1
|
Klinder A, Möws F, Ziebart J, Su Y, Gabler C, Jonitz-Heincke A, van Rienen U, Ellenrieder M, Bader R. Effects of electrical stimulation with alternating fields on the osseointegration of titanium implants in the rabbit tibia - a pilot study. Front Bioeng Biotechnol 2024; 12:1395715. [PMID: 39113790 PMCID: PMC11303232 DOI: 10.3389/fbioe.2024.1395715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/05/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction: Electrical stimulation has been used as a promising approach in bone repair for several decades. However, the therapeutic use is hampered by inconsistent results due to a lack of standardized application protocols. Recently, electrical stimulation has been considered for the improvement of the osseointegration of dental and endoprosthetic implants. Methods: In a pilot study, the suitability of a specifically developed device for electrical stimulation in situ was assessed. Here, the impact of alternating electric fields on implant osseointegration was tested in a gap model using New Zealand White Rabbits. Stimulation parameters were transmitted to the device via a radio transceiver, thus allowing for real-time monitoring and, if required, variations of stimulation parameters. The effect of electrical stimulation on implant osseointegration was quantified by the bone-implant contact (BIC) assessed by histomorphometric (2D) and µCT (3D) analysis. Results: Direct stimulation with an alternating electric potential of 150 mV and 20 Hz for three times a day (45 min per unit) resulted in improved osseointegration of the triangular titanium implants in the tibiae of the rabbits. The ratio of bone area in histomorphometry (2D analysis) and bone volume (3D analysis) around the implant were significantly increased after stimulation compared to the untreated controls at sacrifice 84 days after implantation. Conclusion: The developed experimental design of an electrical stimulation system, which was directly located in the defect zone of rabbit tibiae, provided feedback regarding the integrity of the stimulation device throughout an experiment and would allow variations in the stimulation parameters in future studies. Within this study, electrical stimulation resulted in enhanced implant osseointegration. However, direct electrical stimulation of bone tissue requires the definition of dose-response curves and optimal duration of treatment, which should be the subject of subsequent studies.
Collapse
Affiliation(s)
- A. Klinder
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - F. Möws
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - J. Ziebart
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Y. Su
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - C. Gabler
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - A. Jonitz-Heincke
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - U. van Rienen
- Institute of General Electrical Engineering, University of Rostock, Rostock, Germany
- Department of Ageing of Individuals and Society, Interdisciplinary Faculty, University of Rostock, Rostock, Germany
- Department of Life, Light and Matter, Interdisciplinary Faculty, University of Rostock, Rostock, Germany
| | - M. Ellenrieder
- Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - R. Bader
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
- Department of Life, Light and Matter, Interdisciplinary Faculty, University of Rostock, Rostock, Germany
| |
Collapse
|
2
|
Ellenrieder M, Schulze C, Ganzlin A, Zaatreh S, Bader R, Mittelmeier W. Invasive electrical stimulation in the treatment of avascular osteonecrosis of the femoral head - mid-term results. Acta Orthop Belg 2023; 89:587-593. [PMID: 38205746 DOI: 10.52628/89.4.9082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
The study aimed to evaluate the outcomes of osteonecrosis of the femoral head (ONFH) in adults after surgical treatment including invasive electromagnetic osteostimulation (E-Stim). Further, the influence of disease stage and several comorbidities on the joint preservation rate should be examined. Sixty patients (66 hip joints) with ONFH were included in this retrospective cross-sectional analysis (mean follow-up: 58 months, 19-110 months). Potential ONFH risk factors and comorbidities (ONFH stage, age, sex, alcohol, smoking, cortisone medication, chemotherapy) were recorded. The influence of specific parameters on the joint preservation rates was evaluated by a multivariate logistic regression analysis. Finally, patients with preserved hip joints underwent an assessment of their last available X-rays. The joint preservation rate depended on the initial ONFH Steinberg stage (I+II: 82.8%, III: 70.8%, ≥ IVa: 38.5%). Initially collapsed ONFH (p ≤ 0.001) and cortisone therapy (p = 0.004) significantly decreased the joint preservation rates. In case of progressed ONFH, the presence of ≥ 2 risk factors resulted in higher THA conversion rates (stage III: OR 18.8; stage ≥IVa: OR 12). In 94% of the available X-rays, the ONFH stage improved or did not progress. No complications could be attributed to the E-Stim device or procedure. The present surgical protocol including minimally invasive E-Stim revealed high joint preservation rates for non-collapsed ONFH after mid-term postoperative follow-up. Especially in progressed ONFH, the-risk profile seems to be crucial and hence, for joint preserving surgery, careful patient selection is recommended.
Collapse
|
3
|
Sahm F, Freiin Grote V, Zimmermann J, Haack F, Uhrmacher AM, van Rienen U, Bader R, Detsch R, Jonitz-Heincke A. Long-term stimulation with alternating electric fields modulates the differentiation and mineralization of human pre-osteoblasts. Front Physiol 2022; 13:965181. [PMID: 36246121 PMCID: PMC9562827 DOI: 10.3389/fphys.2022.965181] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Biophysical stimulation by electric fields can promote bone formation in bone defects of critical size. Even though, long-term effects of alternating electric fields on the differentiation of osteoblasts are not fully understood. Human pre-osteoblasts were stimulated over 31 days to gain more information about these cellular processes. An alternating electric field with 0.7 Vrms and 20 Hz at two distances was applied and viability, mineralization, gene expression, and protein release of differentiation factors were analyzed. The viability was enhanced during the first days of stimulation. A higher electric field resulted in upregulation of typical osteogenic markers like osteoprotegerin, osteopontin, and interleukin-6, but no significant changes in mineralization. Upregulation of the osteogenic markers could be detected with a lower electric field after the first days of stimulation. As a significant increase in the mineralized matrix was identified, an enhanced osteogenesis due to low alternating electric fields can be assumed.
Collapse
Affiliation(s)
- Franziska Sahm
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Rostock, Germany
- *Correspondence: Franziska Sahm, ; Anika Jonitz-Heincke,
| | - Vivica Freiin Grote
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Rostock, Germany
| | - Julius Zimmermann
- Chair of Theoretical Electrical Engineering, Institute for General Electrical Engineering, University of Rostock, Rostock, Germany
| | - Fiete Haack
- Institute for Visual and Analytic Computing, University of Rostock, Rostock, Germany
| | - Adelinde M. Uhrmacher
- Institute for Visual and Analytic Computing, University of Rostock, Rostock, Germany
| | - Ursula van Rienen
- Chair of Theoretical Electrical Engineering, Institute for General Electrical Engineering, University of Rostock, Rostock, Germany
- Department Life, Light and Matter, University of Rostock, Rostock, Germany
- Department Ageing of Individuals and Society, University of Rostock, Rostock, Germany
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Rostock, Germany
| | - Rainer Detsch
- Department of Materials Science and Engineering, Institute of Biomaterials, Friedrich Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Anika Jonitz-Heincke
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Rostock, Germany
- *Correspondence: Franziska Sahm, ; Anika Jonitz-Heincke,
| |
Collapse
|
4
|
Kunze KN, Sullivan SW, Nwachukwu BU. Updates on Management of Avascular Necrosis Using Hip Arthroscopy for Core Decompression. Front Surg 2022; 9:662722. [PMID: 35465433 PMCID: PMC9024040 DOI: 10.3389/fsurg.2022.662722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/07/2022] [Indexed: 12/23/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is caused when circulation within the femoral head is disrupted. Etiology of this disease is characterized by either traumatic events or atraumatic risk factors, such as chronic alcohol consumption or glucocorticoid use. ONFH commonly presents as pain in the groin, gluteus muscles, and/or knee with reductions in internal rotation range of motion of the hip. ONFH pathology can be confirmed with radiographic or advanced imaging and characterized by stage, size and location of the lesion. Treatment for ONFH consists of conservative and therapeutic methods as well as surgical intervention. Historically, ONFH has been treated using total hip arthroplasty (THA), but with increasing incidence in a younger, active population, measures to preserve the native hip joint have been explored. Recent advancements in hip arthroscopy and arthroscopy-assisted core decompression have led to improved outcomes, reduced pain and higher hip survival rate for early onset ONFH compared with more invasive approaches such as THA. Biologic treatments combined with arthroscopic core decompression have also shown improved outcomes and quality of life in few reports, suggesting a potential role for biologic adjuncts. The current study provides a comprehensive review and update on the literature surrounding arthroscopy-assisted core decompression for patients with ONFH.
Collapse
|
5
|
Serong S, Haubold J, Theysohn J, Landgraeber S. Arthroscopic assessment of concomitant intraarticular pathologies in patients with osteonecrosis of the femoral head. J Hip Preserv Surg 2020; 7:458-465. [PMID: 33948201 PMCID: PMC8081419 DOI: 10.1093/jhps/hnaa059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 11/12/2022] Open
Abstract
This study's purpose is to arthroscopically assess the occurrence of intraarticular pathologies in patients with osteonecrosis of the femoral head (OFNH) and to compare arthroscopic with radiologic findings. In a retrospective cohort analysis of ONFH patients undergoing combined core decompression (CD) and hip arthroscopy, concomitant intraarticular pathologies were qualitatively and quantitatively assessed by means of arthroscopy. Intraoperative findings were compared with preoperative radiodiagnostics. Descriptive statistics were performed with results displaying type, degree and prevalence of co-pathologies. Based on a cohort of 27 hips with ONFH at ARCO stages II and III, 26 (96.3%) presented with concomitant intraarticular findings. Cam-deformity (n = 22; 81.5%), labral defects (n = 23; 85.2%) and chondral defects (n = 20; 74.1%) were the most frequent. Four hips (14.8%) had foveal ligament anomalies. Intraoperative detection of cam-deformity positively correlated with radiologically assessed pathologic α angles (p = 0.09). Radiologic evaluation of the acetabular labrum distinctly differed from arthroscopic findings. Reliable statements concerning the cartilage status were not possible due to the great difference in quality of the magnetic resonance imaging (MRIs). The results of this study revealed an arthroscopically proven prevalence of co-pathologies in >95% of patients with ONFH. Cam-type deformity, labral anomalies and chondral defects were the most frequent. Comparison of arthroscopic and radiologic findings showed coherent results regarding cam-deformity but revealed distinct difficulties in the assessment of the labral and chondral status emphasizing the need for standardization of preoperative radiodiagnostics. Moreover, it still has to be evaluated whether combined CD and arthroscopy can improve on the overall outcomes achieved by performance of CD only.
Collapse
Affiliation(s)
- Sebastian Serong
- Department of Orthopaedics & Orthopaedic Surgery, Saarland University, Kirrberger Strasse 100, Homburg 66421, Germany.,Sportklinik Duisburg, Dr. Alfred-Herrhausen-Allee 21, Duisburg 47228, Germany
| | - Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, Essen 45147, Germany
| | - Jens Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, Essen 45147, Germany
| | - Stefan Landgraeber
- Department of Orthopaedics & Orthopaedic Surgery, Saarland University, Kirrberger Strasse 100, Homburg 66421, Germany
| |
Collapse
|
6
|
Roth A, Tingart M. [Atraumatic femoral head necrosis in adults]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 32:87-88. [PMID: 32221631 DOI: 10.1007/s00064-020-00654-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Andreas Roth
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich Endoprothetik/Orthopädie, Universitätsklinik Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Markus Tingart
- Klinik für Orthopädie, Universitätsklinikum Aachen, AöR, Aachen, Deutschland
| |
Collapse
|
7
|
Sahm F, Ziebart J, Jonitz-Heincke A, Hansmann D, Dauben T, Bader R. Alternating Electric Fields Modify the Function of Human Osteoblasts Growing on and in the Surroundings of Titanium Electrodes. Int J Mol Sci 2020; 21:ijms21186944. [PMID: 32971771 PMCID: PMC7555878 DOI: 10.3390/ijms21186944] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 12/15/2022] Open
Abstract
Endogenous electric fields created in bone tissue as a response to mechanical loading are known to influence the activity and differentiation of bone and precursor cells. Thus, electrical stimulation offers an adjunct therapy option for the promotion of bone regeneration. Understanding the influence of electric fields on bone cell function and the identification of suitable electrical stimulation parameters are crucial for the clinical success of stimulation therapy. Therefore, we investigated the impact of alternating electric fields on human osteoblasts that were seeded on titanium electrodes, which delivered the electrical stimulation. Moreover, osteoblasts were seeded on collagen-coated coverslips near the electrodes, representing the bone stock surrounding the implant. Next, 0.2 V, 1.4 V, or 2.8 V were applied to the in vitro system with 20 Hz frequency. After one, three, and seven days, the osteoblast morphology and expression of osteogenic genes were analysed. The actin organisation, as well as the proliferation, were not affected by the electrical stimulation. Changes in the gene expression and protein accumulation after electrical stimulation were voltage-dependent. After three days, the osteogenic gene expression and alkaline phosphatase activity were up to 2.35-fold higher following the electrical stimulation with 0.2 V and 1.4 V on electrodes and coverslips compared to controls. Furthermore, collagen type I mRNA, as well as the amount of the C-terminal propeptide of collagen type I were increased after the stimulation with 0.2 V and 1.4 V, while the higher electrical stimulation with 2.8 V led to decreased levels, especially on the electrodes.
Collapse
Affiliation(s)
- Franziska Sahm
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Centre, 18057 Rostock, Germany; (A.J.-H.); (D.H.); (R.B.)
- Correspondence: (F.S.); (J.Z.); Tel.: +49-0381-4949336 (J.Z.)
| | - Josefin Ziebart
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Centre, 18057 Rostock, Germany; (A.J.-H.); (D.H.); (R.B.)
- Correspondence: (F.S.); (J.Z.); Tel.: +49-0381-4949336 (J.Z.)
| | - Anika Jonitz-Heincke
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Centre, 18057 Rostock, Germany; (A.J.-H.); (D.H.); (R.B.)
| | - Doris Hansmann
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Centre, 18057 Rostock, Germany; (A.J.-H.); (D.H.); (R.B.)
| | - Thomas Dauben
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center, Schillingallee 70, 18057 Rostock, Germany;
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Centre, 18057 Rostock, Germany; (A.J.-H.); (D.H.); (R.B.)
| |
Collapse
|
8
|
Theopold J, Armonies S, Pieroh P, Hepp P, Roth A. Nontraumatic avascular necrosis of the femoral head : Arthroscopic and navigation-supported core decompression. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 32:107-115. [PMID: 31781806 DOI: 10.1007/s00064-019-00643-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/08/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim is to address core decompression and pathologies of the femoral head, treating them during the same procedure. Furthermore, radiation exposure will be reduced. INDICATIONS Femoral head necrosis ARCO (Association Research Circulation Osseous) stages I-III. CONTRAINDICATIONS Progressive femoral head necrosis as ARCO stages IIIC-IV. SURGICAL TECHNIQUE Arthroscopically navigated core decompression of the femoral head using an established optoelectronic system with fluoro-free software module. First, hip joint arthroscopy was performed and further pathologies were treated. Second, core decompression was navigated by a navigation pointer and drill sleeve to reach the correct target point. After visualization, the procedure is repeated 3-5 times. POSTOPERATIVE MANAGEMENT Limited weight bearing of the operated leg (20 kg) for 10-14 days. Active or passive continuous motion machine for 4 weeks. Adjuvant postoperative indomethacin therapy for 10 days to reduce pain and bone marrow edema. RESULTS From May 2018 to January 2019, 7 patients (male = 4; 40 ± 9 years) underwent arthroscopically navigated core decompression with 2 (29%) and 5 (71%) patients being classified as ARCO II and III, respectively. Preoperatively, all patients reported load-dependent pain. In all cases, we could identify synovitis, which results in soft tissue release and synovectomy. Furthermore, 4 of 7 patients had an additional labrum lesion, which is addressed by refixation or shrinking. DISCUSSION Compared to the conventional technique, this fluoro-free navigation procedure allows more precise drilling. Moreover, additional pathologies, as found in all our cases, could be simultaneously addressed. The intraoperative radiation exposure for the patient and surgical team could also be reduced. Although arthroscopically assisted core decompression requires more preparation time, there are advantages over conventional surgery.
Collapse
Affiliation(s)
- Jan Theopold
- Department of Orthopedic, Trauma and Plastic Surgery, Division of Arthroscopy, Joint Surgery and Sport Injuries, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Sarah Armonies
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Philipp Pieroh
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Pierre Hepp
- Department of Orthopedic, Trauma and Plastic Surgery, Division of Arthroscopy, Joint Surgery and Sport Injuries, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Andreas Roth
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| |
Collapse
|
9
|
[Core decompression ("conventional method") in atraumatic osteonecrosis of the hip]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 32:89-95. [PMID: 31754745 DOI: 10.1007/s00064-019-00640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/28/2019] [Accepted: 05/08/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Retrograde drilling of a necrotic zone within the femoral head to reduce intraosseous pressure and stimulate revascularization. INDICATIONS Atraumatic osteonecrosis of the hip ARCO stage I (reversible) and ARCO stage II (potentially reversible) with a medial or central necrotic zone <30% or ARCO stage III with a subchondral fracture for reduction of pain. CONTRAINDICATIONS ARCO stage III C, ARCO stage IV (secondary osteoarthritis), stage-independent necrotic zone > 30%, infections. SURGICAL TECHNIQUE Supine position. Visualization of the necrotic zone via an image intensifier, approach is determined by using a Kirschner wire, laterodorsal skin incision on a level with the wire, longitudinal incision of iliotibial band and vastus lateralis muscle, drilling the necrotic zone with a 2-3 mm Kirschner wire, optionally placing more wires or a hollow drill, wound closure. POSTOPERATIVE MANAGEMENT Partial weightbearing with 20 kg for 6 weeks due to risk of fracture, followed by avoidance of jumping or sprinting for another 6 weeks; physiotherapy from day 1 after surgery, thromboembolic prophylaxis until full weightbearing is possible. RESULTS Results are dependent on ARCO stages and are promising in early stages.
Collapse
|
10
|
Nazal MR, Parsa A, Martin SD. Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head-minimum of 5 year follow-up. BMC Musculoskelet Disord 2019; 20:448. [PMID: 31615502 PMCID: PMC6794765 DOI: 10.1186/s12891-019-2853-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 09/25/2019] [Indexed: 12/27/2022] Open
Abstract
Background Osteonecrosis of the femoral head (ONFH) is a progressive disease that leads to collapse and the development of secondary arthritis. The preferred management of ONFH remains controversial. Arthroscopic-assisted management of ONFH is a new and evolving approach for hip preservation. We hypothesis that arthroscopy is able to improve ONFH outcomes by achieving accurate and minimally invasive decompression while successfully addressing concomitant intraarticular pathologies resulting in reliable mid-term outcomes. Methods This was a retrospective cohort analysis. All patients had atraumatic ONFH with a precollapse lesion and a minimum follow-up of 5 years. Results A total cohort of 11 hips (8 patients) was identified. The mean patient follow-up was 7 years ±1.48 years (range, 64—118 months). The Ficat-Alret classification found on preoperative imaging was Stage I—3 (27.2%), IIa—4 (36.4%), and IIb—4 (36.4%) hips. Four (36.4%) hips experienced mechanical issues, including locking, catching, and buckling. The most common concomitant pathology addressed at the time of arthroscopy, was labral repair/debridement—8 (73%), followed by microfracture—7 (64%). At final follow-up, 6 hips (54.5%) had not converted to THA. Upon further stratification, Stage I—100%, Stage IIa—75%, for a combined 87%, had not converted to THA, in contrast, 100% of hips categorized as Stage IIb had converted to THA. Ficat-Alret staging, especially Stage IIb, was significantly associated with conversion to THA. (p-value = 0.015) There were 0% major or minor complications. Conclusions To our knowledge, this is the longest reported follow-up of arthroscopic-assisted management of ONFH. Arthroscopic-assisted management is a promising surgical approach that provides safe, accurate, and minimally invasive decompression, resulting in reliable results with an acceptable conversion rate to THA. Level of evidence Level IV, Case Series.
Collapse
Affiliation(s)
- Mark R Nazal
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, MA, 02114, USA
| | - Ali Parsa
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, MA, 02114, USA. .,Orthopedic Research Center, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran. .,Department Of Orthopedic Surgery, Emam-Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Scott D Martin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, MA, 02114, USA
| |
Collapse
|
11
|
Li J, Li Z, Su X, Liu C, Zhang H, Wang K. [Effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early osteonecrosis of the femoral head]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1025-1030. [PMID: 29798556 PMCID: PMC8458427 DOI: 10.7507/1002-1892.201704126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/16/2017] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early oeteonecrosis of the femoral head (ONFH). Methods Between March 2010 and December 2013, 91 patients with early ONFH were treated with the operation of multiple small-diameter drilling decompression combined with hip arthroscopy in 39 cases (53 hips, group A) or with drilling decompression alone in 52 cases (74 hips, group B). The patients in 2 groups had obvious hip pain and limited motion before operation. There was no significant difference in gender, age, etiology, effected side, stage of osteonecrosis, and preoperative Harris score between 2 groups ( P>0.05). Results All operations succeeded and all incisions healed by first intention. The operation time was significantly longer in group A [(73.3±10.6) minutes] than in group B [(41.5±7.2) minutes] ( t=8.726, P=0.000). Temporary of sciatic nerve apraxia after operation occurred in 2 patients of group A, and no complication occurred in other patients. Patients were followed up 24-52 months (mean, 39.3 months) in group A and 24-48 months (mean, 34.6 months) in group B. At last follow-up, the Harris scores were 83.34±8.76 in group A and 76.61±9.22 in group B, showing significant differences when compared between 2 groups ( t=-4.247, P=0.029) and when compared with preoperative values in 2 groups ( t=-10.327, P=0.001; t=-8.216, P=0.008). X-ray films showed that the collapse of the femoral head was observed in 6 hips (1 hip at stage Ⅰand 5 hips at stage Ⅱ) in group A, and in 16 hips (4 hips at stageⅠand 12 hips at stage Ⅱ) in group B; and hip arthroplasty was performed. The total effective rates were 88.68% (47/53) in group A and 78.38% (58/74) in group B, respectively; showing significant difference between 2 groups ( χ2=5.241, P=0.041). Conclusion Multiple small-diameter drilling decompression combined with hip arthroscopy is effective in pain relief, improvement of hip function, slowing-down the process of femoral head necrosis, delaying the need for total hip arthroplasty in patients with early ONFH.
Collapse
Affiliation(s)
- Ji Li
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853,
| | - Xiangzheng Su
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Chunhui Liu
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Hao Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Ketao Wang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| |
Collapse
|
12
|
Li J, Li ZL, Zhang H, Su XZ, Wang KT, Yang YM. Long-term Outcome of Multiple Small-diameter Drilling Decompression Combined with Hip Arthroscopy versus Drilling Alone for Early Avascular Necrosis of the Femoral Head. Chin Med J (Engl) 2017; 130:1435-1440. [PMID: 28584206 PMCID: PMC5463473 DOI: 10.4103/0366-6999.207470] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Avascular necrosis of femoral head (AVNFH) typically presents in the young adults and progresses quickly without proper treatments. However, the optimum treatments for early stage of AVNFH are still controversial. This study was conducted to evaluate the therapeutic effects of multiple small-diameter drilling decompression combined with hip arthroscopy for early AVNFH compared to drilling alone. METHODS This is a nonrandomized retrospective case series study. Between April 2006 and November 2010, 60 patients (98 hips) with early stage AVNFH participated in this study. The patients underwent multiple small-diameter drilling decompression combined with hip arthroscopy in 26 cases/43 hips (Group A) or drilling decompression alone in 34 cases/55 hips (Group B). Patients were followed up at 6, 12, and 24 weeks, and every 6 months thereafter. Radiographs were taken at every follow-up, Harris scores were recorded at the last follow-up, the paired t-test was used to compare the postoperative Harris scores. Surgery effective rate of the two groups was compared using the Chi-square test. RESULTS All patients were followed up for an average of 57.6 months (range: 17-108 months). Pain relief and improvement of hip function were assessed in all patients at 6 months after the surgery. At the last follow-up, Group A had better outcome with mean Harris' scores improved from 68.23 ± 11.37 to 82.07 ± 2.92 (t = -7.21, P = 0.001) than Group B with mean Harris' scores improved from 69.46 ± 9.71 to 75.79 ± 4.13 (t = -9.47, P = 0.037) (significantly different: t = -2.54, P = 0.017). The total surgery effective rate was also significantly different between Groups A and B (86.0% vs. 74.5%; χ2 = 3.69, P = 0.02). CONCLUSION For early stage of AVNFH, multiple small-diameter drilling decompression combined with hip arthroscopy is more effective than drilling decompression alone.
Collapse
Affiliation(s)
- Ji Li
- Department of Orthopedics, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Zhong-Li Li
- Department of Orthopedics, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Hao Zhang
- Department of Orthopedics, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Xiang-Zheng Su
- Department of Orthopedics, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Ke-Tao Wang
- Department of Orthopedics, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Yi-Meng Yang
- Department of Orthopedics, General Hospital of People's Liberation Army, Beijing 100853, China
| |
Collapse
|
13
|
Haba Y, Wurm A, Köckerling M, Schick C, Mittelmeier W, Bader R. Characterization of human cancellous and subchondral bone with respect to electro physical properties and bone mineral density by means of impedance spectroscopy. Med Eng Phys 2017; 45:34-41. [PMID: 28462825 DOI: 10.1016/j.medengphy.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/23/2017] [Accepted: 04/02/2017] [Indexed: 11/28/2022]
Abstract
Computational simulation of electrical bone stimulation of the electrical and dielectric parameters of osteoarthritic bone tissue is useful for an exact patient-individual adaptation of the bone models. Therefore, we investigated electrical and dielectric parameters at a frequency of 20Hz of cancellous and subchondral human femoral head bone samples. Furthermore, the mechanical properties and the bone mineral density (BMD) were determined. Finally, these data were compared with the electrical and dielectric parameters. The bone samples were taken from patients with hip osteoarthritis. Electrical conductivity and dielectric permittivity of cancellous bone amounted to 0.043S/m and 8.1⋅106. BMD of the bone samples determined by dual-x-ray-absorptiometry (DXA) and ashing resulted in 193 ± 70mg/cm² and 286 ± 59mg/cm³ respectively. Structural modulus (ES) and ultimate compression strength (σmax) were measured with 227 ± 94N/mm² and 6.5 ± 3.4N/mm². No linear correlation of the electrical and dielectric parameters compared with BMD and mechanical properties of cancellous bone samples was found. Electrical conductivity and dielectric permittivity of subchondral bone resulted in 0.029S/m and 8.97×106.
Collapse
Affiliation(s)
- Yvonne Haba
- University Medicine Rostock, Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory Rostock, Germany.
| | - Andreas Wurm
- University of Rostock, Institute of Physics, Polymer Physics Group, Rostock, Germany.
| | - Martin Köckerling
- University of Rostock, Institute of Chemistry, Inorganic Solid State Chemistry Group, Rostock, Germany.
| | - Christoph Schick
- University of Rostock, Institute of Physics, Polymer Physics Group, Rostock, Germany.
| | - Wolfram Mittelmeier
- University Medicine Rostock, Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory Rostock, Germany.
| | - Rainer Bader
- University Medicine Rostock, Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory Rostock, Germany.
| |
Collapse
|
14
|
Ellenrieder M, Tischer T, Bader R, Kreuz PC, Mittelmeier W. Patient-specific factors influencing the traction forces in hip arthroscopy. Arch Orthop Trauma Surg 2017; 137:81-87. [PMID: 27695971 DOI: 10.1007/s00402-016-2572-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The application of traction in hip arthroscopy is associated with peri-operative complications. Within a therapeutic case series, patient-related factors correlating with high-traction forces during hip arthroscopy and occurring complications should be identified. MATERIALS AND METHODS In 30 male and 38 female patients (mean age: 44.5 years), intra-operative traction forces were monitored continuously using a specialised measurement device. A multivariate analysis was employed to identify patient-related factors influencing the traction force. Peri-operative complications (follow-up: 12 weeks) were evaluated by performing a single-case analysis. RESULTS The mean initial force prior to penetration of the capsule ("initial force") was 477 N (men: 517 N; women: 444 N), decreasing after capsulotomy by an average of 17 %. The male gender (p < 0.001), Kellgren and Lawrence radiographic stage (p = 0.037), low minimum joint-space width (p = 0.029) and high body height/weight (p = 0.003/0.037) correlated significantly with higher distraction forces. The patient age and type of anaesthesia (general versus spinal) were not relevant. Complications were observed in ten patients on the first post-operative day. In two of these patients a partial sensory deficit of the lateral cutaneous femoral nerve persisted after 12 weeks. All patients with complications required initial traction forces of >400 N. CONCLUSIONS The study revealed several patient-specific risk factors correlating with high-traction forces during hip arthroscopy. With view to potential complications, these patient groups require special attention during surgical treatment as well as in future studies.
Collapse
Affiliation(s)
- Martin Ellenrieder
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany.
| | - Thomas Tischer
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Peter Cornelius Kreuz
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
| |
Collapse
|
15
|
Stellenwert der Knochenmarkstimulation. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-016-0065-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
16
|
Abstract
Traumatic hip dislocations are high-energy injuries that often result in considerable morbidity. Although appropriate management improves outcomes, associated hip pathology may complicate the recovery and lead to future disability and pain. Historically, open reduction has been the standard of care for treating hip dislocations that require surgical intervention. The use of hip arthroscopy to treat the sequelae and symptoms resulting from traumatic hip dislocations recently has increased, however. When used appropriately, hip arthroscopy is a safe, effective, and minimally invasive treatment option for intra-articular pathology secondary to traumatic hip dislocation.
Collapse
|
17
|
Su Y, Kluess D, Mittelmeier W, van Rienen U, Bader R. An automatic approach for calibrating dielectric bone properties by combining finite-element and optimization software tools. Comput Methods Biomech Biomed Engin 2016; 19:1306-13. [PMID: 26777343 DOI: 10.1080/10255842.2015.1131980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The dielectric properties of human bone are one of the most essential inputs required by electromagnetic stimulation for improved bone regeneration. Measuring the electric properties of bone is a difficult task because of the complexity of the bone structure. Therefore, an automatic approach is presented to calibrate the electric properties of bone. The numerical method consists of three steps: generating input from experimental data, performing the numerical simulation, and calibrating the bone dielectric properties. As an example, the dielectric properties at 20 Hz of a rabbit distal femur were calibrated. The calibration process was considered as an optimization process with the aim of finding the optimum dielectric bone properties that match most of the numerically calculated simulation and experimentally measured data sets. The optimization was carried out automatically by the optimization software tool iSIGHT in combination with the finite-element solver COMSOL Multiphysics. As a result, the optimum conductivity and relative permittivity of the rabbit distal femur at 20 Hz were found to be 0.09615 S/m and 19522 for cortical bone and 0.14913 S/m and 1561507 for cancellous bone, respectively. The proposed method is a potential tool for the identification of realistic dielectric properties of the entire bone volume. The presented approach combining iSIGHT with COMSOL is applicable to, amongst others, designing implantable electro-stimulative devices or the optimization of electrical stimulation parameters for improved bone regeneration.
Collapse
Affiliation(s)
- Yukun Su
- a Department of Orthopaedics , University Medicine Rostock , Rostock , Germany
| | - Daniel Kluess
- a Department of Orthopaedics , University Medicine Rostock , Rostock , Germany
| | - Wolfram Mittelmeier
- a Department of Orthopaedics , University Medicine Rostock , Rostock , Germany
| | - Ursula van Rienen
- b Institute of General Electrical Engineering, University of Rostock , Rostock , Germany
| | - Rainer Bader
- a Department of Orthopaedics , University Medicine Rostock , Rostock , Germany
| |
Collapse
|
18
|
Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update. J Bone Joint Surg Am 2015; 97:1604-27. [PMID: 26446969 DOI: 10.2106/jbjs.o.00071] [Citation(s) in RCA: 308] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.
Collapse
Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Jeffrey J Cherian
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Rafael J Sierra
- Mayo Clinic, 200 First Street S.W., Gonda 14 South, Rochester, MN 55905
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, JHOC 5245, Baltimore, MD 21287
| | - Jay R Lieberman
- Keck Medical Center of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033
| |
Collapse
|
19
|
Wieland D, Krywka C, Mick E, Willumeit-Römer R, Bader R, Kluess D. Investigation of the inverse piezoelectric effect of trabecular bone on a micrometer length scale using synchrotron radiation. Acta Biomater 2015; 25:339-46. [PMID: 26192999 DOI: 10.1016/j.actbio.2015.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/15/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
In the present paper we have investigated the impact of electro stimulation on microstructural parameters of the major constituents of bone, hydroxyapatite and collagen. Therapeutic approaches exhibit an improved healing rate under electric fields. However, the underlying mechanism is not fully understood so far. In this context one possible effect which could be responsible is the inverse piezo electric effect at bone structures. Therefore, we have carried out scanning X-ray microdiffraction experiments, i.e. we recorded X-ray diffraction data with micrometer resolution using synchrotron radiation from trabecular bone samples in order to investigate how the bone matrix reacts to an applied electric field. Different samples were investigated, where the orientation of the collagen matrix differed with respect to the applied electric field. Our experiments aimed to determine whether the inverse piezo electric effect could have a significant impact on the improved bone regeneration owing to electrostimulative therapy. Our data suggest that strain is in fact induced in bone by the collagen matrix via the inverse piezo electric effect which occurs in the presence of an adequately oriented electric field. The magnitude of the underlying strain is in a range where bone cells are able to detect it. STATEMENT OF SIGNIFICANCE In our study we report on the piezoelectric effect in bone which was already discovered and explored on a macro scale in the 1950. Clinical approaches utilize successfully electro stimulation to enhance bone healing but the exact mechanisms taking place are still a matter of debate. We have measured the stress distribution with micron resolution in trabecular bone to determine the piezo electric induced stress. Our results show that the magnitude of the induced stress is big enough to be sensed by cells and therefore, could be a trigger for bone remodeling and growth.
Collapse
|
20
|
de Amorim Cabrita HAB, de Castro Trindade CA, de Campos Gurgel HM, Leal RD, de Souza Marques RDF. Hip arthroscopy. Rev Bras Ortop 2015; 50:245-53. [PMID: 26229924 PMCID: PMC4519569 DOI: 10.1016/j.rboe.2014.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/12/2013] [Indexed: 12/27/2022] Open
Abstract
Hip arthroscopy is a safe method for treating a variety of pathological conditions that were unknown until a decade ago. Femoroacetabular impingement is the commonest of these pathological conditions and the one with the best results when treated early on. The instruments and surgical technique for hip arthroscopy continue to evolve. New indications for hip arthroscopy has been studied as the ligamentum teres injuries, capsular repair in instabilities, dissection of the sciatic nerve and repair of gluteal muscles tears (injuries to the hip rotator cuff), although still with debatable reproducibility. The complication rate is low, and ever-better results with fewer complications should be expected with the progression of the learning curve.
Collapse
Affiliation(s)
| | | | - Henrique Melo de Campos Gurgel
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil ; Instituto Vita, São Paulo, SP, Brazil
| | | | | |
Collapse
|
21
|
Establishment of a novel in vitro test setup for electric and magnetic stimulation of human osteoblasts. Cell Biochem Biophys 2015; 70:805-17. [PMID: 24782061 DOI: 10.1007/s12013-014-9984-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
When large defects occur, bone regeneration can be supported by bone grafting and biophysical stimuli like electric and magnetic stimulation (EMS). Clinically established EMS modes are external coils and surgical implants like an electroinductive screw system, which combines a magnetic and electric field, e.g., for the treatment of avascular bone necrosis or pseudarthrosis. For optimization of this implant system, an in vitro test setup was designed to investigate effects of EMS on human osteoblasts on different 3D scaffolds (based on calcium phosphate and collagen). Prior to the cell experiments, numerical simulations of the setup, as well as experimental validation, via measurements of the electric parameters induced by EMS were conducted. Human osteoblasts (3 × 10(5) cells) were seeded onto the scaffolds and cultivated. After 24 h, screw implants (Stryker ASNIS III s-series) were centered in the scaffolds, and EMS was applied (3 × 45 min per day at 20 Hz) for 3 days. Cell viability and collagen type 1 (Col1) synthesis were determined subsequently. Numerical simulation and validation showed an adequate distribution of the electric field within the scaffolds. Experimental measurements of the electric potential revealed only minimal deviation from the simulation. Cell response to stimulation varied with scaffold material and mode of stimulation. EMS-stimulated cells exhibited a significant decrease of metabolic activity in particular on collagen scaffolds. In contrast, the Col1/metabolic activity ratio was significantly increased on collagen and non-sintered calcium phosphate scaffolds after 3 days. Exclusive magnetic stimulation showed similar but nonsignificant tendencies in metabolic activity and Col1 synthesis. The cell tests demonstrate that the new test setup is a valuable tool for in vitro testing and parameter optimization of the clinically used electroinductive screw system. It combines magnetic and electric stimulation, allowing in vitro investigations of its influence on human osteoblasts.
Collapse
|
22
|
|
23
|
Park MS, Yoon SJ, Lee KH, Cho HM, Chung WC. Hip Arthroscopy: Where We Are, and Where We Are Going. Hip Pelvis 2015; 27:1-8. [PMID: 27536595 PMCID: PMC4972614 DOI: 10.5371/hp.2015.27.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 02/15/2015] [Accepted: 02/16/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Myung Sik Park
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Sun Jung Yoon
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Kwang Hun Lee
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Hong Man Cho
- Department of Orthopedic Surgery, Veteran's Hospital, Gwangju, Korea
| | - Woo Churl Chung
- Department of Orthopedic Surgery, Carollo Hospital, Suncheon, Korea
| |
Collapse
|
24
|
Papavasiliou A, Yercan HS, Koukoulias N. The role of hip arthroscopy in the management of osteonecrosis. J Hip Preserv Surg 2014; 1:56-61. [PMID: 27011804 PMCID: PMC4765287 DOI: 10.1093/jhps/hnu011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/27/2014] [Accepted: 08/20/2014] [Indexed: 11/25/2022] Open
Abstract
Hip arthroscopy has emerged as a diagnostic and therapeutic tool in the management of osteonecrosis (ON) of the femoral head. Direct visualization of the joint, aids the staging of the disease, while mechanical symptoms and pain can be alleviated by addressing the often coexisting intra-articular pathology (labral tears, chondral delamination, loose bodies and synovitis) thereby improving the clinical outcome in some patients. The article explores the role and possible value of hip arthroscopy as a surgical technique in the treatment of hip ON.
Collapse
Affiliation(s)
- A Papavasiliou
- 1. Department of Physical Education and Sport Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - H S Yercan
- 2. Celal Bayar University, Medical school, Department of Orthopedics and Traumatology, Manisa 45020, Turkey
| | - N Koukoulias
- 3. Orthopaedic Department, St luke's Hospital, Arthroscopic Centre of Thessaloniki, Panorama 55236, Greece
| |
Collapse
|
25
|
Su Y, Souffrant R, Kluess D, Ellenrieder M, Mittelmeier W, van Rienen U, Bader R. Evaluation of electric field distribution in electromagnetic stimulation of human femoral head. Bioelectromagnetics 2014; 35:547-58. [PMID: 25251424 DOI: 10.1002/bem.21879] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/03/2014] [Indexed: 11/12/2022]
Abstract
Electromagnetic stimulation is a common therapy used to support bone healing in the case of avascular necrosis of the femoral head. In the present study, we investigated a bipolar induction screw system with an integrated coil. The aim was to analyse the influence of the screw parameters on the electric field distribution in the human femoral head. In addition, three kinds of design parameters (the shape of the screw tip, position of the screw in the femoral head, and size of the screw insulation) were varied. The electric field distribution in the bone was calculated using the finite element software Comsol Multiphysics. Moreover, a validation experiment was set up for an identical bone specimen with an implanted screw. The electric potential of points inside and on the surface of the bone were measured and compared to numerical data. The electric field distribution within the bone was clearly changed by the different implant parameters. Repositioning the screw by a maximum of 10 mm and changing the insulation length by a maximum of 4 mm resulted in electric field volume changes of 16% and 7%, respectively. By comparing the results of numerical simulation with the data of the validation experiment, on average, the electric potential difference of 19% and 24% occurred when the measuring points were at a depth of approximately 5 mm within the femoral bone and directly on the surface of the femoral bone, respectively. The results of the numerical simulations underline that the electro-stimulation treatment of bone in clinical applications can be influenced by the implant parameters.
Collapse
Affiliation(s)
- Yukun Su
- Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | | | | | | | | | | | | |
Collapse
|
26
|
Polesello GC, Pereira Guimarães R, Ricioli Júnior W, Keiske Ono N, Kiyoshi Honda E, Cavalheiro de Queiroz M. Current possibilities for hip arthroplasty. Rev Bras Ortop 2014; 49:103-10. [PMID: 26229784 PMCID: PMC4511696 DOI: 10.1016/j.rboe.2014.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 06/21/2013] [Indexed: 12/16/2022] Open
Abstract
Hip arthroscopy has been popularized over the last decade and, with technical advances regarding imaging diagnostics, understanding of the physiopathology or surgical techniques, several applications have been described. Both arthroscopy for intra-articular conditions and endoscopy for extra-articular procedures can be used in diagnosing or treating different conditions. This updated article has the objective of presenting the various current possibilities for hip arthroscopy.
Collapse
|
27
|
Polesello GC, Pereira Guimarães R, Ricioli Júnior W, Keiske Ono N, Kiyoshi Honda E, Cavalheiro de Queiroz M. Possibilidades atuais da artroscopia do quadril. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
28
|
Beck DM, Park BK, Youm T, Wolfson TS. Arthroscopic treatment of labral tears and concurrent avascular necrosis of the femoral head in young adults. Arthrosc Tech 2013; 2:e367-71. [PMID: 24400184 PMCID: PMC3882712 DOI: 10.1016/j.eats.2013.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/07/2013] [Indexed: 02/03/2023] Open
Abstract
Avascular necrosis (AVN) of the femoral head is a progressive disease affecting young adults that results in collapse of the femoral head and subsequent degenerative joint disease. Although precollapse stages of AVN can be successfully treated with core decompression, making the diagnosis is often difficult given alternative sources of hip pain in this age group. We propose that arthroscopic-assisted core decompression of the femoral head offers an effective method of addressing AVN of the femoral head as well as coexistent hip disorders in the same operation. This article describes in detail the technique used to perform an arthroscopic-assisted core decompression of the femoral head, and a companion video demonstrating the procedure is included. Our experience suggests that arthroscopic-assisted core decompression can be used as an alternative to open core decompression, while simultaneously addressing other sources of hip pain, with successful outcomes.
Collapse
Affiliation(s)
- David M. Beck
- School of Medicine, New York University, New York, New York, U.S.A
| | - Brian K. Park
- Hospital for Joint Diseases, New York University, New York, New York, U.S.A
| | - Thomas Youm
- Hospital for Joint Diseases, New York University, New York, New York, U.S.A
| | | |
Collapse
|