe labellisée Ligue 2012, 1, rue Gaston-Veil, 44035 Nantes, France; Laboratoire de physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives, faculté de médecine, université de Nantes, Nantes Atlantique universités, 1, rue Gaston-Veil, 44035 Nantes, France; Service de chirurgie orthopédique et traumatologique 2, hôpital Trousseau, CHRU de Tours, 37044 Tours, France
| | - P Layrolle
- Inserm, UMR 957, équipe labellisée Ligue 2012, 1, rue Gaston-Veil, 44035 Nantes, France; Laboratoire de physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives, faculté de médecine, université de Nantes, Nantes Atlantique universités, 1, rue Gaston-Veil, 44035 Nantes, France; Service de chirurgie orthopédique et traumatologique 2, hôpital Trousseau, CHRU de Tours, 37044 Tours, France.
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281
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Kuroda Y, Matsuda S, Akiyama H. Joint-preserving regenerative therapy for patients with early-stage osteonecrosis of the femoral head. Inflamm Regen 2016; 36:4. [PMID: 29259677 PMCID: PMC5721724 DOI: 10.1186/s41232-016-0002-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/02/2016] [Indexed: 01/28/2023] Open
Abstract
Osteonecrosis of the femoral head is an intractable disease often occurring in patients aged 30–40 years that can cause femoral head collapse, pain, and gait disturbance. Background factors, including corticosteroid use, alcohol intake, and idiopathic causes, have been indicated. It is estimated that 70–80 % of osteonecrosis patients experience femoral head collapse, for which total hip arthroplasty is considered the most effective treatment, even in young patients. Thus, there is a crucial need for developing a minimally invasive regenerative therapy as a preventive surgery for femoral head collapse: this has been an important area of research in the past decades. Core decompression, the most popular minimally invasive surgery for osteonecrosis of the femoral head, has been used for a long time; however, it has been insufficient to prevent femoral head collapse. For further improvement in therapeutic efficacy, cell transplantation and the use of artificial bone and growth factors have been proposed in addition to core decompression. Since 2000, newer therapies such as autologous bone marrow cell transplantation and the embedding of metal implant rods have been developed in Europe and the USA; however, these approaches have yet to become a global standard. This practical review summarizes applied state-of-the-art regenerative therapy-based core decompression. We introduce the clinical application of recombinant human fibroblast growth factor (rhFGF)-2-impregnated gelatin hydrogel for patients with precollapse osteonecrosis of the femoral head. Radiography and computed tomography have confirmed bone regeneration inside the femoral heads around the region of rhFGF-2 gelatin hydrogel administration. With further development, the minimally invasive method, which can be expected to promote bone regeneration in necrotic areas, could become a useful early-stage treatment for osteonecrosis of the femoral head. Patients can resume their daily routine soon after surgery, and the procedure is inexpensive. As such, it is a promising regenerative therapy that can be actively employed in osteonecrosis of the femoral head before femoral head collapse.
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Affiliation(s)
- Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507 Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507 Japan
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282
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Heparanase: a rainbow pharmacological target associated to multiple pathologies including rare diseases. Future Med Chem 2016; 8:647-80. [PMID: 27057774 DOI: 10.4155/fmc-2016-0012] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In recent years, heparanase has attracted considerable attention as a promising target for innovative pharmacological applications. Heparanase is a multifaceted protein endowed with enzymatic activity, as an endo-β-D-glucuronidase, and nonenzymatic functions. It is responsible for the cleavage of heparan sulfate side chains of proteoglycans, resulting in structural alterations of the extracellular matrix. Heparanase appears to be involved in major human diseases, from the most studied tumors to chronic inflammation, diabetic nephropathy, bone osteolysis, thrombosis and atherosclerosis, in addition to more recent investigation in various rare diseases. The present review provides an overview on heparanase, its biological role, inhibitors and possible clinical applications, covering the latest findings in these areas.
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283
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Scaglione M, Fabbri L, Celli F, Casella F, Guido G. Hip replacement in femoral head osteonecrosis: current concepts. ACTA ACUST UNITED AC 2016; 12:51-4. [PMID: 27134633 DOI: 10.11138/ccmbm/2015.12.3s.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Osteonecrosis of the femoral head is a destructive disease that usually affects young adults with high functional demands and can have devastating effects on hip joint. The treatment depends on extent and location of the necrosis lesion and on patient's factors, that suggest disease progression, collapse probability and also implants survival. Non-idiopathic osteonecrosis patients had the worst outcome. There is not a gold standard treatment and frequently it is necessary a multidisciplinary approach. Preservation procedures of the femoral head are the first choice and can be attempted in younger patients without head collapse. Replacement procedure remains the main treatment after failure of preserving procedures and in the late-stage ONFH, involving collapse of the femoral head and degenerative changes to the acetabulum. Resurfacing procedure still has good results but the patient selection is a critical factor. Total hip arthroplasties had historically poor results in patients with osteonecrosis. More recently, reports have shown excellent results, but implant longevity and following revisions are still outstanding problems.
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Affiliation(s)
| | - Luca Fabbri
- Orthopedic Clinic, University of Pisa, Pisa, Italy
| | - Fabio Celli
- Orthopedic Clinic, University of Pisa, Pisa, Italy
| | | | - Giulio Guido
- Orthopedic Clinic, University of Pisa, Pisa, Italy
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284
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Involvement of MicroRNA-210 Demethylation in Steroid-associated Osteonecrosis of the Femoral Head. Sci Rep 2016; 6:20046. [PMID: 26805628 PMCID: PMC4726266 DOI: 10.1038/srep20046] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/23/2015] [Indexed: 02/06/2023] Open
Abstract
Angiogenesis is an important event in steroid-associated osteonecrosis of the femoral head (SONFH). Here we performed miRNA microarray with SONFH tissues (ONs) and the adjacent normal tissues (NLs) to select the angiogenic miRNA. The results showed that miR-210 was differentially expressed in SONFH versus normal tissues. Unexpectedly, its specific transcription factor, hypoxia-inducible factor-1α, was shown of no significant changes in ONs compared with NLs. Further Bisulfite sequencing revealed that miR-210 is embedded in a CpG island and miR-210 gene has 2 CpG sites with lower methylation percentage in ONs compared with NLs. Additionally, ONs with lower miR-210 gene methylation exhibited higher miR-210 expression. Next, we found that the endothelial cells treated with demethylating agents could significantly increase the expression of miR-210, along with promoted cell viability and differentiation. Some angiogenic genes (VEGF, bFGF, TNF-α and PCNA) were up-regulated as well. In addition, the supernatant of the cells after demethylation treatment displayed an enhanced ability of recruiting new microvessels in vivo. Taken together, our study not only provides novel insights into the regulation of angiogenesis in this disease, but also reveals a therapeutic opportunity for treatment of SONFH patients with demethylating agents.
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285
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Iolascon G, Tarantino U. Rare diseases in orthopedics: algodystrophy and aseptic osteonecrosis. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2015; 12:2-3. [PMID: 27134624 PMCID: PMC4832401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, “Policlinico Tor Vergata” Foundation, Rome, Italy
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