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Griffin JT, Landy DC, Mechas CA, Nazal MR, Foster JA, Moghadamian ES, Srinath A, Aneja A. The Hawkins Sign of the Talus: The Impact of Patient Factors on Prediction Accuracy. J Bone Joint Surg Am 2024; 106:958-965. [PMID: 38512980 DOI: 10.2106/jbjs.23.00906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Osteonecrosis is a complication of talar neck fractures associated with chronic pain and poor functional outcomes. The Hawkins sign, the radiographic presence of subchondral lucency seen in the talar dome 6 to 8 weeks after trauma, is a strong predictor of preserved talar vascularity. This study sought to assess the accuracy of the Hawkins sign in a contemporary cohort and assess factors associated with inaccuracy. METHODS A retrospective review of talar neck fractures at a level-I trauma center from 2008 to 2016 was conducted. Both the Hawkins sign and osteonecrosis were evaluated on radiographs. The Hawkins sign was determined on the basis of radiographs taken approximately 6 to 8 weeks after injury, whereas osteonecrosis was determined based on radiographs taken throughout follow-up. The Hawkins sign accuracy was assessed using proportions with 95% confidence intervals (CIs), and associations were examined with Fisher exact testing. RESULTS In total, 105 talar neck fractures were identified. The Hawkins sign was observed in 21 tali, 3 (14% [95% CI, 3% to 36%]) of which later developed osteonecrosis. In the remaining 84 tali without a Hawkins sign, 32 (38% [95% CI, 28% to 49%]) developed osteonecrosis. Of the 3 tali that developed osteonecrosis following observation of the Hawkins sign, all were in patients who smoked. CONCLUSIONS A positive Hawkins sign may not be a reliable predictor of preserved talar vascularity in all patients. We identified 3 patients with a positive Hawkins sign who developed osteonecrosis, all of whom were smokers. Factors impairing the restoration of microvascular blood supply to the talus may lead to osteonecrosis despite the presence of preserved macrovascular blood flow and an observed Hawkins sign. Further research is needed to understand the factors limiting Hawkins sign accuracy. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jarod T Griffin
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Charles A Mechas
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Mark R Nazal
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Jeffrey A Foster
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric S Moghadamian
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Arjun Srinath
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida
| | - Arun Aneja
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts
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Nakamura J, Fukushima W, Ando W, Hagiwara S, Kawarai Y, Shiko Y, Kawasaki Y, Sakai T, Ito K, Arishima Y, Chosa E, Fujimoto Y, Fujiwara K, Hasegawa Y, Hayashi S, Imagama T, Inaba Y, Ishibashi Y, Ishidou Y, Ito H, Ito H, Ito J, Jinno T, Kabata T, Kaku N, Kaneuji A, Kishida S, Kobayashi S, Komiya S, Kubo T, Majima T, Mashima N, Mawatari M, Miki H, Miyatake K, Motomura G, Nagoya S, Nakamura H, Nakamura Y, Nakanishi R, Nakashima Y, Nakasone S, Nishii T, Nishiyama T, Ohta Y, Ohzono K, Osaki M, Sasaki K, Seki T, Shishido T, Shoji T, Sudo A, Takagi M, Takahashi D, Takao M, Tanaka S, Tanaka T, Tetsunaga T, Ueshima K, Yamamoto K, Yamamoto T, Yamamoto Y, Yamasaki T, Yasunaga Y, Sugano N. Time elapsed from definitive diagnosis to surgery for osteonecrosis of the femoral head: a nationwide observational study in Japan. BMJ Open 2024; 14:e082342. [PMID: 38553078 PMCID: PMC10982743 DOI: 10.1136/bmjopen-2023-082342] [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: 11/23/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES This study documents the time elapsed from the diagnosis of osteonecrosis of the femoral head (ONFH) to surgery, exploring the factors that influence ONFH severity. DESIGN Retrospective observational study of a nationwide database. SETTING The Kaplan-Meier method with log-rank tests was applied to examine the period from definitive diagnosis of ONFH to surgery using any surgery as the end point. For bilateral cases, the date of the first surgery was the endpoint. PARTICIPANTS This study included 2074 ONFH cases registered in 34 university hospitals and highly specialised hospitals of the multicentre sentinel monitoring system of the Japanese Investigation Committee between 1997 and 2018. MAIN OUTCOME MEASURE The primary outcome was the time from diagnosis to surgery. The secondary outcome was the proportion of subjects remaining without surgery at 3, 6 and 9 months, and at 1, 2 and 5 years after diagnosis. RESULTS The median time to surgery was 9 months (IQR 4-22 months) after diagnosis of ONFH. The time to surgery was significantly shorter in the alcohol alone group and the combined corticosteroid and alcohol group than in the corticosteroid alone group (p=0.018 and p<0.001, respectively), in early stage ONFH with no or mild joint destruction (stages II and III, p<0.001), and with joint preserving surgery (p<0.001). The proportion without surgery was 75.8% at 3 months, 59.6% at 6 months, 48.2% at 9 months, 40.5% at 1 year, 22.2% at 2 years and 8.3% at 5 years. CONCLUSION ONFH has been considered to be an intractable disease that often requires surgical treatment, but the fact that surgery was performed in more than half of the patients within 9 months from diagnosis suggests severe disease with a significant clinical impact. TRIAL REGISTRATION NUMBER Chiba University ID1049.
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Affiliation(s)
- Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuya Kawarai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Centre, Chiba University Hospital, Chiba, Japan
- Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Takashi Sakai
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kazuya Ito
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Graduate School of Nursing, Osaka Metropolitan University, Osaka, Japan
| | - Yoshiya Arishima
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, Miyazaki University, Miyazaki, Japan
| | - Yusuke Fujimoto
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Kazuo Fujiwara
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| | | | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University, Kobe, Japan
| | - Takashi Imagama
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | | | - Yasuhiro Ishidou
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Hideya Ito
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Juji Ito
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Oita University, Yufu, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Japan
| | - Shunji Kishida
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seneki Kobayashi
- Department of Orthopaedic Surgery, Suwa Red Cross Hospital, Suwa, Japan
| | - Setsuro Komiya
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Toshikazu Kubo
- Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tokifumi Majima
- Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Naohiko Mashima
- Department of Orthopaedic Surgery, Ehime University, Toon, Japan
| | | | - Hidenobu Miki
- Department of Orthopaedic Surgery, Osaka National Hospital, Osaka, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Satoshi Nagoya
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Osaka, Japan
| | | | - Ryosuke Nakanishi
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | | | - Satoshi Nakasone
- Department of Orthopaedic Surgery, Ryukyu University, Nakagami-gun, Japan
| | - Takashi Nishii
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Osaka, Japan
| | - Kenji Ohzono
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Nagasaki University, Nagasaki, Japan
| | - Kan Sasaki
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University, Nagoya, Japan
- Depatrment of Orthopedic Surgery, Aichi Medical University Medical Centre, Okazaki, Japan
| | - Takaaki Shishido
- Department of Orthopaedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Shoji
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University, Tsu, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Ehime University, Toon, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Takeyuki Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Keiichiro Ueshima
- Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kengo Yamamoto
- Department of Orthopaedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
- Department of Orthopaedic Surgery, Fukuoka University, Fukuoka, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University, Hirosaki, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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Wang Y, Ma X, Guo J, Li Y, Xiong Y. Correlation between ESR1 and APOE gene polymorphisms and risk of osteonecrosis of the femoral head: a case-control study. J Orthop Surg Res 2023; 18:968. [PMID: 38102657 PMCID: PMC10722694 DOI: 10.1186/s13018-023-04447-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a disease with a high disability rate, and genetic factors are closely related to its pathogenesis. This study aimed to investigate the possible correlation between ESR1 and APOE gene polymorphisms and the risk of ONFH. METHODS In this case-control study, the potential association between three genetic variants (rs2982573 C < T, rs10872678 C < T, and rs9322332 A < C) of the ESR1 gene and two genetic variants (rs7259620 A < G and rs769446 C < T) of the APOE gene with the risk of ONFH was investigated. Correlations between gene polymorphisms and ONFH risk were assessed using logistic regression analysis, with calculation of odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The overall analysis demonstrated that rs9322332 in the ESR1 gene exhibited a correlation with a decreased risk of ONFH under the homozygous (AA vs.CC: OR = 0.69, 95% CI [0.53-0.90], p = 0.006), dominant (CA + AA vs. CC: OR = 0.70, 95% CI [0.54-0.90], p = 0.006), and additive (OR = 0.79, 95% CI [0.66-0.95], p = 0.013) models. The stratification analysis revealed that rs9322332 was linked to a lower risk of ONFH in subgroups characterized by individuals aged over 51 years and non-smokers. Nevertheless, there were no notable correlations found between ESR1 rs2982573 and rs10872678, as well as APOE rs7259620 and rs769446, with the risk of ONFH. CONCLUSION ESR1-rs9322332 is closely linked to a decreased risk of ONFH, thereby enhancing our understanding of the relationship between gene polymorphisms and ONFH.
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Affiliation(s)
- Yuan Wang
- College of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China
- Provincial Key Laboratory of Biotechnology of Shaanxi, Northwest University, Xi'an, 710069, Shaanxi, China
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China
- Department of Joint Surgery, Affiliated Hospital of Weifang Medical University, Weifang, 261031, Shandong, China
| | - Xiaoya Ma
- College of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China
- Provincial Key Laboratory of Biotechnology of Shaanxi, Northwest University, Xi'an, 710069, Shaanxi, China
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Jinping Guo
- College of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China
- Provincial Key Laboratory of Biotechnology of Shaanxi, Northwest University, Xi'an, 710069, Shaanxi, China
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Yujie Li
- College of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China
- Provincial Key Laboratory of Biotechnology of Shaanxi, Northwest University, Xi'an, 710069, Shaanxi, China
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Yuyan Xiong
- College of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China.
- Provincial Key Laboratory of Biotechnology of Shaanxi, Northwest University, Xi'an, 710069, Shaanxi, China.
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China.
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Okewunmi JO, Duey AH, Zubizarreta N, Kodali H, Poeran J, Hayden BL, Moucha CS, Chen DD. Did the COVID-19 Pandemic Coincide With an Increase in Osteonecrosis as Indication for Total Hip Arthroplasty in Older Patients? J Arthroplasty 2023; 38:2634-2637. [PMID: 37315633 PMCID: PMC10260267 DOI: 10.1016/j.arth.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head is a common indication for total hip arthroplasty (THA). It is unclear to what extent the COVID-19 pandemic has impacted its incidence. Theoretically, the combination of microvascular thromboses and corticosteroid use in patients who have COVID-19 may increase the risk of osteonecrosis. We aimed to (1) assess recent osteonecrosis trends and (2) investigate if a history of COVID-19 diagnosis is associated with osteonecrosis. METHODS This retrospective cohort study utilized a large national database between 2016 and 2021. Osteonecrosis incidence in 2016 to 2019 was compared to 2020 to 2021. Secondly, utilizing a cohort from April 2020 through December 2021, we investigated whether a prior COVID-19 diagnosis was associated with osteonecrosis. For both comparisons, Chi-square tests were applied. RESULTS Among 1,127,796 THAs performed between 2016 and 2021, we found an osteonecrosis incidence of 1.6% (n = 5,812) in 2020 to 2021 compared to 1.4% (n = 10,974) in 2016 to 2019; P < .0001. Furthermore, using April 2020 to December 2021 data from 248,183 THAs, we found that osteonecrosis was more common among those who had a history of COVID-19 (3.9%; 130 of 3,313) compared to patients who had no COVID-19 history (3.0%; 7,266 of 244,870); P = .001). CONCLUSION Osteonecrosis incidence was higher in 2020 to 2021 compared to previous years and a previous COVID-19 diagnosis was associated with a greater likelihood of osteonecrosis. These findings suggest a role of the COVID-19 pandemic on an increased osteonecrosis incidence. Continued monitoring is necessary to fully understand the impact of the COVID-19 pandemic on THA care and outcomes.
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Affiliation(s)
- Jeffrey O Okewunmi
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island; Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Akiro H Duey
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicole Zubizarreta
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hanish Kodali
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jashvant Poeran
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett L Hayden
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Calin S Moucha
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Darwin D Chen
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Tani T, Ando W, Fukushima W, Hamada H, Takao M, Ito K, Sakai T, Sugano N. Geographic distribution of the incidence of osteonecrosis of the femoral head in Japan and its relation to smoking prevalence. Mod Rheumatol 2022; 32:186-192. [PMID: 33719872 DOI: 10.1080/14397595.2021.1899452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Alcohol intake and smoking are modifiable lifestyle-related risk factors for osteonecrosis of the femoral head (ONFH). We investigated geographic differences in ONFH incidence in Japan and the correlation with alcohol intake and smoking to develop prevention strategies for ONFH in Japan. METHODS This ecological study was conducted in Japan primarily using the following data sources: nationwide epidemiological survey and national survey. We estimated the annual ONFH incidence and the prevalence of alcohol drinking and smoking in each prefecture. Prefectural incidence and prevalence were calculated by sex and age-standardization. RESULTS The mean annual ONFH incidence per 100,000 population was 3.08 in men and 1.63 in women, respectively. There was no significant correlation between ONFH incidence and the prevalence of any levels of alcohol intake, while smoking ≥20 cigarettes/day showed a significant and moderate correlation in men (r = 0.47, p = .01). This correlation remained significant after adjustment for the prevalence of any levels of alcohol intake (standardized partial regression coefficient = 0.47-0.49, p = .009-.01). CONCLUSION ONFH incidence is geographically variable in Japan, and this may be partly explained by the distribution of smoking prevalence. Smoking cessation may contribute to an effective decline in the overall ONFH incidence in Japan.
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Affiliation(s)
- Tetsuro Tani
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Ito
- Department of Healthcare Management, College of Healthcare Management, Fukuoka, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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Aseptic Necrosis of Femoral Head - Clinical Study. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:228-236. [PMID: 34765243 PMCID: PMC8551901 DOI: 10.12865/chsj.47.02.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/05/2021] [Indexed: 11/18/2022]
Abstract
Femoral head osteonecrosis is a disease characterized by the decrease of blood vascularization in the femoral head, which leads to death of the osteocytes, demineralization and resorption of bone spans, change of trabecular architecture, with the reduction of the bone mechanical resistance and collapse of the articular surface in the femoral head. Left untreated, the disease may have a rapid progression, leading to severe symptoms, with significant articular dysfunction, functional impotence and a serious impact on the patient’s quality of life. The prevalence of the disease is ever growing all over the world, affecting mainly people in their 30s, 40s or 50s. In the present study, we analyzed a number of 76 patients with femoral head osteonecrosis with severe symptoms that required a surgical treatment. There was observed that more than ¾ of the investigated patients were males, while 81.58% were younger than 60 years old. Among the identified risk factors, smoking came first, followed by alcohol intake, obesity and chronic administration of corticosteroids. A very high percentage of patients (84.21%) were diagnosed in stages III and IV of the disease.
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7
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Hamada H, Ando W, Takao M, Sugano N. Gamma-Glutamyl Transferase: A Useful Marker of Habitual Drinking in Cases of Alcohol-Associated Osteonecrosis of the Femoral Head. Alcohol Alcohol 2021; 56:175-180. [PMID: 33179047 DOI: 10.1093/alcalc/agaa117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Alcohol intake is one of the factors associated with the occurrence of osteonecrosis of the femoral head (ONFH), and its epidemiological information regarding alcohol intake depends on patients' self-reports. Therefore, we analysed the efficacy of laboratory tests as an objective diagnostic tool to indicate habitual drinking in patients with alcohol-associated ONFH. METHODS This study included 109 consecutive patients diagnosed with ONFH who underwent primary hip surgery in our institution between 2010 and 2018. The patients were classified into group AL (alcohol-associated ONFH; n = 26) and group NO (alcohol-unassociated ONFH; n = 83), based on their self-reported information. Serum levels of gamma-glutamyl transferase (GGT), mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol and triglycerides were compared between both groups. The sensitivities and specificities with the optimal cut-off values for detecting alcohol-associated ONFH were compared among these markers. RESULTS The median serum levels of GGT, AST and ALT were significantly higher in the AL group than in the NO group. The receiver operating characteristic curve analysis demonstrated an area under the curve of 0.795 for GGT, 0.731 for AST and 0.709 for ALT. The optimal cut-off level of GGT as a marker for alcohol-associated ONFH was 36.5 units/L, with a sensitivity of 76% and specificity of 80%, and it was found to be the best marker among the other examined laboratory markers. CONCLUSION Serum GGT level is a useful laboratory marker with moderate accuracy that indicates habitual drinking in patients with alcohol-associated ONFH.
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Affiliation(s)
- Hidetoshi Hamada
- Departments of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Wataru Ando
- Departments of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Masaki Takao
- Departments of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Nobuhiko Sugano
- Departments of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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8
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Ando W, Sakai T, Fukushima W, Kaneuji A, Ueshima K, Yamasaki T, Yamamoto T, Nishii T, Sugano N. Japanese Orthopaedic Association 2019 Guidelines for osteonecrosis of the femoral head. J Orthop Sci 2021; 26:46-68. [PMID: 33388233 DOI: 10.1016/j.jos.2020.06.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The Clinical Practice Guidelines for Osteonecrosis of the Femoral Head (ONFH) 2019 Edition, written by the working group for ONFH guidelines of the Japanese Investigation Committee (JIC) for ONFH under the auspices of the Japanese Ministry of Health, Labour, and Welfare and endorsed by the Japanese Orthopaedic Association, were published in Japanese in October 2019. The objective of this guideline is to provide a support tool for decision-making between doctors and patients. METHODS Procedures for developing this guideline were based on the Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014, which proposed an appropriate method for preparing clinical guidelines in Japan. RESULTS This clinical practice guideline consists of 7 chapters: epidemiology; pathology; diagnosis; conservative therapy; surgical treatment: bone transplantation/cell therapy; surgical treatment: osteotomy; and surgical treatment: hip replacement. Twelve background questions and 13 clinical questions were determined to define the basic features of the disease and to be addressed when deciding treatment in daily practice, respectively. CONCLUSIONS The clinical practice guidelines for the ONFH 2019 edition will be useful for physicians, investigators, and medical staff in clinical practice, as well as for patients, during the decision-making process when defining how to treat ONFH.
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Affiliation(s)
- Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Keiichiro Ueshima
- Department of Orthopaedic Surgery, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Kyoto, Kyoto, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Fukuoka, Japan
| | - Takashi Nishii
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | | | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
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9
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Yang SY, Zeng LY, Li C, Yan H. Correlation between an ABO Blood Group and Primary Femoral Head Necrosis: A Case-Control Study. Orthop Surg 2020; 12:450-456. [PMID: 32167665 PMCID: PMC7189034 DOI: 10.1111/os.12628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the relationship between primary femoral head necrosis (ONFH) and an ABO blood group. Methods This study was a retrospective case–control trial. An analysis of the clinical data of an ABO blood group with 516 patients (case group) with ONFH and 489 limb‐fracture patients (control group) without previous hip pain was obtained from the Second Hospital of Shanxi Medical University from November 2015 to November 2018. The clinical data included gender, age, height, weight, a history of smoking, alcohol abuse, prior medical history, hormone use, and ABO blood type. A logistic regression model was used for univariate and multivariate analysis. Results From November 2015 to November 2018, there were 267 males and 249 females in the 516 cases of ONFH in the case group. The control group included 289 males and 200 females. In terms of age, the average age of the case group was significantly lower than that of the control group. In terms of body mass index (BMI), the BMI of the case group was significantly higher than that of the control group (P < 0.05). From the previous medical history of patients in the two groups (coronary heart disease, hypertension, cerebrovascular disease, diabetes, and peripheral vascular disease), there was no significant difference between the two groups from a statistical perspective (P < 0.05). However, according to the risk factors of ONFH (smoking, alcohol abuse, hyperlipidemia, and hormone‐use history), there were significant differences between the case group and the control group. There was no statistical difference in the quantitative distribution ratio of the four blood types – A, B, O, and AB – between the case group and the control group. The outcomes of logistic multiple regression analysis presented that there was no significant correlation between the occurrence of ONFH and blood type A, B, AB, and O (P > 0.05). However, there are significant differences in the disease progression between the different blood types. There was a significant difference in the progression of disease between type A and type O. Among them, patients with ONFH and type A blood had the fastest progression with an average of 2.318 years, and the slowest progression was found in type O blood with an average of 5.15 years. Conclusions The ABO blood group has no correlation with the occurrence of ONFH, but the ABO blood type is closely related to the disease progression of ONFH.
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Affiliation(s)
- Shu-Yan Yang
- Department of Blood Transfusion, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ling-Yuan Zeng
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chao Li
- Department of Blood Transfusion, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Hong Yan
- Department of Blood Transfusion, The Second Hospital of Shanxi Medical University, Taiyuan, China
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Zhao D, Zhang F, Wang B, Liu B, Li L, Kim SY, Goodman SB, Hernigou P, Cui Q, Lineaweaver WC, Xu J, Drescher WR, Qin L. Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). J Orthop Translat 2020; 21:100-110. [PMID: 32309135 PMCID: PMC7152793 DOI: 10.1016/j.jot.2019.12.004] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/29/2019] [Accepted: 12/05/2019] [Indexed: 12/26/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a common and refractory disease in orthopaedic clinics. The number of patients with ONFH is increasing worldwide every year. There are an estimated 8.12 million patients with nontraumatic osteonecrosis in China alone. Treatment of nontraumatic osteonecrosis has always been a clinical challenge for orthopaedic surgeons. To further standardize diagnosis and treatment of ONFH, these guidelines provide not only basic diagnosis, treatment, and evaluation systems for ONFH but also expert advice and standards in many aspects, including epidemiology, aetiology, diagnostic criteria, pathological staging, prevention and treatment options, and postoperative rehabilitation. The aetiological factors of ONFH can currently be divided into two major categories: traumatic and nontraumatic; however, the specific pathological mechanism of ONFH is not completely clear. Currently, the staging system of ONFH formulated by the Association Research Circulation Osseous is widely used in clinical practice. Based on the changes in the intraosseous blood supply at different stages, the corresponding nonsurgical and surgical treatments are recommended, and when there are risk factors for possible ONFH, certain preventive measures to avoid the occurrence of osteonecrosis are recommended. These guidelines provide brief classification criteria and treatment regimen for osteonecrosis. Specification of the aetiology, treatment plan based on comprehensive consideration of the different stages of osteonecrosis, hip function, age, and occupation of the patients are important steps in diagnosis and developing treatment strategies. TRANSLATIONAL POTENTIAL OF THIS ARTICLE New advances in the epidemiology, etiology, pathophysiology, imaging, diagnosis and treatment of ONFH have been renewed in this revision. This guideline can be used for reference by orthopedic professionals and researchers, and for standardized diagnosis and treatment management under the clinical guidance, which is conducive to the prevention, treatment and further research of ONFH, improving the diagnosis and treatment level, making patients' symptoms under good control, and improving their quality of life.
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Key Words
- ARCO, Association Research Circulation Osseous
- BMES, Bone marrow oedema syndrome
- CT, Computed tomography
- DSA, Digital subtraction angiography
- Diagnosis
- Guideline
- MRI, Magnetic resonance imaging
- ONFH, Osteonecrosis of the femoral head
- Osteonecrosis of the femoral head (ONFH)
- PET, Positron emission tomography
- RHS, Reconstruction Hip Scores
- SPECT, Single-photon emission computed tomography
- T1WI, T1-weighted images
- Treatment
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Affiliation(s)
- Dewei Zhao
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Feng Zhang
- JMS Burn and Reconstructive Center, Jackson, MS, USA
| | - Benjie Wang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Baoyi Liu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Lu Li
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Shin-Yoon Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery and (by Courtesy) Bioengineering, Stanford University Medical Center Outpatient Center, Redwood City, CA, 94063, USA
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Virginia, 22903, USA
| | | | - Jiake Xu
- School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Wolf R. Drescher
- Department of Orthopaedic Surgery of the Lower Limb and Arthroplasty, Rummelsberg Hospital, D-90592, Schwarzenbruck, Germany
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, PR China
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Jiang J, Liu X, Lai B, Hu D, Lai L, Xu J, Chen S, Li X. Correlational analysis between neutrophil granulocyte levels and osteonecrosis of the femoral head. BMC Musculoskelet Disord 2019; 20:393. [PMID: 31470845 PMCID: PMC6717348 DOI: 10.1186/s12891-019-2778-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background The correlation between peripheral blood neutrophil level and osteonecrosis of the femoral head (ONFH) has not been extensively studied. Thus, we aimed to investigate the correlation between neutrophil level in the peripheral blood (neutrophil granulocyte) and ONFH. Methods A total of 984 cases of ONFH and femoral neck fractures (non-ONFH) diagnosed at the Department of Orthopedics at our institution between January 1, 2011 and December 31, 2016 were retrospectively reviewed. The ONFH and non-ONFH groups comprised 488 and 496 cases, respectively. Basic information and peripheral blood cell levels of the two groups were compared. Results The patients’ mean age was 59.89 ± 17.06 years (range: 38–82 years). There were 457 male and 527 female patients, with a male-to-female ratio of 1:1.15. We found that neutrophil granulocyte levels and percentage of neutrophil granulocytes were significantly different between the ONFH and non-ONFH groups. Multimodal regression analysis showed that the percentage of neutrophil granulocytes was an independent protective factor against ONFH. Conclusions The factors influencing ONFH are neutrophil granulocyte levels and percentage of neutrophil granulocytes. Percentage of neutrophil granulocytes has a significant correlation with aseptic femoral head necrosis, providing a new perspective and direction for further study of femoral head necrosis.
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Affiliation(s)
- Jiang Jiang
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Xuqiang Liu
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Baojian Lai
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Dengjiong Hu
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Lizhen Lai
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Jiaxiang Xu
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Songqing Chen
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Xiaofeng Li
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China.
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Abstract
Osteonecrosis arises throughout the foot and ankle in various forms and due to numerous causes, with a thousand US cases per year estimated for the ankle alone. Although research continues to elucidate specific mechanisms at work, the pathophysiology remains poorly understood. Nevertheless, the various osteonecrosis pathways converge on osteocyte death, and bony lesions follow a pattern of progression. Understanding the specific anatomy and biomechanics associated with common forms of foot and ankle osteonecrosis should help guide diagnosis and interventions, particularly at earlier stages of disease where etiology-specific approaches might become optimal.
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Affiliation(s)
- Daniel K Moon
- Department of Orthopedic Surgery, University of Colorado, 12631 East 17th Avenue, Mail Stop B202, Room 4602, Aurora, CO 80045, USA.
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13
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Chinese Guideline for the Diagnosis and Treatment of Osteonecrosis of the Femoral Head in Adults. Orthop Surg 2017; 9:3-12. [PMID: 28371498 DOI: 10.1111/os.12302] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/04/2016] [Indexed: 01/15/2023] Open
Abstract
The treatment of adult osteonecrosis of the femoral head (ONFH), with 8.12 million patients in China, remains a challenge to surgeons. To standardize and improve the efficacy of the treatment of ONFH, Chinese specialists updated the experts' suggestions in March 2015, and an experts' consensus was given to provide a current basis for the diagnosis, treatment and evaluation of ONFH. The current guideline provides recommendations for ONFH with respect to epidemiology, etiology, diagnostic criteria, differential diagnosis, staging, treatment, as well as rehabilitation. Risk factors of non-traumatic ONFH include corticosteroid use, alcohol abuse, dysbarism, sickle cell disease and autoimmune disease and others, but the etiology remains unclear. The Association Research Circulation Osseous (ARCO) staging system, including plain radiograph, magnetic resonance imaging, radionuclide examination, and histological findings, is frequently used in staging ONFH. A staging and classification system was proposed by Chinese scholars in recent years. The major differential diagnoses include mid-late term osteoarthritis, transient osteoporosis, and subchondral insufficiency fracture. Management alternatives for ONFH consist of non-operative treatment and operative treatment. Core decompression is currently the most common procedure used in the early stages of ONFH. Vascularized bone grafting is the recommended treatment for ARCO early stage III ONFH. This guideline gives a brief account of principles for selection of treatment for ONFH, and stage, classification, volume of necrosis, joint function, age of the patient, patient occupation, and other factors should be taken into consideration.
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14
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Influence of cigarette smoking on osteonecrosis of the femoral head (ONFH): a systematic review and meta-analysis. Hip Int 2017; 27:425-435. [PMID: 28574127 DOI: 10.5301/hipint.5000516] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Current studies demonstrate controversy regarding the relationship between cigarette smoking and osteonecrosis of the femoral head (ONFH). METHODS We conducted a meta-analysis to evaluate the association between smoking and ONFH. Relevant articles published before September 2016 were identified by a systematic search of EMBASE and MEDLINE via Ovid. Summary odds ratios (OR) were calculated using random effects models, and study quality was assessed using a modified Newcastle-Ottawa scale. RESULTS 102 citations were screened and 7 case-control studies were identified and included in the review. When compared with nonsmokers, current smokers had a higher risk of developing ONFH (OR 2.53; 95% confidence interval [CI] 1.68-3.79), as did former smokers (OR 1.82; 95% CI, 1.10-3.00). Within the group of current smokers, those classified as heavy smokers (with a daily number >20 cigarettes/day) demonstrated higher risks of ONFH (OR 2.03; 95% CI, 1.29-3.19), and light smokers classified as smoking <20 cigarettes/day, also demonstrated a higher risk of ONFH when compared with nonsmokers (OR 1.73; 95% CI, 1.06-2.83). When smoking was classified by pack-years, heavy smokers (>20 pack-years) were at a higher risk of ONFH (OR 2.26; 95% CI, 1.24-4.13), but no significant difference in risk was identified in light smokers (<20 pack-years) (OR 1.81; 95% CI, 0.88-3.71) when compared with nonsmokers. CONCLUSIONS Our meta-analysis showed that current smokers were at a higher risk of ONFH, this high risk can also be found in former smokers. And heavy cigarette smoking showed a higher risk of ONFH than light smoking.
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Kuroda T, Sato H. Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus. Lupus 2017. [DOI: 10.5772/intechopen.68143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Zhao DW, Yu M, Hu K, Wang W, Yang L, Wang BJ, Gao XH, Guo YM, Xu YQ, Wei YS, Tian SM, Yang F, Wang N, Huang SB, Xie H, Wei XW, Jiang HS, Zang YQ, Ai J, Chen YL, Lei GH, Li YJ, Tian G, Li ZS, Cao Y, Ma L. Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population: Results from a Nationally Representative Survey. Chin Med J (Engl) 2016; 128:2843-50. [PMID: 26521779 PMCID: PMC4756878 DOI: 10.4103/0366-6999.168017] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Nontraumatic osteonecrosis of the femoral head (NONFH) is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population. Methods: A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging examination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH. Results: NONFH was diagnosed in 218 subjects (0.725%) and the estimated NONFH cases were 8.12 million among Chinese people aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females (1.02% vs. 0.51%, χ2 = 24.997, P < 0.001). Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents (0.85% vs. 0.61%, χ2 = 5.847, P = 0.016). Our multivariate regression analysis showed that high blood levels of triglycerides, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head, heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH. Conclusions: Our findings highlight that NONFH is a significant public health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares a number of risk factors with atherosclerosis.
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Affiliation(s)
- De-Wei Zhao
- Orthopedic Medical Research Center, Dalian University; Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, China
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Kuroda T, Tanabe N, Wakamatsu A, Takai C, Sato H, Nakatsue T, Wada Y, Nakano M, Narita I. High triglyceride is a risk factor for silent osteonecrosis of the femoral head in systemic lupus erythematosus. Clin Rheumatol 2015; 34:2071-7. [PMID: 26384821 DOI: 10.1007/s10067-015-3075-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/07/2015] [Accepted: 09/07/2015] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to clarify the factors related to silent osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE). Seventy-eight patients with SLE were selected on the basis of having been newly diagnosed and requiring high-dose prednisolone, including pulse therapy with methylprednisolone, as the initial treatment. All the patients initially underwent MRI at 3 months after the start of corticosteroid treatment to detect any early changes in the femoral head. These examinations were then performed again 3 months later. Laboratory parameters were evaluated at the start of steroid treatment and at 1 month thereafter. By 3 months after the start of corticosteroid treatment, silent ONFH was diagnosed by MRI in 21 patients (26.9 %), being bilateral in 11 patients and unilateral in 10. The occurrence of silent ONFH was not related to SLE disease activity index, serological activity, or renal function; it was also unrelated to body mass index (BMI), body surface area (BSA), and the initial dose of prednisolone per unit body weight. However, the total cholesterol level at 4 weeks after the start of steroid treatment tended to be higher in patients with silent ONFH. Patients with a higher triglyceride level showed a significantly higher frequency of silent ONFH both before (p = 0.002) and 4 weeks after (p = 0.036) steroid initiation.A high triglyceride level is an important risk factor for silent ONFH in patients with SLE, and large-scale epidemiologic surveys of such early events are needed in this patient population.
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Affiliation(s)
- Takeshi Kuroda
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan.
| | - Naohito Tanabe
- Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture, 471 Ebigase, Higashi-ku, Niigata, 950-8680, Japan.
| | - Ayako Wakamatsu
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan.
| | - Chinatsu Takai
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan.
| | - Hiroe Sato
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan.
| | - Takeshi Nakatsue
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan.
| | - Yoko Wada
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan.
| | - Masaaki Nakano
- Department of Medical Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8518, Japan.
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan.
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Takahashi S, Fukushima W, Yamamoto T, Iwamoto Y, Kubo T, Sugano N, Hirota Y. Temporal Trends in Characteristics of Newly Diagnosed Nontraumatic Osteonecrosis of the Femoral Head From 1997 to 2011: A Hospital-Based Sentinel Monitoring System in Japan. J Epidemiol 2015; 25:437-44. [PMID: 25912097 PMCID: PMC4444498 DOI: 10.2188/jea.je20140162] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nontraumatic osteonecrosis of the femoral head (ONFH) is a rare disorder caused by ischemic necrosis of unknown etiology. A few studies have demonstrated trends in the number of patients with ONFH. However, there are no data on temporal trends in characteristics such as age, gender, and causative factors. To investigate this, we examined data from a multicenter hospital-based sentinel monitoring system in Japan. METHODS A total of 3041 newly-diagnosed ONFH patients from 34 participating hospitals who were reported to the system from 1997-2011 were analyzed. We examined age at diagnosis, potential causative factors, and underlying diseases for which patients received systemic steroid administration. Their temporal trends were assessed according to date of diagnosis in 5-year intervals (1997-2001, 2002-2006, and 2007-2011). RESULTS The gender ratio and distribution of potential causative factors did not change. Regarding underlying diseases requiring steroid administration, the proportion of patients with systemic lupus erythematosus decreased in males (10% to 6.4%) and in females (37% to 29%). Proportion of patients with renal transplantation fell consistently across the study period in both males (3.8% to 1.2%) and females (3.2% to 0.8%). In contrast, the proportion of patients receiving steroids for pulmonary disease (except asthma) significantly increased in both males (0.5% to 5.5%) and females (0.5% to 3.6%). CONCLUSIONS This large descriptive study is the first to investigate temporal trends in the characteristics of ONFH, which provide useful information for future studies.
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Affiliation(s)
- Shinji Takahashi
- Department of Public Health, Osaka City University Faculty of Medicine
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Ikeuchi K, Hasegawa Y, Seki T, Takegami Y, Amano T, Ishiguro N. Epidemiology of nontraumatic osteonecrosis of the femoral head in Japan. Mod Rheumatol 2014; 25:278-81. [PMID: 25036228 DOI: 10.3109/14397595.2014.932038] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To elucidate the epidemiology of nontraumatic osteonecrosis of the femoral head (ONFH), and to estimate the annual incidence rate in Japan. METHODS We examined, over the course of 3 years, personal records and radiographic images from the national registry of documents used for the study of nontraumatic ONFH in patients in Aichi Prefecture, Japan (population: 7.4 million). Those patients not meeting the diagnostic criteria according to the Japanese Investigation Committee for nontraumatic ONFH were excluded from this study. RESULTS A total of 285 out of the 327 patients who applied for the national registration of nontraumatic ONFH during the 3-year study met the diagnostic criteria for personal records, radiographic images, and magnetic resonance images. Forty-two patients (12.8%) were not considered to have nontraumatic ONFH. The mean age of patients was 50.4 years, and the male-female ratio was 2.1:1. Nontraumatic ONFH was steroid-induced in 135 cases (47.4%), alcohol-associated in 87 cases (30.5%), steroid-induced and alcohol- associated in 14 cases (4.9%), and idiopathic in 49 cases (17.2%). CONCLUSIONS The age-adjusted annual incidence of nontraumatic ONFH in Aichi Prefecture was estimated at 138.5 patients.Thus the annual incidence rate in Japan (population 128 million) was 1.91/100,000.
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Affiliation(s)
- Kazuma Ikeuchi
- Nagoya University Hospital, Nagoya University Graduate School of Medicine , Nagoya , Japan
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