1
|
Beck EC, Trasolini NA. Editorial Commentary: Osteochodral Autograft and Allograft Show Favorable Outcomes for High-Grade Hip Femoral Cartilage Lesions, but Caution Is Required for Impaction Injuries and Osteonecrosis. Arthroscopy 2024:S0749-8063(24)00295-0. [PMID: 38677565 DOI: 10.1016/j.arthro.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 03/30/2024] [Accepted: 03/30/2024] [Indexed: 04/29/2024]
Abstract
Articular cartilage defects of the hip pose therapeutic challenges. Among patients undergoing hip arthroscopy for femoroacetabular impingement syndrome, more than 20% may have partial- or full-thickness chondral damage, and patients with high-grade (International Cartilage Repair Society grade 3 or 4) damage who undergo arthroscopic treatment of femoroacetabular impingement syndrome have higher rates of reoperation at 10-year follow-up. Arthroscopic and open techniques have been developed to translate cartilage restoration options initially developed in the knee for use in the hip. Arthroscopic options include chondroplasty, microfracture, biologic cartilage scaffolds, autologous chondrocyte implantation, and minced cartilage autograft (albeit more commonly in the acetabulum than the femoral head). Open techniques include autologous chondrocyte grafting, osteochondral autograft transfer (including mosaicplasty), osteochondral allograft transplantation, and arthroplasty. Open osteochondral allograft and autograft transplantation show improved patient-reported outcomes and forestall arthroplasty in young patients with high-grade cartilage defects of the femoral head. A recent review shows survivorship of 70% to 87.5% for allograft and 61.5% to 96% for autograft. At the same time, outcomes are not universally positive, particularly for patients with posttraumatic impaction injuries and high-grade osteonecrosis. Until further data better clarify the indications and contraindications, widespread adoption of open cartilage transplantation to the femoral head should be approached with caution, especially for older patients, in whom the gold standard of total hip arthroplasty has excellent survivorship at long-term follow-up.
Collapse
|
2
|
Fong S, Lee MS, Pettinelli N, Norman M, Park N, Gillinov SM, Zhu J, Gagné J, Lee AY, Mahatme RJ, Jimenez AE. Osteochondral Allograft or Autograft Transplantation of the Femoral Head Leads to Improvement in Outcomes but Variable Survivorship: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00128-2. [PMID: 38365122 DOI: 10.1016/j.arthro.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE To review patient-reported outcomes (PROs) and survivorship in patients undergoing osteochondral autograft or allograft transplantation (OAT) of the femoral head. METHODS PubMed, Cochrane Center for Register of Controlled Trials, and Scopus databases were searched in November 2022 with an updated search extending to December 2023 using criteria from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the following keywords: (hip OR femoral head) AND (mosaicplasty OR osteochondral allograft OR osteochondral autograft OR osteochondral lesion). Articles were included if they evaluated postoperative PROs in patients who underwent OAT of the femoral head and had a study size of 5 or more hips (n ≥ 5). Survivorship was defined as freedom from conversion to total hip arthroplasty. For PROs evaluated in 3 studies or more, forest plots were created and I2 was calculated. RESULTS Twelve studies were included in this review, with a total of 156 hips and a mean follow-up time ranging between 16.8 and 222 months. In total, 104 (66.7%) hips were male while 52 (33.3%) were female. Age of patients ranged from 17.0 to 35.4 years, while body mass index ranged from 23.3 to 28.1. Eight studies reported on osteochondral autograft transplantation and 4 studies on osteochondral allograft transplantation. Three studies reported significant improvement in at least 1 PRO. Survivorship ranged from 61.5% to 96% at minimum 2-year follow-up and from 57.1% to 91% at minimum 5-year follow-up. At a follow-up of less than 5 years, osteochondral allograft transplantation studies showed 70% to 87.5% survivorship, while autograft varied from 61.54% to 96%. CONCLUSIONS Patients with osteochondral lesions of the femoral head who underwent osteochondral autograft or allograft transplantation demonstrated improved PROs but variable survivorship rates. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
Collapse
Affiliation(s)
- Scott Fong
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | | | - Mackenzie Norman
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Nancy Park
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Justin Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jack Gagné
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Amy Y Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A..
| |
Collapse
|
3
|
Gong Y, Jin Z, Zhou H, Su H, Chen G, Zhong Y, Tong P. Modified osteochondral autograft transplantation for steroid-induced osteonecrosis of femoral head in idiopathic thrombocytopenic purpura: a case report and literature. BMC Musculoskelet Disord 2024; 25:19. [PMID: 38167054 PMCID: PMC10759329 DOI: 10.1186/s12891-023-07108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024] Open
Abstract
Osteochondral autograft transplantation (OAT) has been commonly applied in the knee and ankle while the technique has not yet been a popularity in the femoral head. In this article, we present a 28-year-old female patient, who has a history of 1-year-use of glucocorticoid in the treatment of idiopathic thrombocytopenic purpura, with steroid-induced osteonecrosis of the femoral head (SONFH). She underwent surgical hip dislocation, osteochondroplasty, OAT, and internal fixation. Her Harris Hip Score improved from 64 to 82 in 36 months to follow-up. The case is valuable considering that a single, instead of several, 1.5 cm autograft was harvested from the non-bearing part of the same femoral head. This modification dispensed with the need of surgery for harvesting autograft from knee or ankle and reduced the structural vulnerability brought by the multihole donor part of the femoral head.
Collapse
Affiliation(s)
- Yichen Gong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Zhaokai Jin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Haojin Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Hai Su
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Guoqian Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Ying Zhong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China.
| |
Collapse
|
4
|
Passaplan C, Hanauer M, Gautier L, Stetzelberger VM, Schwab JM, Tannast M, Gautier E. Surface repair of the femoral head using press-osteochondral autograft transfer. Bone Jt Open 2023; 4:523-531. [PMID: 37429592 DOI: 10.1302/2633-1462.47.bjo-2022-0137.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
Aims Hyaline cartilage has a low capacity for regeneration. Untreated osteochondral lesions of the femoral head can lead to progressive and symptomatic osteoarthritis of the hip. The purpose of this study is to analyze the clinical and radiological long-term outcome of patients treated with osteochondral autograft transfer. To our knowledge, this study represents a series of osteochondral autograft transfer of the hip with the longest follow-up. Methods We retrospectively evaluated 11 hips in 11 patients who underwent osteochondral autograft transfer in our institution between 1996 and 2012. The mean age at the time of surgery was 28.6 years (8 to 45). Outcome measurement included standardized scores and conventional radiographs. Kaplan-Meier survival curve was used to determine the failure of the procedures, with conversion to total hip arthroplasty (THA) defined as the endpoint. Results The mean follow-up of patients treated with osteochondral autograft transfer was 18.5 years (9.3 to 24.7). Six patients developed osteoarthritis and had a THA at a mean of 10.3 years (1.1 to 17.3). The cumulative survivorship of the native hips was 91% (95% confidence interval (CI) 74 to 100) at five years, 62% (95% CI 33 to 92) at ten years, and 37% (95% CI 6 to 70) at 20 years. Conclusion This is the first study analyzing the long-term results of osteochondral autograft transfer of the femoral head. Although most patients underwent conversion to THA in the long term, over half of them survived more than ten years. Osteochondral autograft transfer could be a time-saving procedure for young patients with devastating hip conditions who have virtually no other surgical options. A larger series or a similar matched cohort would be necessary to confirm these results which, in view of the heterogeneity of our series, seems difficult to achieve.
Collapse
Affiliation(s)
- Caroline Passaplan
- Department of Orthopaedic Surgery, HFR - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Matthieu Hanauer
- Department of Orthopaedic Surgery, HFR - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | | | - Vera M Stetzelberger
- Department of Orthopaedic Surgery, HFR - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Joseph M Schwab
- Department of Orthopaedic Surgery, HFR - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, HFR - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Emanuel Gautier
- Department of Orthopaedic Surgery, HFR - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| |
Collapse
|
5
|
Li J, Mo L, Bai G, Wang Z, Zhang H, Li J. One in five patients require conversion to arthroplasty after non-vascularized bone grafts in patients with osteonecrosis of the femoral head: a systematic review. J Orthop Surg Res 2023; 18:77. [PMID: 36721188 PMCID: PMC9887751 DOI: 10.1186/s13018-023-03544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/15/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Non-vascularized bone grafting (NVBG) has demonstrated to treat osteonecrosis of the femoral head (ONFH). There are a number of articles updating the use of NVBG to treat the ONFH, but the percentage of patients subsequently undergoing a total hip arthroplasty (THA) is controversial. METHODS Several electronic databases, including PubMed, Embase, Web of Science, and Cochrane databases, were searched to find studies using NVBG to treat ONFH. The pooled rate and 95% confidence interval (CI) were used to assess the conversion rate to THA after NVBG. In addition, we performed subgroup, sensitivity, and publication bias analysis. RESULTS A total of 37 studies describing 2599 hips were included. The mean weighted follow-up time was 50.5 months and the mean age at surgery was 36.3 years. The conversion rate to THA after NVBG was 21% (95%CI: 17% to 25%), and subgroup analyzes indicated lightbulb, trapdoor and Phemister techniques incidences with THA of 15%, 19%, and 24%, respectively. CONCLUSIONS This study preliminarily obtained the general trend of the survival rate of NVBG patients, but these results should be interpreted cautiously. Pooled results from 2599 hips and of these nearly 80% with early stage of osteonecrosis, showed that approximately 21% of patients underwent a THA following NVBG. NVBG treatment for patient with ONFH appears to defer or at least delay the need for THA.
Collapse
Affiliation(s)
- Jianxiong Li
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Liang Mo
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Guowen Bai
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Zhangzheng Wang
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Hua Zhang
- grid.412595.eThe First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Jie Li
- grid.412595.eThe First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| |
Collapse
|
6
|
Díaz-Dilernia F, Astore F, Buttaro M, Zanotti G. Short-Term Results of Osteochondral Autologous Transfer and Femoral Neck Osteochondroplasty for the Treatment of Osteochondral Lesions of the Femoral Head and Concomitant Femoroacetabular Impingement Syndrome: A Case Series. Hip Pelvis 2022; 34:177-184. [PMID: 36299472 PMCID: PMC9577305 DOI: 10.5371/hp.2022.34.3.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 11/07/2022] Open
Abstract
This study aimed to analyse the initial results of five patients with symptomatic osteochondral lesions (OCL) and femoroacetabular impingement (FAI) who were treated successfully with osteochondral autologous transfer (OAT) and femoral neck osteochondroplasty (OCP) through surgical dislocation of the hip. Five patients with FAI and OCL of the femoral head who underwent surgery between 2015-2018 were studied retrospectively. All patients had a grade IV OCL, and the median defect size was 2 cm2 (interquartile range [IQR], 2-2). At the final follow-up, the modified Harris hip score showed a median value of 94 (IQR, 91-95) (P=0.04). Pain evaluation using the visual analogue scale showed a median value of 1 (IQR, 1-2) (P=0.04). Adequate graft union and healthy formation of the chondral surface were observed by magnetic resonance imaging. Although the procedure is demanding, the combination of OAT and femoral neck OCP appears to be an effective alternative in young patients.
Collapse
Affiliation(s)
- Fernando Díaz-Dilernia
- Sunnybrook Health Sciences Centre/Holland Orthopaedic & Arthritic Centre, Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Franco Astore
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Martin Buttaro
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gerardo Zanotti
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
7
|
Liu N, Zheng C, Wang Q, Huang Z. Treatment of non-traumatic avascular necrosis of the femoral head (Review). Exp Ther Med 2022; 23:321. [PMID: 35386618 PMCID: PMC8972838 DOI: 10.3892/etm.2022.11250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/26/2022] [Indexed: 11/06/2022] Open
Abstract
Non-traumatic osteonecrosis of the femoral head is the main cause of disability in young individuals and incurs major health care expenditure. The lifestyle changes in recent years, especially increased use of hormones and alcohol consumption, has greatly increased the incidence of femoral head necrosis. The underlying causes and risk factors of osteonecrosis of the femoral head are increasingly being elucidated, which has led to the development of novel surgical and non-surgical treatment options. Although the main goal of any treatment method is prevention and delaying the progression of disease, there is no common consensus on the most suitable method of treatment. The present review discussed the latest developments in the etiology and treatment methods for femoral head necrosis.
Collapse
Affiliation(s)
- Ning Liu
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | | | - Qinglong Wang
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Zhipeng Huang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, Shaanxi 710000, P.R. China
| |
Collapse
|
8
|
Verma T, Mishra A, Agarwal G, Maini L. Three dimensional surgical planning for mosaicplasty in chondroblastoma of femoral head with articular disruption. J Orthop Sci 2021; 26:719-724. [PMID: 30391136 DOI: 10.1016/j.jos.2018.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/25/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Tarun Verma
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | - Abhishek Mishra
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | - Gaurang Agarwal
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | - Lalit Maini
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| |
Collapse
|
9
|
He M, Wei Q, Chen Z, Yang F, Chen X, Qin YX, Fang B, He W. Porous tantalum rod implantation is associated with low survival rates in patients with type C2 osteonecrosis of the femoral head but has no effect on the clinical outcome of conversion total hip arthroplasty: a retrospective study with an average 8-year follow-up. BMC Musculoskelet Disord 2020; 21:841. [PMID: 33308229 PMCID: PMC7733268 DOI: 10.1186/s12891-020-03860-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Our study aimed to investigate the clinical outcomes and survival rates following porous tantalum rod surgery (PTRS) and conversion total hip arthroplasty (THA) subsequent to failed PTRS. Methods A total of 38 subjects (40 hips) with osteonecrosis of the femoral head (ONFH) were included in this retrospective study between January 2008 and December 2011. All subjects were evaluated before surgery by using the Association Research Circulation Osseous (ARCO) classification system, the Japan Investigation Committee (JIC) classification and the Harris hip score (HHS). The endpoint of this study was set as final follow-up (including the survival time of PTRS and conversion THA). The rates of radiological progression were also evaluated. Patients who received conversion THA were further followed and compared to a control group of 58 patients with ONFH who underwent primary THA. Results The mean follow-up time was 120.7 ± 9.2 (range, 104–143) months, and the overall survival rate was 75% at 96 months (ARCO stage II: 81.5%; stage III: 38.5%; JIC type C1: 83.3%; C2: 30%). The HHS before surgery was 59 (55–61), in contrast to 94 (91–96) at 96 months follow-up (P < 0.01). HHS in stage III show a significant poorer result compared to stage II at 24 months. HHS in Type C2 group show no significant difference compared to HHS before surgery at 24 and 60 months follow up (P = 0.91, P = 0.30). Twelve hips requiring secondary THA were followed for 66.9 ± 31.7 months, and control hips that underwent primary THA was followed for 75.4 ± 14.9 months. The HHS in the conversion group was 89 (86–93) and that in the primary THA group was 92 (79–95, P = 0.09) at the 5-year follow-up. Conclusion In the mid-term follow-up, porous tantalum implants showed an encouraging survival rate in symptomatic patients in early stages (ARCO stage II) or with limited necrotic lesions (JIC type C1). In addition, our results did not demonstrated any difference between primary THA and conversion THA.
Collapse
Affiliation(s)
- Mincong He
- Department of Orthopedic Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.,Laboratory of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Qiushi Wei
- Institute of Orthopedics of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.12 Jichang Road, Guangzhou, Guangdong, 510405, People's Republic of China
| | - Zhenqiu Chen
- Laboratory of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fan Yang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Xiaojun Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Yi-Xian Qin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Bin Fang
- Department of Orthopedic Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China. .,Laboratory of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Wei He
- Institute of Orthopedics of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. .,The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.12 Jichang Road, Guangzhou, Guangdong, 510405, People's Republic of China.
| |
Collapse
|
10
|
Osteochondral autograft transplantation of the femoral head in sequelae of developmental dysplasia of hip: A case report and review of the literature. Jt Dis Relat Surg 2020; 31:619-625. [PMID: 32962599 PMCID: PMC7607946 DOI: 10.5606/ehc.2020.75135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although osteochondral autograft transplantation (OAT) in the knee and ankle has gained much popularity on the other hand the technique has rarely been applied in the femoral head. In this article, we present a 15-year-old female patient with unstable chondral lesion on the right femoral head. She had a history of open reduction for developmental dysplasia which resulted in avascular necrosis. She had coxa magna, breva and trochanteric overgrowth along with an unstable chondral lesion on the superolateral part of the femoral head. She underwent OAT for chondral lesion, femoral head reshaping and relative neck lengthening. Her Harris Hip Score improved from 55 to 90 in the 18 months of follow-up. The case is unique in a way that the autografts were harvested from the anterior part of the same femoral head that was already intended to be removed during osteochondroplasty.
Collapse
|
11
|
Bone marrow lesion on magnetic resonance imaging indicates the last chance for hip osteonecrosis treated with vascularized fibular grafting before collapse. INTERNATIONAL ORTHOPAEDICS 2020; 44:2529-2536. [PMID: 32712789 DOI: 10.1007/s00264-020-04697-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Timing of surgery is the most critical prognostic factor for hip osteonecrosis treated with free vascularized fibular grafting (FVFG). Bone marrow lesion (BML) on MRI usually occurs immediately before femoral head collapse. We conducted a retrospective cohort study to evaluate whether the noncollapsed hips with BML can benefit from FVFG. METHODS Consecutive patients undergoing modified FVFG were identified from our clinical repository between January 2014 and December 2014. Based on whether BML was pre-operatively detected, the four year radiographic and clinical outcomes were compared. RESULTS In the BML cohort, 22 of 53 hips (42%) showed radiographic signs of osteonecrosis progression, which was significantly higher than that in the control cohort (8 of 49, 16%; P = 0.005). The BML hips showed a significantly lower pre-operative Harris Hip Score (HHS) than those without BML (77.8 vs. 85.5, P = 0.046), whereas no such difference was observed in the final HHS or its post-operative improvement (HHS 90 vs. 94, P = 0.397; HHS improvement 12 vs. 8, P = 0.067). In the subgroup of patients with a pre-operative HHS lower than 80, BML hips were associated with a slightly lower final HHS than hips without BML. Four of 5 (80%) failed hips with BML had a poor pre-operative hip function. CONCLUSION BML indicates the last chance for a reproducible improvement in the treatment of hip osteonecrosis with FVFG before collapse. However, the concomitant lower pre-operative HHS (< 80) is a poor prognostic factor for BML-positive hips.
Collapse
|
12
|
Massin P. Treatments of avascular osteonecrosis of the hip: Current treatments. Morphologie 2020; 105:120-126. [PMID: 32653168 DOI: 10.1016/j.morpho.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/17/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022]
Abstract
Conservative treatments for aseptic osteonecrosis of the femoral head have their ancestor in the core decompression of the femoral neck, recommended by Ficat. Due to inconsistent results, this treatment has been optimized by either vascularized fibular grafting, or by injecting autologous stem cells into the necrotic zone. The French promoters have published long-term results, showing efficacy in the early stages of the disease, where the femoral head has not yet lost its sphericity. Over the last 10years, comparative studies, sometimes randomized, opposing them to simple core decompression, have been published by non-promoters, confirming the possibility of stabilization or even regression of necrosis area. But these techniques are not easy to implement. Cell therapy requires treatment of marrow samples by centrifugation to obtain a pellet with a high concentration of haematopoietic cells. The now proven long-term efficacy as well as the safety of this technique make it the method of choice for treating young patients detected at the sub-radiological stage by MRI. Unfortunately, many are seen late with detached cephalic cartilage or collapsed femoral head and have no other option than total hip arthroplasty. This technique is very reliable. With alumina ceramics, results of more than 20years show the absence of wear and osteolysis, although other complications such as instability or periprosthetic fractures may occur in these young and active patients.
Collapse
Affiliation(s)
- P Massin
- CMC Ambroise-Paré-Hartmann, 3, rue de l'Hôtel-de-Ville, 92200 Neuilly-sur-Seine, France.
| |
Collapse
|
13
|
Cheng Q, Zhao FC, Xu SZ, Zheng L, Zheng X. Modified trapdoor procedures using autogenous tricortical iliac graft without preserving the broken cartilage for treatment of osteonecrosis of the femoral head: a prospective cohort study with historical controls. J Orthop Surg Res 2020; 15:183. [PMID: 32448346 PMCID: PMC7245755 DOI: 10.1186/s13018-020-01691-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/29/2020] [Indexed: 01/23/2023] Open
Abstract
Background The aim of the present study was to investigate clinical and radiological outcomes of autologous tricortical iliac grafting performed through a window created at the femoral head without suturing the opened articular cartilage for the treatment of osteonecrosis of the femoral head (ONFH), called modified trapdoor procedures. Materials and methods A total of 59 consecutive patients (67 hips; 36 males and 23 females) with ONFH were included in this study, which was conducted from April 2009 to March 2012. Patients’ age ranged from 27 to 46 years old, with a mean age of 36.3 years. Harris hip scores (HHS) were used to evaluate hip function pre- and postoperatively. Anteroposterior and frog-position X-rays and magnetic resonance imaging (MRI) were conducted to assess lesion location, size, and ARCO stage. Clinical failure was defined as score < 80 points or treatment by total hip arthroplasty (THA). Radiographic failure was defined as a > 3 mm of collapse in the hip. This group was retrospectively matched according to the ARCO stage, extent, location, etiology of the lesion, average age, gender, and preoperative Harris hip score to a group of 59 patients (67 hips) who underwent the “light bulb” approach between March 2007 and April 2009. Results Mean follow-up was 91.2 ± 13.6 months (range, 75–115 months). Mean HHS was 91.3 ± 4.5, compared with 83.1 ± 4.5 in the “light bulb” cohort at the 6-year follow-up examination (P < 0.001). At the 6-year follow-up, for modified trapdoor procedures, five hips (8.5%) were classified as clinical failure, and three hips underwent total hip arthroplasty; seven hips were classified as (10.4%) radiographic failure. The clinical and radiographic failure of the hips treated with the modified trapdoor procedure was significantly lower compared to the hips treated with the “light bulb” procedure (P < 0.05). Survival of the joint was not significantly related to the location of the femoral head lesion between two groups; however, better clinical and radiographic results were observed in modified trapdoor procedures with size C and the ARCO stage III. Conclusion The present study demonstrated superior midterm clinical results in ONFH with the use of autologous tricortical iliac block graft through a femoral head window, without suturing the opened articular cartilage. The femoral head-preserving procedure was superior compared to the “light bulb” procedure treatment in patients with postcollapse osteonecrosis and large lesion.
Collapse
Affiliation(s)
- Qi Cheng
- Department of Orthopedic Surgery, The Xuzhou Third Hospital, Xuzhou City, 221000, Jiangsu Province, China
| | - Feng-Chao Zhao
- Department of Orthopedic Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, 310003, Zhejiang Province, China.
| | - Shi-Zhuang Xu
- Department of Orthopedic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, 221002, Jiangsu Province, China
| | - Li Zheng
- Department of Orthopedic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, 221002, Jiangsu Province, China
| | - Xin Zheng
- Department of Orthopedic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, 221002, Jiangsu Province, China
| |
Collapse
|
14
|
Viamont-Guerra MR, Bonin N, May O, Le Viguelloux A, Saffarini M, Laude F. Promising outcomes of hip mosaicplasty by minimally invasive anterior approach using osteochondral autografts from the ipsilateral femoral head. Knee Surg Sports Traumatol Arthrosc 2020; 28:767-776. [PMID: 30820604 DOI: 10.1007/s00167-019-05442-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/22/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Recent studies demonstrated promising results of mosaicplasty for femoral head osteochondral lesions using posterior and lateral approaches. This study aimed to evaluate outcomes of mosaicplasty using ipsilateral femoral head autografts by minimally invasive anterior approach. The hypothesis was that this surgical technique would grant satisfactory clinical outcomes with considerable improvement of clinical scores. METHODS A consecutive series of 27 mosaicplasties, to treat osteochondral lesions of the femoral head measuring 1.6 ± 0.7 cm2 (range 0.8-4.0) in patients aged 28.7 ± 7.4 years (range 19-44), was evaluated using the mHHS and WOMAC scores at minimum follow-up of 12 months. All patients were operated by minimally invasive anterior (Hueter) approach and osteochondral plugs were harvested from the non-weight-bearing portion of the femoral head. Adjuvant osteoplasty was necessary for some patients at the acetabulum (n = 3), femur (n = 14) or both (n = 2). RESULTS Three patients were excluded due to concomitant periacetabular osteotomies or shelf procedures, one patient could not be reached, and another was revised to THA. This left 22 patients for clinical assessment at 39.4 ± 23.2 months (12.0-90.2). Their mHHS improved from 56.3 ± 12.6 to 88.4 ± 9.9, and WOMAC improved from 45.1 ± 16.9 to 80.6 ± 13.0. Two patients (8.4%) underwent arthroscopy at 13 and 30 months to remove painful residual cam-type deformities. Regression analyses revealed that net improvement in WOMAC decreased with lesion size (p = 0.002) and increased with follow-up (p = 0.004). CONCLUSIONS Hip mosaicplasty using autografts from the ipsilateral femoral head, performed by minimally invasive anterior approach, granted satisfactory outcomes and functional improvements. Caution is, however, advised for lesions > 2 cm2 (diameter > 16 mm) which may be a threshold limit for this procedure. LEVEL OF EVIDENCE Level IV, Case series.
Collapse
Affiliation(s)
- Maria-Roxana Viamont-Guerra
- Ramsey General de Santé, Clinique du Sport Paris V, 36 Boulevard Saint-Marcel, 75005, Paris, France.,Lyon-Ortho-Clinic, 29B Avenue des sources, 69009, Lyon, France
| | - Nicolas Bonin
- Lyon-Ortho-Clinic, 29B Avenue des sources, 69009, Lyon, France
| | - Olivier May
- Clinique Médipole-Garonne, 45 rue Gironis, 31036, Toulouse, France
| | | | - Mo Saffarini
- ReSurg SA, 35 chemin de la Vuarpillière, 1260, Nyon, Switzerland.
| | - Frédéric Laude
- Ramsey General de Santé, Clinique du Sport Paris V, 36 Boulevard Saint-Marcel, 75005, Paris, France
| |
Collapse
|
15
|
Abstract
Osteonecrosis of the femoral head is a poorly understood condition that may lead to progressive destruction of the hip joint. Its incidence is common between the third and fifth decades of life and it is the diagnosis behind 5–18% of annually performed total hip arthroplasties (THAs) in the USA. Regarding the high rate of complications of THA in that age group, authors have agreed on the importance of joint-preservation techniques for this disease but techniques vary to establish a generally accepted algorithmic approach. Surgical head-preserving procedures, core decompression with or without graft, stem cell augmentation, or biologic adjuncts, vascularized bone grafting, and proximal femoral osteotomies have all been published on with heterogeneous results and with limited evidence to date. Consensus states that the prognosis of patients with osteonecrosis of the femoral head can be significantly improved with early diagnosis and timely intervention.
Cite this article: EFORT Open Rev 2019;4:647-658. DOI: 10.1302/2058-5241.4.180073
Collapse
Affiliation(s)
- Bülent Atilla
- Hacettepe University Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Sancar Bakırcıoğlu
- Hacettepe University Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Alexander J Shope
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Javad Parvızı
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
16
|
Zhao D, Liu B, Wang B. Vascularized Greater Trochanter Bone Flap Transfer for Treatment of ARCO Stage-IIB to IIIB Osteonecrosis of the Femoral Head. JBJS Essent Surg Tech 2019; 9:e20. [PMID: 31579538 DOI: 10.2106/jbjs.st.18.00092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The goal of a vascularized bone flap transfer is to replace the necrotic bone of the femoral head, restore the blood supply, and provide new bone and mechanical support for the femoral head. Description The major steps of the procedure that are demonstrated in this article are: (1) using the anterolateral approach to the hip, the incision is made; (2) the interval between the rectus femoris and vastus lateralis is split, the transverse branch of the lateral femoral circumflex artery is identified, and the pedicle is isolated and protected; (3) the vascularized bone flap is harvested from the greater trochanter; (4) necrotic bone is debrided through a bone window made at the junction of the femoral neck and head; (5) the cancellous bone from the greater trochanter is implanted, and the vascularized bone flap is positioned and fixed; and (6) the wound is closed in layers. Complications are rare, and full weight-bearing is allowed after 3 months postoperatively. Alternatives Free vascularized fibular graft. Rationale Compared with a free vascularized fibular grafting technique, vascularized bone-grafting of the greater trochanter has the advantages of being less invasive, incurring lower donor-site morbidity, and not requiring any microsurgical technique because there is no vascular anastomosis.
Collapse
Affiliation(s)
- Dewei Zhao
- Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Baoyi Liu
- Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Benjie Wang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| |
Collapse
|
17
|
Dallich AA, Rath E, Atzmon R, Radparvar JR, Fontana A, Sharfman Z, Amar E. Chondral lesions in the hip: a review of relevant anatomy, imaging and treatment modalities. J Hip Preserv Surg 2019; 6:3-15. [PMID: 31069090 PMCID: PMC6501440 DOI: 10.1093/jhps/hnz002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/13/2018] [Accepted: 02/03/2019] [Indexed: 12/20/2022] Open
Abstract
The diagnosis and treatment of chondral lesions in the hip is an ongoing challenge in orthopedics. Chondral lesions are common and several classification systems exist to classify them based on severity, location, radiographic parameters, and potential treatment options. When working up a patient with a potential hip chondral lesion, a complete history, thorough physical exam, and ancillary imaging are necessary. The physical exam is performed with the patient in standing, supine, prone, and lateral positions. Plain film radiographs are indicated as the first line of imaging; however, magnetic resonance arthrogram is currently the gold standard modality for the diagnosis of chondral lesions outside of diagnostic arthroscopy. Multiple treatment modalities to address chondral lesions in the hip exist and new treatment modalities continue to be developed. Currently, chondroplasty, microfracture, cartilage transplants (osteochondral autograft transfer, mosaicplasty, Osteochondral allograft transplantation) and incorporation of orthobiologics (Autologous chondrocyte implantation, Autologous matrix-induced chondrogenesis, Mononuclear concentrate in platelet-rich plasma) are some techniques that have been successfully applied to address chondral pathology in the hip. Further refinement of these modalities and research in novel techniques continues to advance a surgeon’s ability to address chondral lesions in the hip joint.
Collapse
Affiliation(s)
- Alison A Dallich
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Atzmon
- Department of Orthopedics, Assuta Medical Center, Ashdod, Israel
| | - Joshua R Radparvar
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrea Fontana
- Orthopaedics Department, C.O.F. Lanzo Hospital, Como, Italy in association with the Orthopaedics Department, University of Pavia, Pavia, Italy
| | - Zachary Sharfman
- Department of Orthopedic Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, USA
| | - Eyal Amar
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
18
|
Zhang Y, Yu J, Ren K, Zuo J, Ding J, Chen X. Thermosensitive Hydrogels as Scaffolds for Cartilage Tissue Engineering. Biomacromolecules 2019; 20:1478-1492. [PMID: 30843390 DOI: 10.1021/acs.biomac.9b00043] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Yanbo Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130033, P. R. China
| | - Jiakuo Yu
- Knee Surgery Department of the Institute of Sports Medicine, Peking University Third Hospital, 49 Huayuanbei Road, Beijing 100191, P. R. China
| | - Kaixuan Ren
- Mork Family Department of Chemical Engineering & Materials Science, University of Southern California, 925 West 34th Street, Los Angeles, California 90089, United States of America
| | - Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130033, P. R. China
| | - Jianxun Ding
- Key Laboratory
of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, P. R. China
- Jilin Biomedical Polymers Engineering Laboratory, 5625 Renmin Street, Changchun 130022, P. R. China
| | - Xuesi Chen
- Key Laboratory
of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, P. R. China
- Jilin Biomedical Polymers Engineering Laboratory, 5625 Renmin Street, Changchun 130022, P. R. China
| |
Collapse
|
19
|
Zhao D, Wang B, Liu B. Vascularized Iliac Bone Flap Transfer for Early and Middle Stages of Osteonecrosis of the Femoral Head. JBJS Essent Surg Tech 2019; 9:e5. [PMID: 31086723 DOI: 10.2106/jbjs.st.18.00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Osteonecrosis of the femoral head often affects young active adults and leads to destruction of the hip joint and severe arthritis1-4. Despite improvements in hip arthroplasty design and techniques, it is unlikely that prosthetic replacements will endure for life. Alternatively, various head-preserving procedures have been used to avert or delay the need for a total hip arthroplasty5-11. Vascularized iliac bone flap transfer is a joint-preserving procedure that can be considered for younger patients with early or middle-stage osteonecrosis of the femoral head. Description The major steps of the procedure include (1) an anterior approach to the affected hip, (2) creation of a bone flap from the iliac crest pedicled with the ascending branch of the lateral circumflex femoral artery, (3) obtaining cancellous bone from the iliac crest, (4) exposure of the anterior aspect of the femoral neck, (5) creation of a 2 × 2-cm window at the junction of the femoral head and neck, (6) debridement and removal of the necrotic bone, (7) implantation of the cancellous bone and vascularized bone flap, (8) fixation of the bone flap, and (9) layer-by-layer wound closure. Complications are rare, and full weight-bearing is allowed at 6 months postoperatively. Alternatives Alternatives to the procedure include core decompression, nonvascularized bone-grafting, free vascularized fibular grafting, and vascularized greater trochanter grafting. Rationale Various femoral head-preserving procedures have been reported. Core decompression is an effective femoral head-preserving procedure and is recommended as the first surgical treatment option for symptomatic small to medium-sized precollapse lesions. However, outcomes are poor when a patient has a large lesion or femoral head collapse. The advantage of vascularized iliac bone flap transfer is that it allows femoral head decompression, restores blood supply, and provides structural support. Thus, this procedure can be performed in patients with later osteonecrosis stages before hip osteoarthritis has progressed.
Collapse
Affiliation(s)
- Dewei Zhao
- Zhongshan Hospital of Dalian University, Dalian, China
| | - Benjie Wang
- Zhongshan Hospital of Dalian University, Dalian, China
| | - Baoyi Liu
- Zhongshan Hospital of Dalian University, Dalian, China
| |
Collapse
|
20
|
The use of non-vascularized bone grafts to treat osteonecrosis of the femoral head: indications, techniques, and outcomes. INTERNATIONAL ORTHOPAEDICS 2018; 43:1315-1320. [DOI: 10.1007/s00264-018-4056-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
|
21
|
Zhang C, Zhu X, Pei G, Xu P, Zeng X, Zhang L, Zhang N, Zeng D, Cao L, Yu W, Zhang X. Dyslipidaemia for patients with low-energy femoral neck fractures after the treatment of cancellous screws: a retrospective study with a 3-year minimum follow-up. BMC Musculoskelet Disord 2017; 18:440. [PMID: 29126401 PMCID: PMC5681794 DOI: 10.1186/s12891-017-1804-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 11/03/2017] [Indexed: 01/13/2023] Open
Abstract
Background Avascular necrosis of the femoral head (AVNFH) occurs infrequently following femoral neck fracture. The association between AVNFH and dyslipidaemia remains controversial. Although major risk factors for AVNFH have been proposed, most of them remain under discussion. Our purpose herein was to evaluate the association between dyslipidaemia and AVNFH following low-energy femoral neck fractures treated with cancellous screws in elderly patients in our tertiary care centre. Methods Four hundred and seventy-two consecutive patients (472 hips) with low-energy femoral neck fractures were identified and treated with cancellous screws from July 2007 to April 2013. Patients underwent evaluations preoperatively and each subsequent postoperative visit (months 1, 6, 12, 18, 24, 30, and 36). Clinical and radiographic evaluations were documented at each visit. The risk factors of AVNFH were assessed by multivariate binary logistic analysis. Results Follow-up was available for 277 patients, which included 135 patients diagnosed with AVNFH (AVNFH group) and 142 patients without AVNFH (control group). The median follow-up for patients alive at the time of analysis was 40 months (range, 37 to 46 months). The mean total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and apolipoprotein B (Apo-B) values were considerably higher in the AVNFH group compared with those in the control group. The mean high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1(Apo-A1) values were significantly lower in the AVNFH group compared with those in the control group. A multivariate logistic backward regression model showed that HDL-C and LDL-C were the only variables associated with the development of postoperative AVNFH in patients with a femoral neck fracture (Odds ratio[OR] 33.09, 95% Confidence Interval[CI]: 2.65–19.42, p < 0.001 and OR 45.94, 95% CI: 0.47–27.75, p < 0.001, respectively). Conclusion Our results suggest that both low HDL-C and high LDL-C have a tendency to result in the occurrence of AVNFH in elderly patients with low-energy femoral neck fractures treated with cancellous screws.
Collapse
Affiliation(s)
- Chi Zhang
- The first clinical college of Jinan University, Huangpu Avenue West No.613, Tianhe District, Guangzhou, 510630, China.,Department of joint surgery, The Third Affiliated Hospital of Guangzhou Medical University, Duobao Road No.63, Liwan District, Guangzhou, Guangdong, 510150, China
| | - Xiaoxiao Zhu
- Endocrine Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Genwang Pei
- Department of ENT, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Ping Xu
- Radiology Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Xianshang Zeng
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Lili Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Nan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Dan Zeng
- Ultrasonography Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Lei Cao
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Gusao Road No. 16, Jianghan District, Wuhan, Hubei, 430014, China
| | - Weiguang Yu
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai City, 201508, China.
| |
Collapse
|
22
|
Chughtai M, Piuzzi NS, Khlopas A, Jones LC, Goodman SB, Mont MA. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J 2017; 99-B:1267-1279. [PMID: 28963146 DOI: 10.1302/0301-620x.99b10.bjj-2017-0233.r2] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/09/2017] [Indexed: 12/24/2022]
Abstract
Non-traumatic osteonecrosis of the femoral head is a potentially devastating condition, the prevalence of which is increasing. Many joint-preserving forms of treatment, both medical and surgical, have been developed in an attempt to slow or reverse its progression, as it usually affects young patients. However, it is important to evaluate the best evidence that is available for the many forms of treatment considering the variation in the demographics of the patients, the methodology and the outcomes in the studies that have been published, so that it can be used effectively. The purpose of this review, therefore, was to provide an up-to-date, evidence-based guide to the management, both non-operative and operative, of non-traumatic osteonecrosis of the femoral head. Cite this article: Bone Joint J 2017;99-B:1267-79.
Collapse
Affiliation(s)
| | | | - A Khlopas
- Cleveland Clinic, Cleveland, Ohio, USA
| | - L C Jones
- Johns Hopkins University, Baltimore, Maryland, USA
| | - S B Goodman
- Stanford University, Stanford, California, USA
| | - M A Mont
- Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
23
|
Kocadal O, Akman B, Güven M, Şaylı U. Arthroscopic-assisted retrograde mosaicplasty for an osteochondral defect of the femoral head without performing surgical hip dislocation. SICOT J 2017; 3:41. [PMID: 28573968 PMCID: PMC5454798 DOI: 10.1051/sicotj/2017030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/05/2017] [Indexed: 11/14/2022] Open
Abstract
Osteochondral autograft transplantation (mosaicplasty) for the osteochondral defects of the femoral head is generally performed with safe dislocation of the hip joint. Here, we present a 27-year-old male patient who had a symptomatic osteochondral defect of the femoral head and underwent mosaicplasty applied by hip arthroscopy without surgical hip dislocation. The preoperative radiological evaluation showed a focal osteochondral defect on the weight-bearing surface of the femoral head. With the assistance of hip arthroscopy, the defect area was reconstructed with osteochondral plug, which was taken from the ipsilateral knee, inserted in a retrograde fashion, and positioned with the spherical surface of the femoral head cartilage under fluoroscopic and arthroscopic control. At the final follow-up (26 months postoperatively), he had full range of motion (ROM) without pain and radiographic evaluation showed near complete incorporation of the graft with preservation of the native joint space. Mosaicplasty can be applied in a retrograde fashion with the assistance of hip arthroscopy without using surgical hip dislocation and may be an alternative treatment option for the osteochondral defects of the femoral head in young patients.
Collapse
Affiliation(s)
- Onur Kocadal
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Yeditepe University, 34854 Istanbul, Turkey
| | - Budak Akman
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Yeditepe University, 34854 Istanbul, Turkey
| | - Melih Güven
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Yeditepe University, 34854 Istanbul, Turkey
| | - Uğur Şaylı
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Yeditepe University, 34854 Istanbul, Turkey
| |
Collapse
|
24
|
Makhni EC, Stone AV, Ukwuani GC, Zuke W, Garabekyan T, Mei-Dan O, Nho SJ. A Critical Review: Management and Surgical Options for Articular Defects in the Hip. Clin Sports Med 2017; 36:573-586. [PMID: 28577713 DOI: 10.1016/j.csm.2017.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patients with articular cartilage lesions of the hip may present with pain and symptoms that may be vague in nature and onset. Therefore, a thorough history and physical examination should be performed for every patient presenting with hip pain and/or disability. The management may be operative or nonoperative. Nonoperative management includes a trial of rest and/or activity modification, along with anti-inflammatory medications, physical therapy, and biologic injections. Operative treatment in the form of arthroscopic techniques continues to decrease morbidity and offer innovative solutions and new applications for microfracture, ACT, and AMIC.
Collapse
Affiliation(s)
- Eric C Makhni
- Division of Sports Medicine, Department of Orthopedic Surgery, Henry Ford Health System, 6777 West Maple Road, 3rd Floor East, West Bloomfield, MI 48322, USA
| | - Austin V Stone
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA
| | - Gift C Ukwuani
- Division of Hip Preservation Surgery, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA
| | - William Zuke
- Division of Hip Preservation Surgery, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA
| | - Tigran Garabekyan
- Southern California Hip Institute, 10640 Riverside Drive, North Hollywood, CA 9160, USA
| | - Omer Mei-Dan
- CU Sports Medicine and Performance Center, University of Colorado, 2150 Stadium Drive, Boulder, CO 80309, USA
| | - Shane J Nho
- Division of Hip Preservation Surgery, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA.
| |
Collapse
|
25
|
Yan P, Zhu Y, Zhao H, Lu Y, Gao Y. Differential proteomic screening and identification for non-traumatic necrotic femoral osseous tissue. Exp Ther Med 2017; 13:2900-2904. [PMID: 28587357 PMCID: PMC5450605 DOI: 10.3892/etm.2017.4326] [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: 09/06/2016] [Accepted: 02/13/2017] [Indexed: 01/12/2023] Open
Abstract
Currently, there is a lack of effective early screening and detection methods for femoral head necrosis. Current research on most orthopedic diseases focuses on proteomics in the preliminary stage. The recent fluorescence differential in gel electrophoresis (DIGE) has advantages such as a high reproducibility, high sensitivity, high throughput, and high dynamic range. It is currently one of the most widely used quantitative proteomic research means. We conducted this study to investigate the pathogenesis of non-traumatic femoral head necrosis using the fluorescence DIGE to screen non-traumatic femoral head necrosis based on proteomics and provide a theoretical basis for screening possible biomarkers and molecular targeted treatment. The DIGE technique was used to separate the protein. An electrophoretogram was established on the basis of scanning and analysis. Identification and a bioinformatics analysis were conducted for the differential protein. The protein with differential expression of over 2-fold was excavated and ionized by means of substrate assisted laser desorption. The flight time was identified with a mass spectrometer (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, MALDI-TOF/TOF). The formation on sequences, structures and functions of these proteins were obtained through database retrieval. Western blot analysis was used to verify the differential protein expression and the reliability of the DIGE result was verified. DIGE was used to successfully separate 1,500±40 protein spots. There were 252 significant differential protein spots. The Ettan™ Spot Picker automatic work station was used to excavate 49 significant differential protein spots with expression difference over 2-fold. The MALDI-TOF/TOF mass spectrometer was used to identify these differential protein spots. Six proteins were identified in total, which include apolipoprotein A1 (APOA1), fibrous protein original chain, fibrous protein original chain, serum albumin, sulfur-oxygen protein peroxiredoxin 2 (PRDX2) and actin. APOA1 and PRDX2 were subject to western blot analysis detection; results were consistent with the DIGE result. Based on an analysis of the biological information, these proteins may be associated with the incidence and progression of femoral head necrosis.
Collapse
Affiliation(s)
- Peng Yan
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Yeping Zhu
- Recovery Unit, Jinzhou Central Hospital, Jinzhou, Liaoning 121000, P.R. China
| | - Hui Zhao
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Yanyan Lu
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Yuzhong Gao
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| |
Collapse
|
26
|
Won Y, Lee GS, Kim SB, Kim SJ, Yang KH. Osteochondral Autograft from the Ipsilateral Femoral Head by Surgical Dislocation for Treatment of Femoral Head Fracture Dislocation: A Case Report. Yonsei Med J 2016; 57:1527-30. [PMID: 27593886 PMCID: PMC5011290 DOI: 10.3349/ymj.2016.57.6.1527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/08/2016] [Accepted: 04/28/2016] [Indexed: 11/27/2022] Open
Abstract
As anatomical reduction of the articular surface of femoral head fractures and restoration of damaged cartilage are essential for good long-term results, many treatment options have been suggested, including fixation of the fracture using various surgical exposures and implants, as well as arthroscopic irrigation and debridement, bone marrow stimulating techniques, osteochondral allograft, autograft, and autogenous chondrocyte implantation. We report a case of osteochondral autograft harvested from its own femoral articular surface through surgical hip dislocation. The osteochondral graft was harvested from the inferior non-weight-bearing articular surface and grafted to the osteochondral defect. One year later, the clinical and radiological results were good, without the collapse of the femoral head or arthritic change. This procedure introduced in our case is considered convenient and able to lessen surgical time without morbidity of the donor site associated with the harvest.
Collapse
Affiliation(s)
- Yougun Won
- Department of Orthopedic Surgery, College of Medicine, Konyang University, Daejeon, Korea
| | - Gi Soo Lee
- Department of Orthopedic Surgery, College of Medicine, Konyang University, Daejeon, Korea.
| | - Sang Bum Kim
- Department of Orthopedic Surgery, College of Medicine, Konyang University, Daejeon, Korea
| | - Sun Joong Kim
- Department of Orthopedic Surgery, College of Medicine, Konyang University, Daejeon, Korea
| | - Kyu Hyun Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
27
|
Long-term result of mosaicplasty for femoral head osteochondral lesion: a case report with 8 years follow-up. Hip Int 2016; 25:589-92. [PMID: 25952916 DOI: 10.5301/hipint.5000244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Treatment of the chondral lesions of the hip joint is problematic due to its deep anatomy and complex biomechanical demands. The purpose of the study is to present the long-term result of a deep, large femoral head cartilage defect treated successfully with surgical safe dislocation of the hip and autologous osteochondral grafting. METHODS A 27-year-old male patient was admitted to our clinic with left hip pain. On assessment, a large femoral head osteochondral defect was detected in his left hip. An open safe hip dislocation and autologous osteochondral grafting was performed due to the large size of the lesion and subchondral bone involvement. RESULTS Using a Kocher-Langenbeck incision, the hip was dislocated after a trochanteric flip osteotomy. The defect was reconstructed with 3 x 13 mm and 1 x 11 mm osteochondral plug from the ipsilateral knee. We have not encountered any complication at the postoperative period. After 8 years follow-up his left hip range of motion was preserved and The Harris Hip Score was qualified as excellent with 96 points. CONCLUSIONS Chondral defects of the femoral head are still a challenging problem in orthopaedic practice. Mosaicplasty of the femoral head is a demanding procedure with safe dislocation of the hip. However, if successful it can provide satisfactory functional and radiological results in the long-term.
Collapse
|
28
|
Horner NS, Ekhtiari S, Simunovic N, Bedi A, Glyn-Jones S, Ayeni OR. Early evidence reports positive outcomes after osteochondral grafts and chondrocyte transplantation in the hip: a systematic review. J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
29
|
Marquez-Lara A, Mannava S, Howse EA, Stone AV, Stubbs AJ. Arthroscopic Management of Hip Chondral Defects: A Systematic Review of the Literature. Arthroscopy 2016; 32:1435-43. [PMID: 27117866 DOI: 10.1016/j.arthro.2016.01.058] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To critically evaluate the evidence for arthroscopic management of chondral defects in the hip through a systematic literature review. METHODS A systematic literature review was performed to identify all articles addressing the arthroscopic management of chondral defects about the hip. Case reports, open techniques, and those associated with osteonecrosis were excluded. Articles were assessed for sample size, location, severity, and size of chondral defects, and the surgical technique. Associated injuries, follow-up duration (months), and functional outcomes were recorded. Study cohorts were defined by a surgical technique (debridement v microfracture v autologous chondrocyte transplantation [ACT]). Statistical analysis was performed with a χ(2) test and analysis of variance with post hoc pairwise analysis for categorical and continuous data, respectively, with significance defined as P < .05. RESULTS The literature search identified 269 articles, of which 12 clinical studies met inclusion criteria for this analysis. After pooling the data, there were 579 (64.7%) debridements, 279 (31.2%) microfracture, and 37 (4.1%) ACT performed. Patients were followed for an average of 27.1 months (range: 5 to 72 months). All lesions treated with either a microfracture or ACT were high grade (Outerbridge 3 to 4). However, lesion size was significantly larger in ACT-treated patients compared with those who underwent microfracture (357.3 ± 96.0 mm(2)v 149.5 ± 20.7 mm(2); P = .020). All cohorts showed significant improvement in functional outcomes after hip arthroscopy (P < .001). CONCLUSIONS This systematic review showed that arthroscopic debridement, microfracture, and ACT are associated with equivalent improvement in clinical outcomes in patients with high-grade chondral defects in the hip in the short- and midterm follow-up. In addition, although there were no differences in patient characteristics and demographics based on the surgical technique, we confirmed the hypothesis that lesion size varied significantly between arthroscopic techniques, and that the decision to use one technique over another may be determined by the size of the defect. Therefore, lesion size is likely to influence the development of hip- and technique-specific indications, and may also represent a useful metric for success of surgical intervention. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
Collapse
Affiliation(s)
- Alejandro Marquez-Lara
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, U.S.A
| | - Sandeep Mannava
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, U.S.A
| | - Elizabeth A Howse
- Department of Emergency Medicine, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, U.S.A
| | - Austin V Stone
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, U.S.A
| | - Allston J Stubbs
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, U.S.A..
| |
Collapse
|
30
|
Mosaicplasty for the treatment of a large traumatic osteochondral femoral head lesion: a case report with 2 year follow-up and review of the literature. Arch Orthop Trauma Surg 2016; 136:41-6. [PMID: 26506828 DOI: 10.1007/s00402-015-2352-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Indexed: 10/22/2022]
Abstract
Different joint-preserving techniques have been described for the treatment of traumatic osteochondral lesions of the femoral head especially in young active patients. Mosaicplasty with autologous transplantation of osteochondral cylinders is an established surgical technique in the knee. Little evidence, however, exists for the treatment of osteochondral lesions in the hip using this technique. Here, we report on the result of treatment of a traumatic 5 cm(2) osteochondral lesion of the femoral head in a young patient treated with mosaicplasty. Grafts were taken from the ipsilateral knee. After 2 years, the outcome was satisfactory with partial return to previous activity level.
Collapse
|
31
|
Hafke B, Petri M, Suero E, Neunaber C, Kwisda S, Krettek C, Jagodzinski M, Omar M. Chondrocyte survival in osteochondral transplant cylinders depends on the harvesting technique. INTERNATIONAL ORTHOPAEDICS 2015; 40:1553-8. [PMID: 26660516 DOI: 10.1007/s00264-015-3065-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/27/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE In autologous osteochondral transplantation, the edges of the harvested plug are particularly susceptible to mechanical or thermal damage to the chondrocytes. We hypothesised that the applied harvesting device has an impact on chondrocyte vitality. METHODS Both knees of five blackhead sheep (ten knees) underwent open osteochondral plug harvesting with three different circular harvesting devices (osteoarticular transfer system harvester [OATS; diameter 8 mm; Arthrex, Munich, Germany], diamond cutter [DC; diameter 8.35 mm; Karl Storz, Tuttlingen, Germany] and hollow reamer with cutting crown [HRCC; diameter 7 mm; Dannoritzer, Tuttlingen, Germany]) from distinctly assigned anatomical sites of the knee joint. The rotary cutters (DC and HRCC) were either used with (+) or without cooling (-). Surgical cuts of the cartilage with a scalpel blade were chosen as control method. After cryotomy cutting, chondrocyte vitality was assessed using fluorescence microscopy and a Live/Dead assay. RESULTS There were distinct patterns of chondrocyte vitality, with reproducible accumulations of dead chondrocytes along the harvesting edge. No statistical difference in chondrocyte survivorship was seen between the OATS technique and the control method, or between the HRCC+ technique and the control method (P > 0.05). The DC+, HRCC- and DC- techniques yielded significantly lower chondrocyte survival rates compared with the control method (P < 0.05). CONCLUSIONS Chondrocyte survival in osteochondral cylinders depends on the applied harvesting technique. The use of rotary cutters without cooling yielded worst results, while the traditional OATS punch and rotary cutters with cooling achieved comparable rates of chondrocyte vitality.
Collapse
Affiliation(s)
- Benedikt Hafke
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Maximilian Petri
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Eduardo Suero
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Claudia Neunaber
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Sebastian Kwisda
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Michael Jagodzinski
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| |
Collapse
|
32
|
Abstract
The healing potential for articular cartilage lesions is limited due to many physiological, local and mechanical factors. Spontaneous healing of partial- and full-thickness lesions is slow, and subsequent tissue response is usually not durable. In symptomatic, and high-demand, patients, a definitive treatment modality must be offered which allows for a sustained recovery with minimal debilitation. Injuries, which damage the subchondral bone, heal with the formation of fibrocartilage. This tissue fails long-term survival because of its inability to withstand the variable cyclic loads and compression forces that it is subjected to. While regeneration of the damaged cartilage by an entirely new articular surface is a goal beyond current available techniques, repair of the osteochondral defects with normal hyaline cartilage is possible by various options. Osteochondral defects that are larger then 2 cm are best treated by osteochondral autograft technique. The short-term outcomes of the present series show excellent results.
Collapse
|
33
|
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
|
34
|
Fotopoulos VC, Mouzopoulos G, Floros T, Tzurbakis M. Steroid-induced femoral head osteonecrosis in immune thrombocytopenia treatment with osteochondral autograft transplantation. Knee Surg Sports Traumatol Arthrosc 2015; 23:2605-10. [PMID: 25173503 DOI: 10.1007/s00167-014-3239-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 08/11/2014] [Indexed: 01/17/2023]
Abstract
Osteonecrosis of the femoral head is a devastating complication of steroid administration and has rarely been observed in the treatment of immune thrombocytopenia. The treatment of osteochondral defects in advanced stages of avascular necrosis (AVN), characterized by collapse of the subchondral bone, remains an unsolved burden in orthopedic surgery. In this report, we present a case of a 19-year-old female that was admitted in the Emergency Department with walking disability and painful hip joint movement due to steroid-induced femoral head osteonecrosis. Two years before she was diagnosed with immune thrombocytopenia, for which she received pulse steroid therapy with high dose of dexamethasone and underwent a splenectomy. This case report is the first to describe the use of osteochondral autograft transplantation as a treatment of steroid-induced AVN of the femoral head due to immune thrombocytopenia at the age of 19 years with very good clinical and radiological results 3 years postoperatively.
Collapse
|
35
|
Alshameeri Z, McCaskie A. The role of orthobiologics in hip preservation surgery. J Hip Preserv Surg 2015; 2:339-54. [PMID: 27011858 PMCID: PMC4732367 DOI: 10.1093/jhps/hnv042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/21/2015] [Accepted: 05/17/2015] [Indexed: 02/06/2023] Open
Abstract
The potential regenerative role of different orthobiologics is becoming more recognized for the treatment of chronic and degenerative musculoskeletal conditions. Over the last few years there has been an increasing number of publications on cell therapy and other orthobiologics for the treatment of avascular necrosis of the femoral head and other hip conditions with promising short–term clinical results. In this article, we have used a systematic search of the literature to identify potentially relevant topics on orthobiologics and then selected those most applicable to hip preservation surgery. We identified several innovative strategies and present a summary of the currently available evidence on their potential role in hip preservation surgery. For many of these treatment strategies there was a lack of clinical evidence and therefore we suggest that there is a need for comparative studies in this field.
Collapse
Affiliation(s)
- Zeiad Alshameeri
- 1. Health Education East of England, 2-4 victoria house, Cambridge, CB21 5XB
| | - Andrew McCaskie
- 2. Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge and; 3. Arthritis Research UK Tissue Engineering Centre
| |
Collapse
|
36
|
Pierce TP, Elmallah RK, Jauregui JJ, Poola S, Mont MA, Delanois RE. A current review of non-vascularized bone grafting in osteonecrosis of the femoral head. Curr Rev Musculoskelet Med 2015; 8:240-5. [PMID: 26009009 DOI: 10.1007/s12178-015-9282-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Over the past three decades, non-vascularized bone grafts have been demonstrated to be viable treatments for pre- and early post-collapse osteonecrosis of the femoral head; however, there are limited reviews on this topic. Therefore, the purposes of this review are to (1) provide a summary of the different surgical techniques and their respective clinical outcomes and (2) evaluate new adjunct therapies. Originally, non-vascularized bone grafting was performed using the Phemister technique with varying results. More recently, newer techniques such as the lightbulb and trapdoor are used to place non-vascularized bone grafts with excellent results. The addition of various biological agents has demonstrated positive results; however, further studies are needed to confirm the best appropriate indications and to elucidate long-term results.
Collapse
Affiliation(s)
- Todd P Pierce
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | | | | | | | | | | |
Collapse
|
37
|
Gao YH, Li SQ, Wang YF, Yang C, Liu JG, Qi X. Arthroplasty in patients with extensive femoral head avascular necrosis: Cementless arthroplasty in extensive femoral head necrosis. INTERNATIONAL ORTHOPAEDICS 2015; 39:1507-11. [PMID: 25690921 DOI: 10.1007/s00264-015-2693-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/26/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to investigate the outcomes of using cementless femoral stem for extensive osteonecrosis of the femoral head involving the proximal femur. METHODS A total of 21 patients (27 hips) in the study group defined as extensive ONFH involving proximal femur and 42 patients (52 hips) with the diagnosis of regular osteonecrosis of the femoral head in the control group were enrolled in the study. Clinical and radiographic follow-ups were documented at three, six, 12 and 24 months postoperatively. RESULTS Results improved for Harris hip score in both groups. In the study group undersized stem implantation and lateralized mal-position were identified. Subsequent subsidence was also found. CONCLUSIONS Pre-operative templating and intra-operative X-ray confirmation are necessary to avoid complications.
Collapse
Affiliation(s)
- Yu-Hang Gao
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Xinmin St 71, Changchun, China
| | | | | | | | | | | |
Collapse
|
38
|
Response to comment on Gagala et al.: Clinical and radiological outcomes of treatment of avascular necrosis of the femoral head using autologous osteochondral transfer (mosaicplasty). Preliminary report. INTERNATIONAL ORTHOPAEDICS 2014; 37:1641-2. [PMID: 23797457 PMCID: PMC3728406 DOI: 10.1007/s00264-013-1975-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
39
|
Kumar V, Sharma S, Aggarwal S, Goni VG. Comment on Gagala et al.: Clinical and radiological outcomes of avascular necrosis of the femoral head using autologous osteochondral transfer (mosaicplasty). Preliminary report. INTERNATIONAL ORTHOPAEDICS 2013; 37:1639-40. [PMID: 23793466 DOI: 10.1007/s00264-013-1974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
|