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Yang P, He W, Yang W, Jiang L, Lin T, Sun W, Zhang Q, Bai X, Guo D, Sun W. Panoramic heat map for spatial distribution of necrotic lesions. Bone Joint Res 2024; 13:294-305. [PMID: 38884556 PMCID: PMC11181948 DOI: 10.1302/2046-3758.136.bjr-2023-0181.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
Aims In this study, we aimed to visualize the spatial distribution characteristics of femoral head necrosis using a novel measurement method. Methods We retrospectively collected CT imaging data of 108 hips with non-traumatic osteonecrosis of the femoral head from 76 consecutive patients (mean age 34.3 years (SD 8.1), 56.58% male (n = 43)) in two clinical centres. The femoral head was divided into 288 standard units (based on the orientation of units within the femoral head, designated as N[Superior], S[Inferior], E[Anterior], and W[Posterior]) using a new measurement system called the longitude and latitude division system (LLDS). A computer-aided design (CAD) measurement tool was also developed to visualize the measurement of the spatial location of necrotic lesions in CT images. Two orthopaedic surgeons independently performed measurements, and the results were used to draw 2D and 3D heat maps of spatial distribution of necrotic lesions in the femoral head, and for statistical analysis. Results The results showed that the LLDS has high inter-rater reliability. As illustrated by the heat map, the distribution of Japanese Investigation Committee (JIC) classification type C necrotic lesions exhibited clustering characteristics, with the lesions being concentrated in the northern and eastern regions, forming a hot zone (90% probability) centred on the N4-N6E2, N3-N6E units of outer ring blocks. Statistical results showed that the distribution difference between type C2 and type C1 was most significant in the E1 and E2 units and, combined with the heat map, indicated that the spatial distribution differences at N3-N6E1 and N1-N3E2 units are crucial in understanding type C1 and C2 necrotic lesions. Conclusion The LLDS can be used to accurately measure the spatial location of necrotic lesions and display their distribution characteristics.
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Affiliation(s)
- Peng Yang
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Wei He
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Traumatology & Orthopedics Institute of Chinese Medicine of Guangdong, Guangzhou, China
| | - Weiming Yang
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Luoyong Jiang
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
| | - Tianye Lin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weichao Sun
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qingwen Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Traumatology & Orthopedics Institute of Chinese Medicine of Guangdong, Guangzhou, China
| | - Xueling Bai
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Da Guo
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wei Sun
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
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Xu M, Motomura G, Utsunomiya T, Ikemura S, Yamaguchi R, Yamamoto N, Tanaka H, Ayabe Y, Sakamoto K, Wang Y, Nakashima Y. Effects of bone mineral density at the lateral sclerotic boundary on the femoral head collapse onset in osteonecrosis of the femoral head: A preliminary study. Clin Biomech (Bristol, Avon) 2024; 111:106156. [PMID: 38029477 DOI: 10.1016/j.clinbiomech.2023.106156] [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: 06/27/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND In the natural course of osteonecrosis of the femoral head, sclerotic changes at the boundary of necrotic lesion gradually occur until femoral head collapse. This study aims to examine the effects of bone mineral density at the lateral boundary of necrotic lesion on a subsequent femoral head collapse. METHODS We developed patient-specific finite element models of 9 hips with subsequent collapse and 10 hips without subsequent collapse. Cubic regions of interest were selected at both subchondral areas of the lateral boundary and the adjacent necrotic lesion. Bone mineral density values of the regions of interest were quantitatively measured, and a ratio of bone mineral density values (lateral boundary/necrotic lesion) was calculated. Stress values at the lateral boundary were also evaluated. FINDINGS The ratio of bone mineral density values was significantly higher in hips with subsequent collapse than that without subsequent collapse (p = 0.0016). The median equivalent stress and shear stress were significantly higher in hips with subsequent collapse than that without subsequent collapse (p = 0.0071, and p = 0.0143, respectively). The ratio of bone mineral density values showed a promising value in predicting the occurrence of subsequent femoral head collapse (AUC = 0.97). INTERPRETATION Our results indicated that bone mineral density value at the lateral boundary of necrotic lesion may be associated with the occurrence of subsequent femoral head collapse in pre-collapse stage osteonecrosis of the femoral head.
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Affiliation(s)
- Mingjian Xu
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Nantong 226001, People's Republic of China; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Noriko Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hidenao Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yusuke Ayabe
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kousei Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Youhua Wang
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Nantong 226001, People's Republic of China
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Huang Y, Gu C, Xi H, Chen H, Gao F, Yuan X, Guo M, Mai J, Liu X, Du B. Sclerosis rim volume ratio and Japanese Investigation Committee classification as predictive factors for femoral head collapse progression after non-vascularized fibular grafting in osteonecrosis patients. Asian J Surg 2024; 47:250-255. [PMID: 37661477 DOI: 10.1016/j.asjsur.2023.08.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/22/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE The purpose of this retrospective cohort study was to determine the relationship between sclerosis rim volume ratio (SVR) and the progression of femoral head collapse after non-vascularized fibular grafting (NVFG) surgery in patients with osteonecrosis of the femoral head (ONFH), investigating risk factors associated with femoral head collapse progression and establishing a predictive model to enhance clinical decision-making. METHODS ONFH patients who underwent NVFG between January 2008 and December 2021 were analyzed retrospectively to assess the risk of post-operative collapse progression (collapse >2 mm). A logistic regression model was used to evaluate the independent risk factors associated with collapse progression, including age, sex, etiology, affected side, Japanese Investigation Committee classification (JIC), and the sclerosis rim volume ratio (SVR). SVR values was collected from three weight-bearing columns, namely SVR1, SVR2, and SVR3, respectively. RESULTS 57 patients with 64 hips who had undergone NVFG and were followed up for at least one year were included. During the follow-up, collapse>2 mm occurred in 30 hips (46.88%). Multivariable analysis revealed that JIC (p =0.037) and SVR1 (p = 0.04) were independent risk factors for collapse progression after NVFG. The results of the receiver operating characteristic (ROC) analysis indicated that the aforementioned indices provided a satisfactory prediction of early femoral head collapse progression in ONFH patients after NVFG. The regression model using the above two indicators as a composite index showed satisfactory performance in predicting early postoperative femoral head collapse progression, with an area under the curve (AUC) of 84.6%. CONCLUSIONS SVR is significant predictor of post-operative collapse progression following NVFG, and the composite index provides an optimal predictive value for femoral head collapse progression after surgery.
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Affiliation(s)
- Yixuan Huang
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Changyuan Gu
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Hongzhong Xi
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Hao Chen
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Feifei Gao
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Xinwei Yuan
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Mingbin Guo
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Jianbin Mai
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Xin Liu
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China.
| | - Bin Du
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China.
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Inoue T, Shoji T, Kato Y, Fujiwara Y, Sumii J, Shozen H, Adachi N. Investigating the subchondral trabecular bone microstructure in patients with osteonecrosis of the femoral head using multi-detector row computed tomography. Mod Rheumatol 2023; 33:1190-1196. [PMID: 36208297 DOI: 10.1093/mr/roac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/19/2022] [Accepted: 09/25/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To analyse the microstructural changes of subchondral trabecular bone in patients with osteonecrosis of the femoral head (ONFH) using multi-detector row computed tomography (MDCT). METHODS We retrospectively investigated 76 hips in 50 patients diagnosed with ONFH between 2017 and 2021. Groups 1, 2, 3, and 4 comprised hips without ONFH, ONFH without femoral head collapse (FHC), ONFH with mild collapse (<2 mm), and ONFH with severe collapse (>2 mm), respectively. All patients underwent MDCT, and the subchondral trabecular bone microstructure was assessed. Regions of interests were set at the lateral boundary of the femoral head necrotic lesion and centre of the acetabular weight-bearing portion. RESULTS In both the femoral head and the acetabular regions, there were significant differences in Groups 2 and 3 compared to Group 1, with increased volumetric bone mineral density and apparent bone volume fraction, and more plate-like with increased connectivity, indicating that osteosclerotic changes were occurring. CONCLUSIONS In both the femoral head and the acetabular regions, osteosclerotic changes of subchondral trabecular bone microstructure were present before FHC.
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Affiliation(s)
- Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Shoji
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yusuke Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Shozen
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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He MC, Tian JQ, He XM, Yang P, Lin TY, Zhang QW, He W, Wei QS. Mechanical properties of trabeculae and osteocyte morphology change significantly in different areas of the necrotic femoral head. Front Cell Dev Biol 2023; 11:1250070. [PMID: 37822871 PMCID: PMC10562544 DOI: 10.3389/fcell.2023.1250070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Background: Osteonecrosis of the femoral head is a complex hip ailment. The precise changes in bone tissue during the disease's onset remain unclear. It is vital to assess both the quantity and quality of the trabecular state in a necrotic femoral head. Aim: This study aims to identify and compare the ultrastructural changes in osteocyte morphology and nanomechanical characteristics within various regions of necrotic femoral heads. Methods: Between December 2016 and May 2023, we gathered ten necrotic femoral heads from patients and five femoral heads from cadavers. The samples from the necrotic femoral heads were categorized into three areas: necrotic, sclerotic, and normal. Our assessment methods encompassed hematoxylin and eosin staining, sclerostin (SOST) immunohistochemistry, micro-computed tomography, nanoindentation, and acid-etched scanning electron microscopy. These techniques enabled us to examine the SOST expression, trabecular microstructure, micromechanical properties of trabeculae, and modifications in osteocyte morphology at the ultrastructural level. Results: The protein level of SOST was found to be lower in the sclerotic area. In the necrotic area, decreased values of bone volume fraction, trabecular thickness, and trabecular number and an increased value of trabecular separation were found. Conversely, in the sclerotic area, higher mean values of bone volume fraction, trabecular number, and trabecular thickness and lower trabecular separation indicated significant changes in the structural characteristics of trabeculae. Compared with the healthy area, the elastic modulus and hardness in the sclerotic area were significantly higher than those in the necrotic, normal, and control areas, while those in necrotic areas were significantly lower than those in the healthy area. The number of osteocytes tended to increase in the sclerotic area with more canalicular cells compared to the healthy area and control group. Conclusion: These results imply that the stress distribution within the sclerotic area could potentially lead to enhanced trabecular quality and quantity. This effect is also reflected in the increased count of osteocytes and their canaliculars. It is plausible that the sclerotic trabecular bone plays a pivotal role in the repair of necrotic femoral heads.
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Affiliation(s)
- Min-Cong He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia-Qing Tian
- The Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Ming He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Yang
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tian-Ye Lin
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qing-Wen Zhang
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiu-Shi Wei
- The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
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Bae J, Lee SK, Kim J, Kim JY, Kim JH. What Is New in Stage 3 of the 2019 Revised Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head: A Relationship to Bone Resorption. J Comput Assist Tomogr 2023; 47:774-781. [PMID: 37707408 DOI: 10.1097/rct.0000000000001478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE The aim of the study is to evaluate the stage 3 findings of the 2019 revision of the Association Research Circulation Osseous (ARCO) staging system for osteonecrosis of the femoral head between 3A and 3B and the relationship with bone resorption area. MATERIALS AND METHODS We retrospectively enrolled 87 patients with ARCO stage 3 osteonecrosis of the femoral head, divided into stage 3A (n = 73) and 3B (n = 14). The revised stage 3 findings included subchondral fracture, fracture in necrotic portion, and flattening of the femoral head and were compared between stage 3A and 3B. The association between these findings and the causative features of bone resorption area was also evaluated. RESULTS All stage 3 cases had subchondral fractures. In stage 3A, these fractures were generated by crescent sign (41.1%) and by fibrovascular reparative zone in 58.9%; however, in stage 3B, fibrovascular reparative zone generated 92.9% of these fractures and crescent sign only 7.1% with statistical significance ( P = 0.034). Necrotic portion fracture was noted in 36.7% and femoral head flattening was observed in 14.9% of all stage 3. Necrotic portion fracture (92.9% vs 26.0%) and femoral head flattening (71.4% vs 4.1%) were observed more frequently in stage 3B than 3A ( P < 0.001). Almost all subchondral fractures by fibrovascular reparative zone (96.4%) and necrotic portion fracture (96.9%), and all femoral head flattening was presented with bone resorption area with expanding areas. CONCLUSIONS The ARCO stage 3 descriptions reflect severity in this order: subchondral fracture, necrotic portion fracture, and femoral head flattening. More severe findings are usually associated with expanding bone resorption areas.
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Affiliation(s)
- Jiwon Bae
- From the Department of Radiology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Seul Ki Lee
- From the Department of Radiology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Jiyoung Kim
- From the Department of Radiology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Jee-Young Kim
- From the Department of Radiology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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Fischer B, Reise R, Schleifenbaum S, Roth A. Mechanical parameter assessment of fresh human cancellous bone of the femoral head in atraumatic femoral head necrosis and primary coxarthrosis. Clin Biomech (Bristol, Avon) 2023; 108:106057. [PMID: 37549470 DOI: 10.1016/j.clinbiomech.2023.106057] [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: 04/05/2023] [Revised: 06/23/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Atraumatic femoral head necrosis is a rare pathological change of the femoral head. It is characterized by local necrosis of the cancellous bone as a result of reduced blood supply to the bone. Even today it remains unclear how to assess the hardness of the necrosis, whether it is soft tissue that is easily removed, or hard tissue that is difficult to resect. METHODS Femoral heads with primary coxarthrosis were selected as a comparison group. For this purpose, 49 femoral heads obtained during total hip arthroplasty surgery with either condition (23 femoral head necrosis, 26 coxarthrosis) were transferred to the testing laboratory in fresh condition. Cylindrical specimens were obtained using a tenon cutter along the main trabecular load direction in the subchondral region of the femoral head. Additionally, thin bone slices were extracted proximal and distal to the specimens for density measurements. Brass plates were glued to the circular surfaces of the specimens. After curing of the adhesive, the specimens were mounted in the testing machine and destructive uniaxial compression tests were conducted. FINDINGS The recorded mean compressive strengths and elastic moduli were almost identical for both groups, but the necrosis group showed significantly higher data scattering and range regarding the elastic modulus. The mean density of the coxarthrosis specimens was significantly higher than that of the necrotic specimens. INTERPRETATION The mechanical properties of cancellous bone vary considerably in the presence of femoral head necrosis. The existence of hard necrosis implies a potential challenge regarding the clinical resection of these tissues.
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Affiliation(s)
- Benjamin Fischer
- ZESBO - Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany; Institute of Anatomy, Leipzig University, Leipzig, Germany.
| | - Rebekka Reise
- ZESBO - Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany; Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Stefan Schleifenbaum
- ZESBO - Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany; Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Andreas Roth
- Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
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Yamamoto N, Motomura G, Ikemura S, Yamaguchi R, Utsunomiya T, Kawano K, Xu M, Tanaka H, Ayabe Y, Nakashima Y. Relationship between the degree of subchondral collapse and articular surface irregularities in osteonecrosis of the femoral head. J Orthop Res 2023. [PMID: 36906838 DOI: 10.1002/jor.25539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/11/2023] [Accepted: 02/22/2023] [Indexed: 03/13/2023]
Abstract
Articular surface irregularities are often observed in collapsed femoral heads with osteonecrosis, while the effects of the degree of collapse on the articular surface are poorly understood. We first macroscopically assessed the articular surface irregularities on 2-mm coronal slices obtained using high-resolution microcomputed tomography of 76 surgically resected femoral heads with osteonecrosis. These irregularities were observed in 68/76 femoral heads, mainly at the lateral boundary of the necrotic region. The mean degree of collapse was significantly larger for femoral heads with articular surface irregularities than for those without (p < 0.0001). Receiver operating characteristic analysis showed that the cutoff value for the degree of collapse in femoral heads with articular surface irregularities at the lateral boundary was 1.1 mm. Next, for femoral heads with <3-mm collapse (n = 28), articular surface irregularities were quantitatively assessed based on the number of automatically counted negative curvature points. Quantitative evaluation showed that the degree of collapse was positively correlated with the presence of articular surface irregularities (r = 0.95, p < 0.0001). Histological examination of articular cartilage above the necrotic region (n = 8) revealed cell necrosis in the calcified layer and abnormal cellular arrangement in the deep and middle layers. In conclusion, articular surface irregularities of the necrotic femoral head depended on the degree of collapse, and articular cartilage was already altered even in the absence of macroscopically determined gross irregularities.
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Affiliation(s)
- Noriko Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichiro Kawano
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mingjian Xu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidenao Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yusuke Ayabe
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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9
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Mourad C, Omoumi P, Vande Berg B. The Many Faces of Marrow Necrosis. Semin Musculoskelet Radiol 2023; 27:103-113. [PMID: 36868248 DOI: 10.1055/s-0043-1761497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Depending on the age and location within the skeleton, bone marrow can be mostly fatty or hematopoietic, and both types can be affected by marrow necrosis. This review article highlights the magnetic resonance imaging findings of disorders in which marrow necrosis is the dominant feature.Fatty marrow necrosis is detected on T1-weighted images that show an early and specific finding: the reactive interface. Collapse is a frequent complication of epiphyseal necrosis and detected on fat-suppressed fluid-sensitive sequences or using conventional radiographs. Nonfatty marrow necrosis is less frequently diagnosed. It is poorly visible on T1-weighted images, and it is detected on fat-suppressed fluid-sensitive images or by the lack of enhancement after contrast injection.Pathologies historically "misnamed" as osteonecrosis but do not share the same histologic or imaging features of marrow necrosis are also highlighted.
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Affiliation(s)
- Charbel Mourad
- Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui - CHU, Beyrouth, Lebanon.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bruno Vande Berg
- Department of Radiology, Musculoskeletal Section, Centre Hospitalier Chretien, CHC, Clinique Mont Legia, Liege, Belgium
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Gómez-Barrena E, Padilla-Eguiluz NG, López-Marfil M, Ruiz de la Reina R. Volume and location of bone regeneration after autologous expanded mesenchymal stromal cells in hip osteonecrosis : a pilot study. Bone Joint Res 2022; 11:881-889. [PMID: 36464628 PMCID: PMC9792875 DOI: 10.1302/2046-3758.1112.bjr-2022-0152.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS Successful cell therapy in hip osteonecrosis (ON) may help to avoid ON progression or total hip arthroplasty (THA), but the achieved bone regeneration is unclear. The aim of this study was to evaluate amount and location of bone regeneration obtained after surgical injection of expanded autologous mesenchymal stromal cells from the bone marrow (BM-hMSCs). METHODS A total of 20 patients with small and medium-size symptomatic stage II femoral head ON treated with 140 million BM-hMSCs through percutaneous forage in the EudraCT 2012-002010-39 clinical trial were retrospectively evaluated through preoperative and postoperative (three and 12 months) MRI. Then, 3D reconstruction of the original lesion and the observed postoperative residual damage after bone regeneration were analyzed and compared per group based on treatment efficacy. RESULTS The mean preoperative lesion volume was 18.7% (SD 10.2%) of the femoral head. This reduced to 11.6% (SD 7.5%) after three months (p = 0.015) and 3.7% (SD 3%) after one year (p < 0.001). Bone regeneration in healed cases represented a mean 81.2% (SD 13.8%) of the initial lesion volume at one year. Non-healed cases (n = 1 stage progression; n = 3 THAs) still showed bone regeneration but this did not effectively decrease the ON volume. A lesion size under mean 10% (SD 6%) of the femoral head at three months predicted no ON stage progression at one year. Regeneration in the lateral femoral head (C2 under Japanese Investigation Committee (JCI) classification) and in the central and posterior regions of the head was predominant in cases without ON progression. CONCLUSION Bone regeneration was observed in osteonecrotic femoral heads three months after expanded autologous BM-hMSC injection, and the volume and location of regeneration indicated the success of the therapy.Cite this article: Bone Joint Res 2022;11(12):881-889.
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Affiliation(s)
- Enrique Gómez-Barrena
- Department of Orthopedic Surgery and Traumatology, La Paz Hospital, IdiPaz, Universidad Autónoma de Madrid, Madrid, Spain, Enrique Gómez-Barrena. E-mail:
| | - Norma-Griset Padilla-Eguiluz
- Department of Orthopedic Surgery and Traumatology, La Paz Hospital, IdiPaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marta López-Marfil
- Biomedical Engineering Master program, Universidad Politécnica de Madrid, Madrid, Spain
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11
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Liu X, Wang C, Meng H, Liao S, Zhang J, Guan Y, Tian H, Peng J. Research Progress on Exosomes in Osteonecrosis of the Femoral Head. Orthop Surg 2022; 14:1951-1957. [PMID: 35924692 PMCID: PMC9483046 DOI: 10.1111/os.13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/28/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a progressive disease that often necessitates hip replacement if hip preservation therapy fails. ONFH places a heavy economic burden and severe psychological pressure on patients. At present, ONFH is treated by either surgical or non‐surgical methods. In clinical practice, stem cells combined with surgery has achieved some positive results, but many problems remain to be resolved. Exosomes are small vesicles of 30–150 nm, which are rich in various nucleic acids, proteins, and small molecules depending on the cells from which they are derived. A growing number of studies have found that exosomes play an important role in tissue damage repair. In comparison with stem cells, exosomes have lower immunogenicity. Also, exosomes can promote cell proliferation and inhibit tumor growth. In addition, exosomes can also be used as natural carriers of drugs. Many studies have shown that exosomes have therapeutic effects in hormone‐induced ONFH. Exosomes have the effect of promoting vascular regeneration and show good application prospects in ONFH. Here, we present a review of studies on the application of exosomes in ONFH to provide a reference for future research.
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Affiliation(s)
- Xiuzhi Liu
- Medical School of Chinese PLA, Beijing, China.,Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Cheng Wang
- Department of Orthopedics, Engineering Research Center of Bone and Joint Precision Medicine, Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Haoye Meng
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Sida Liao
- Medical School of Chinese PLA, Beijing, China
| | - Jian Zhang
- Medical School of Chinese PLA, Beijing, China
| | - Yanjun Guan
- Medical School of Chinese PLA, Beijing, China
| | - Hua Tian
- Department of Orthopedics, Engineering Research Center of Bone and Joint Precision Medicine, Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Jiang Peng
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
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12
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Wang P, Wang C, Meng H, Liu G, Li H, Gao J, Tian H, Peng J. The Role of Structural Deterioration and Biomechanical Changes of the Necrotic Lesion in Collapse Mechanism of Osteonecrosis of the Femoral Head. Orthop Surg 2022; 14:831-839. [PMID: 35445585 PMCID: PMC9087473 DOI: 10.1111/os.13277] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/21/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a crippling disease which is due to a lack of effective therapeutic measures. Its natural progression is rapid, the internal bone structure of the femoral head changes dramatically, and the subsequent fractures and collapse cause severe hip pain and loss of hip function. Femoral head collapse is a critical turning point in the development of ONFH and is related to the prognosis of patients. Early prevention and intervention help to preserve the hip joint and delay femoral head collapse. However, the mechanism of collapse still needs to be further studied because it is affected by different complex factors. This review discusses the underlying causes of femoral head collapse from two aspects: structural degradation and regional changes of biomechanical properties in the necrotic femoral head.
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Affiliation(s)
- Peng Wang
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Cheng Wang
- Department of Orthopedics,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Haoye Meng
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Guangbo Liu
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Huo Li
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Jianming Gao
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Hua Tian
- Department of Orthopedics,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Jiang Peng
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
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13
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Zheng GS, Qiu X, Wang BJ, Zhao DW. Relationship Between Blood Flow and Collapse of Nontraumatic Osteonecrosis of the Femoral Head. J Bone Joint Surg Am 2022; 104:13-18. [PMID: 35389902 DOI: 10.2106/jbjs.20.00490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To investigate the collapse mechanism in osteonecrosis of the femoral head (ONFH), we studied the relationship between the femoral head (FH) blood circulation changes and the collapse area histomorphometry characteristics. METHODS A technique involving microvascular perfusion of the FH in vitro to reconstruct the vessels in the FH at different stages of nontraumatic ONFH (40 cases). In addition, we also examined the histomorphometry characteristics in the collapse area during ONFH at different stages using the hard tissue section technique. To investigate the blood supply changes in the FH on pathological involved in the FH collapse process. RESULTS The results showed that in all FHs, the collapse area always involved the margin of the necrotic lesion of the lateral column. Histologically, the fracture occurred between the thickened and necrotic trabeculae at the junction. We found that the collapse started at the lateral column of the FH in the necrotic lesion and that the lateral column was ischemic, which caused the FH to begin to collapse. CONCLUSIONS Based on the above findings, the relationship between associations of the blood circulation to the collapse showed that if a portion of the blood supply of the lateral column (the superior retinacular artery) was preserved, the prognosis of the natural progression of the diseases was improved, the collapse rate was low and collapse occurred later. The blood circulation of artery in the lateral column was good, and the FH maintained an intact shape even if the internal region was ischemic. Therefore, we can predict the collapse of the FH by measuring the blood flow in the lateral area of the FH, thus providing guidance for the selection of FH-preserving clinical therapy in young and middle-aged patients. CLINICAL RELEVANCE This work provides a proof of how to predict the collapse of the FH by measuring the blood flow, providing guidance for FH-preserving clinical therapy in young and middle-aged patients.
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Affiliation(s)
- Guo-Shuang Zheng
- Laboratory of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China.,Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China.,National-Local Joint Engineering Laboratory for the Development of Orthopedic Implant Materials, Dalian, Liaoning, China
| | - Xing Qiu
- Laboratory of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China.,Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Ben-Jie Wang
- Laboratory of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China.,Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - De-Wei Zhao
- Laboratory of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China.,Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China.,National-Local Joint Engineering Laboratory for the Development of Orthopedic Implant Materials, Dalian, Liaoning, China
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14
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Ikemura S, Motomura G, Kawano K, Hamai S, Fujii M, Nakashima Y. The Discrepancy in the Posterior Boundary of Necrotic Lesion Between Axial and Oblique Axial Slices of MRI in Patients with Osteonecrosis of the Femoral Head. J Bone Joint Surg Am 2022; 104:33-39. [PMID: 35108239 DOI: 10.2106/jbjs.20.00493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known concerning differences in assessment of anteroposterior osteonecrotic lesion of the femoral head (ONFH) between the axial plane parallel to the body axis (axial) and the axial plane parallel to the femoral neck axis (oblique axial) using magnetic resonance imaging (MRI). This study aimed to compare the posterior boundary of necrotic lesions between the axial and oblique axial planes on MRI. METHODS This study retrospectively reviewed 120 consecutive hips in 71 patients (47 males and 24 females; mean age, 42 years) with ONFH, for which both axial and oblique axial MRI slices were available. The posterior boundaries of the necrotic lesions were calculated as the ratio of posterior intact circumference to anteroposterior circumference of the femoral head using mid-axial and mid-oblique axial MRI slices. The necrotic angles, calculated using the modified Kerboul method, were compared between cases with progression and nonprogression of collapse. RESULTS The mean posterior intact ratio in the axial slice was 49.2% (range, 8.6 to 85.1%), while that in the oblique axial slice was 33.5% (7.5 to 79.2%). The posterior intact ratio in the oblique axial slice significantly decreased compared to that in the axial slice (p < 0.0001). In cases with progression of collapse, the mean necrotic angle was significantly larger in the oblique axial slice than in the axial slice (p < 0.0001). The sensitivity and specificity of the necrotic angle with regard to the prognosis of the femoral head were both higher when using the oblique axial slice (sensitivity: 88.4%, specificity: 82.3%) than when using the axial slice (sensitivity: 85.1%, specificity: 62.0%). The posterior intact ratio at a mean of 6.8 mm superior to the mid-axial slice corresponded to that of the mid-oblique axial slice. CONCLUSION Our findings suggest that the posterior boundaries of necrotic lesions differ between axial and oblique axial slices, and examination of the oblique axial MRI slice might be more suitable for predicting the prognosis of the femoral head. LEVEL OF EVIDENCE Diagnostic-Investigating a diagnostic test. Level IV (Case series).
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Affiliation(s)
- Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
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15
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Icariin regulates miR-23a-3p-mediated osteogenic differentiation of BMSCs via BMP-2/Smad5/Runx2 and WNT/β-catenin pathways in osteonecrosis of the femoral head. Saudi Pharm J 2022; 29:1405-1415. [PMID: 35002378 PMCID: PMC8720822 DOI: 10.1016/j.jsps.2021.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/22/2021] [Indexed: 01/03/2023] Open
Abstract
Icariin is commonly used for the clinical treatment of osteonecrosis of the femoral head (ONFH). miR-23a-3p plays a vital role in regulating the osteogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSCs). The present study aimed to investigate the roles of icariin and miR-23a-3p in the osteogenic differentiation of BMSCs and an ONFH model. BMSCs were isolated and cultured in vitro using icariin-containing serum at various concentrations, and BMSCs were also transfected with a miR-23a inhibitor. The alkaline phosphatase (ALP) activity and cell viability as well as BMP-2/Smad5/Runx2 and WNT/β-catenin pathway-related mRNA and protein expression were measured in BMSCs. Additionally, a dual-luciferase reporter assay and pathway inhibitors were used to verify the relationship of icariin treatment/miR-23a and the above pathways. An ONFH rat model was established in vivo, and a 28-day gavage treatment and lentivirus transfection of miR-23a-3p inhibitor were performed. Then, bone biochemical markers (ELISA kits) in serum, femoral head (HE staining and Digital Radiography, DR) and the above pathway-related proteins were detected. Our results revealed that icariin treatment/miR-23a knockdown promoted BMSC viability and osteogenic differentiation as well as increased the mRNA and protein expression of BMP-2, BMP-4, Runx2, p-Smad5, Wnt1 and β-catenin in BMSCs and ONFH model rats. In addition, icariin treatment/miR-23a knockdown increased bone biochemical markers (ACP-5, BAP, NTXI, CTXI and OC) and improved ONFH in ONFH model rats. In addition, a dual-luciferase reporter assay verified that Runx2 was a direct target of miR-23a-3p. These data indicated that icariin promotes BMSC viability and osteogenic differentiation as well as improves ONFH by decreasing miR-23a-3p levels and regulating the BMP-2/Smad5/Runx2 and WNT/β-catenin pathways.
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Key Words
- BAP, bone-specific alkaline phosphatase
- BMP-2, bone morphogenetic protein-2
- BMP-2/Smad5/Runx2 pathway
- BMP-4, bone morphogenetic protein-4
- BMSCs, bone marrow-derived mesenchymal stem cells
- CTX-1, C-terminal telopeptides of type I collagen
- DMEM, Dulbecco’s modified Eagle’s medium
- DR, Digital Radiography
- FBS, fetal bovine serum
- HE, Hematoxylin‐eosin
- Icariin
- LPS, lipopolysaccharide
- NTX-1, N-terminal telopeptides of type I collagen
- OC, osteocalcin
- ONFH, osteonecrosis of the femoral head
- Osteonecrosis of the femoral head
- RT-PCR, Real time PCR
- SI, icariin-containing serum
- TRACP-5b, tartrate-resistant acid phosphatase 5b
- WNT/β-catenin pathway
- miR-23a-3p
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16
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Chen Y, Miao Y, Liu K, Xue F, Zhu B, Zhang C, Li G. Evolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems. J Orthop Translat 2022; 32:28-40. [PMID: 35591937 PMCID: PMC9072800 DOI: 10.1016/j.jot.2021.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a recalcitrant ischemic disorder, which could be classified into two major categories: traumatic and nontraumatic. Regardless of different risk factors, it has been testified that ONFH results from primitive vascular problems, leading to temporary or permanent loss of blood supply to bone tissue. Histopathological and microarchitectural alterations ensues, which is a gradual evolutionary process involving bone marrow and osteocyte necrosis, progressive destruction of subchondral bone, unsuccessful reparative process, and eventual articular collapse and degenerative arthritis. Based on the imaging features of ONFH, different classification systems have been developed to evaluate the severity and prognosis of the disease, which is pivotal for implementation of treatment strategy, especially the joint-preserving surgery. However, patients classified with the same severity stage, especially in the peri-collapse stage, sometimes responded differently after similar joint-preserving surgery. The unusual phenomenon may be attributed to the limitation of the current imaging classification systems, which might underestimate the disease severity, especially when referring to the early stages. In this review, we briefly summarize the etiology and pathogenesis of ONFH. The imaging features and staging classification systems of ONFH are also described. More importantly, we focus on histopathological and microstructural alterations of the femoral head, and provide an overview of their essential contribution to ONFH progression. Given the observation of discordance between imaging characteristics and histopathological alterations, a substantial amount of research on the relationship between imaging and histopathological features is required to further modify and revise the current wide-accepted classification systems.
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17
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Li Z, Liu P, Yuan Y, Liang X, Lei J, Zhu X, Zhang Z, Cai L. Loss of longitudinal superiority marks the microarchitecture deterioration of osteoporotic cancellous bones. Biomech Model Mechanobiol 2021; 20:2013-2030. [PMID: 34309757 DOI: 10.1007/s10237-021-01491-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/05/2021] [Indexed: 12/11/2022]
Abstract
Osteoporosis (OP), a skeletal disease making bone mechanically deteriorate and easily fracture, is a global public health issue due to its high prevalence. It has been well recognized that besides bone loss, microarchitecture degradation plays a crucial role in the mechanical deterioration of OP bones, but the specific role of microarchitecture in OP has not been well clarified and quantified from mechanics perspective. Here, we successfully decoupled and identified the specific roles of microarchitecture, bone mass and tissue property in the failure properties of cancellous bones, through μCT-based digital modeling and finite element method simulations on bone samples from healthy and ovariectomy-induced osteoporotic mice. The results show that the microarchitecture of healthy bones exhibits longitudinal superiority in mechanical properties such as the effective stiffness, strength and toughness, which fits them well to bearing loads along their longitudinal direction. OP does not only reduce bone mass but also impair the microarchitecture topology. The former is mainly responsible for the mechanical degradation of bones in magnitude, wherever the latter accounts for the breakdown of their function-favorable anisotropy, the longitudinal superiority. Hence, we identified the microarchitecture-deterioration-induced directional mismatch between material and loading as a hazardous feature of OP and defined a longitudinal superiority index as measurement of the health status of bone microarchitecture. These findings provide useful insights and guidelines for OP diagnosis and treat assessment.
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Affiliation(s)
- Zhenzi Li
- Department of Mechanical Engineering, School of Civil Engineering, Wuhan University, Wuhan, 430072, People's Republic of China
| | - Pan Liu
- Department of Mechanical Engineering, School of Civil Engineering, Wuhan University, Wuhan, 430072, People's Republic of China
| | - Yanan Yuan
- Department of Mechanical Engineering, School of Civil Engineering, Wuhan University, Wuhan, 430072, People's Republic of China
| | - Xiaoxiao Liang
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Jun Lei
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Xiaobin Zhu
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China.
| | - Zuoqi Zhang
- Department of Mechanical Engineering, School of Civil Engineering, Wuhan University, Wuhan, 430072, People's Republic of China. .,Engineering Research Centre on Building Examination and Reinforcement Technology (Ministry of Education), Wuhan University, Wuhan, 430071, People's Republic of China. .,School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 637551, Singapore.
| | - Lin Cai
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
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18
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Mourad C, Galant C, Wacheul E, Kirchgesner T, Michoux N, Vande Berg B. Topology of microfractures in osteonecrotic femoral heads at μCT and histology. Bone 2020; 141:115623. [PMID: 32877712 DOI: 10.1016/j.bone.2020.115623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/14/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022]
Abstract
AIM To assess the topology of bone and cartilage microfractures in osteonecrotic femoral heads. METHOD Sixteen resected human femoral heads with collapsed osteonecrosis (ON, n = 11) or osteoarthritis (OA, n = 5) were imaged at μCT with 12 μ nominal resolution. Forty-seven histological sections and μCT reformats with (n = 30) or without (8 from ON and 9 from OA femoral heads) osteonecrotic lesions were obtained and divided in 2 × 2 mm segments by a superposed grid. A radiologist and a pathologist separately assessed the presence of bone and cartilage microfractures in each segment on μCT and histological images, respectively. We determined the frequency and distribution of segments with bone microfractures according to a zonal distribution. Matrix analysis was performed by using Matlab to calculate the connectivity index and long/short axis ratios of clustered segments with microfractures. RESULTS Segments with bone microfractures but not with cartilage microfractures were found more frequently in ON than in OA femoral heads. In the 38 matched μCT and histological images from ON femoral heads, 86%/82% of segments with cortical microfracture, 91%/96% of segments with trabecular microfractures involved ON lesions at μCT/histology. At histology, 83% of segments with cartilage microfractures involved ON lesions. In the 30 paired μCT and histological images containing necrotic lesions, the frequency of segments with trabecular microfractures in the superficial layers (55% at μCT/51% at histology) was statistically significantly higher than in the deep layer (25% P < 0.0001/35%; P = 0.0006). Clustered segments with cortical/trabecular microfractures, exclusively found in osteonecrotic lesions, had a connectivity index >2.0/20.0 and mean long/short axis ratio > 2.35/2.2, respectively. CONCLUSION Segments with bone microfractures predominate in necrotic lesions. Segments with trabecular microfractures form elongated clusters near the femoral head surface.
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Affiliation(s)
- Charbel Mourad
- Department of Radiology, Hôpital Libanais Geitaoui-CHU, Achrafieh, 1100 Beyrouth, Lebanon; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, 55 Avenue Hippocrate, 1200 Woluwé-Saint-Lambert, Brussels, Belgium.
| | - Christine Galant
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, 55 Avenue Hippocrate, 1200 Woluwé-Saint-Lambert, Brussels, Belgium; Department of Anatomopathology, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Woluwé-Saint-Lambert, Brussels, Belgium.
| | - Emilie Wacheul
- Department of Anatomopathology, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Woluwé-Saint-Lambert, Brussels, Belgium.
| | - Thomas Kirchgesner
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, 55 Avenue Hippocrate, 1200 Woluwé-Saint-Lambert, Brussels, Belgium; Department of Radiology, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Woluwé-Saint-Lambert, Brussels, Belgium.
| | - Nicolas Michoux
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, 55 Avenue Hippocrate, 1200 Woluwé-Saint-Lambert, Brussels, Belgium; Department of Radiology, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Woluwé-Saint-Lambert, Brussels, Belgium.
| | - Bruno Vande Berg
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, 55 Avenue Hippocrate, 1200 Woluwé-Saint-Lambert, Brussels, Belgium; Department of Radiology, Cliniques Universitaires Saint Luc, 10 Avenue Hippocrate, 1200 Woluwé-Saint-Lambert, Brussels, Belgium.
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19
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Kawano K, Motomura G, Ikemura S, Yamaguchi R, Baba S, Xu M, Nakashima Y. Differences in the microarchitectural features of the lateral collapsed lesion between osteonecrosis and subchondral insufficiency fracture of the femoral head. Bone 2020; 141:115585. [PMID: 32795680 DOI: 10.1016/j.bone.2020.115585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/03/2020] [Accepted: 08/09/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Like osteonecrosis of the femoral head (ONFH), subchondral insufficiency fracture of the femoral head (SIF) causes femoral head collapse. However, little is known about the differences between the two diseases regarding the morphological features of the collapsed lesion. We tested the hypothesis that the morphological features of the lateral collapsed lesion would differ between ONFH and SIF. METHODS Twenty femoral heads histopathologically diagnosed as ONFH (n = 10) or SIF (n = 10) were used in this study. In the lateral collapsed lesion of each femoral head, cubic regions of interest (ROIs) were selected within the collapsed subchondral area and the nearby non-collapsed subchondral area. Micro-CT-based microarchitectural parameters were compared between the ROIs in each disease. Additionally, correlations between histopathological and microarchitectural features were evaluated. RESULTS In ONFH, bone volume fraction, trabecular thickness, and bone mineral density in the collapsed area were all significantly lower than those in the nearby non-collapsed area where thickened bone trabeculae accompanied by appositional bone formation were invariably seen. On the other hand, in SIF there were no significant differences between the ROIs in any of these microarchitectural parameters. Histopathologically, varying degrees of callus formation overlying the fracture of the subchondral plate were seen around the lateral collapsed lesion. CONCLUSION The morphological features of the lateral collapsed lesion were inconsistent between ONFH and SIF, suggesting different pathomechanisms of femoral head collapse.
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Affiliation(s)
- Koichiro Kawano
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Shoji Baba
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Mingjian Xu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Baba S, Motomura G, Ikemura S, Yamaguchi R, Utsunomiya T, Hatanaka H, Kawano K, Xu M, Nakashima Y. Is bone mineral density lower in the necrotic lesion in pre-collapse osteonecrosis of the femoral head? J Orthop Res 2020; 38:2434-2442. [PMID: 32232982 DOI: 10.1002/jor.24674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to clarify whether bone mineral density (BMD) of the necrotic lesion in precollapse osteonecrosis of the femoral head (ONFH) is reduced according to Hounsfield unit (HU) values on computed tomography (CT). The superior one-third of the femoral head in the coronal section was set as the region of interest (ROI) for the measurement of HU values. First, HU values of 101 control participants were assessed to identify relevant confounding factors. Next, the relationship between HU values and BMD on dual-energy X-ray absorptiometry (DXA) was verified. Then the mean HU value of the ROI in patients with pre-collapse ONFH was compared with that in propensity score-matched control participants. Finally, the HU values of the lateral boundary in the patients with and without subsequent collapse were compared. Multivariable analysis showed that both age and BMI were significantly correlated with the HU value, which showed a strong correlation with the BMD of the femoral neck on DXA (r = 0.92). In 25 ONFH patients and 25 propensity-matched control participants, no significant difference was found in the HU value of the ROI (p = .54). The mean HU value of the lateral boundary in patients with subsequent collapse was found to be significantly higher than that in patients without subsequent collapse (p < .01). The assessment of HU values on CT was useful for the evaluation of BMD of the femoral head. The current assessment did not demonstrate reduced bone mineral density of the necrotic lesion in pre-collapse ONFH.
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Affiliation(s)
- Shoji Baba
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Hatanaka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichiro Kawano
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mingjian Xu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Combined Pharmacotherapy with Alendronate and Desferoxamine Regulate the Bone Resorption and Bone Regeneration for Preventing Glucocorticoids-Induced Osteonecrosis of the Femoral Head. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3120458. [PMID: 33029500 PMCID: PMC7532397 DOI: 10.1155/2020/3120458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 12/01/2022]
Abstract
Background Osteonecrosis of the femoral head (ONFH) is a challenge for surgeons and is still without effective treatment method. This study is aimed at evaluating the combined pharmacotherapy with alendronate and desferoxamine for preventing glucocorticoid-induced osteonecrosis of the femoral head (GIOFH) and evaluating the efficacy of the combined medicine in regulating the bone resorption and bone regeneration. Materials and Methods Thirty-six rats were randomly assigned to three groups: group A received alendronate and desferoxamine (n = 12), group B received alendronate only (n = 12), and group C acted as the control group received placebo (n = 12). All rats induced the GIOFH using methylprednisolone combined with lipopolysaccharide. Eight weeks later, all rats were killed and their tissues were subjected to radiographic and histological analyses. Results According to the results, alendronate administration improved the trabecular thickness and separation in micro-CT analysis but had no significant evidence in increasing the bone area and decreasing the ratio of osteocyte lacunae in histological analysis when compared with the control group. Meanwhile, the alendronate group had more OCs, but less OCN and VEGF levels along with decreased p-AKT, HIF-1α, RANKL, and NFATc1 expressions than the control group. For comparison, alendronate combined with DFO further improved the bone volume, trabecular number, trabecular separation, and trabecular thickness with lower ratio of osteocyte lacunae and OC number, higher expression of OCN and VEGF and upregulated signal factors of HIF-1α and β-catenin, and decreased RANKL and NFATc1. Conclusion Combined pharmacotherapy with alendronate and desferoxamine provide significant effects in regulating the bone resorption and bone regeneration for preventing GIOFN.
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Li TX, Huang ZQ, Li Y, Xue ZP, Sun JG, Gao HH, He HJ, Chen WH. Prediction of Collapse Using Patient-Specific Finite Element Analysis of Osteonecrosis of the Femoral Head. Orthop Surg 2020; 11:794-800. [PMID: 31663283 PMCID: PMC6819171 DOI: 10.1111/os.12520] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/11/2019] [Accepted: 07/28/2019] [Indexed: 01/12/2023] Open
Abstract
Objective To develop a prediction method for femoral head collapse by using patient‐specific finite element analysis of osteonecrosis of the femoral head (ONFH). Methods The retrospective study recruited 40 patients with ARCO stage‐II ONFH (40 pre‐collapse hips). Patients were divided into two groups according to the 1‐year follow‐up outcomes: patient group without femoral head collapse (noncollapse group, n = 20) and patient group with collapse (collapse group, n = 20). CT scans of the hip were performed for all patients once they joined the study. Patient‐specific finite element models were generated based on these original CT images following the same procedures: segmenting the necrotic lesion and viable proximal femur, meshing the computational models, assigning different material properties according to the Hounsfield unit distribution, simulating the stress loading of the slow walking gait, and measuring the distribution of the von Mises stress. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of the maximum level of the von Mises stress. The optimal cut‐off value was selected based on the Youden index and the corresponding predictive accuracy was reported as well. Results The mean level of the maximum von Mises stress in the collapse group was 2.955 ± 0.539 MPa, whereas the mean stress level in the noncollapse group was 1.923 ± 0.793 MPa (P < 0.01). ROC analysis of the maximum von Mises stress found that the area under the ROC curve was 0.842 (95% CI: 0.717–0.968, P < 0.01). The maximum Youden index was 0.60, which corresponded to two optimal cut‐off values: 2.7801 MPa (sensitivity: 0.70; specificity: 0.90; predictive accuracy: 80.00%; LR+: 7), and 2.7027 MPa (sensitivity: 0.75; specificity: 0.85; predictive accuracy: 77.50%; LR+: 5). Conclusion Finite element analysis is a potential method for femoral head collapse prediction among pre‐collapse ONFH patients. The maximum level of the von Mises stress on the weight‐bearing surface of the femoral head could be a good biomechanical marker to classify the collapse risk. The collapse prediction method based on patient‐specific finite element analysis is, thus, suitable to apply to clinical practice, but further testing on a larger dataset is desirable.
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Affiliation(s)
- Tai-Xian Li
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ze-Qing Huang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Li
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhi-Peng Xue
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ji-Gao Sun
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huan-Huan Gao
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hai-Jun He
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei-Heng Chen
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Baba S, Motomura G, Ikemura S, Kubo Y, Utsunomiya T, Hatanaka H, Kawano K, Nakashima Y. Quantitative evaluation of bone-resorptive lesion volume in osteonecrosis of the femoral head using micro-computed tomography. Joint Bone Spine 2020; 87:75-80. [DOI: 10.1016/j.jbspin.2019.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 09/04/2019] [Indexed: 12/16/2022]
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Wu RW, Lian WS, Kuo CW, Chen YS, Ko JY, Wang FS. S100 Calcium Binding Protein A9 Represses Angiogenic Activity and Aggravates Osteonecrosis of the Femoral Head. Int J Mol Sci 2019; 20:ijms20225786. [PMID: 31752076 PMCID: PMC6887714 DOI: 10.3390/ijms20225786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/13/2022] Open
Abstract
Ischemic damage aggravation of femoral head collapse is a prominent pathologic feature of osteonecrosis of the femoral head (ONFH). In this regard, S100 calcium binding protein A9 (S100A9) is known to deteriorate joint integrity, however, little is understood about which role S100A9 may play in ONFH. In this study, a proteomics analysis has revealed a decrease in the serum S100A9 level in patients with ONFH upon hyperbaric oxygen therapy. Serum S100A9 levels, along with serum vascular endothelial growth factor (VEGF), soluble vascular cell adhesion molecule-1 (sVCAM-1), interleukin-6 (IL-6), and tartrate-resistant acid phosphatase 5b levels were increased in patients with ONFH, whereas serum osteocalcin levels were decreased as compared to healthy controls. Serum S100A9 levels were increased with the Ficat and Arlet stages of ONFH and correlated with the patients with a history of being on glucocorticoid medication and alcohol consumption. Osteonecrotic tissue showed hypovasculature histopathology together with weak immunostaining for vessel marker CD31 and von Willrbrand factor (vWF) as compared to femoral head fracture specimens. Thrombosed vessels, fibrotic tissue, osteocytes, and inflammatory cells displayed strong S100A9 immunoreactivity in osteonecrotic lesion. In vitro, ONFH serum and S100A9 inhibited the tube formation of vessel endothelial cells and vessel outgrowth of rat aortic rings, whereas the antibody blockade of S100A9 improved angiogenic activities. Taken together, increased S100A9 levels are relevant to the development of ONFH. S100A9 appears to provoke avascular damage, ultimately accelerating femoral head deterioration through reducing angiogenesis. This study provides insight into the molecular mechanism underlying the development of ONFH. Here, analysis also highlights that serum S100A9 is a sensitive biochemical indicator of ONFH.
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Affiliation(s)
- Re-Wen Wu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (R.-W.W.); (J.-Y.K.)
- Department of Medicine; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Wei-Shiung Lian
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (W.-S.L.); (C.-W.K.); (Y.-S.C.)
- Core Laboratory for Phenomics & Diagnostics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chung-Wen Kuo
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (W.-S.L.); (C.-W.K.); (Y.-S.C.)
- Core Laboratory for Phenomics & Diagnostics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Yu-Shan Chen
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (W.-S.L.); (C.-W.K.); (Y.-S.C.)
- Core Laboratory for Phenomics & Diagnostics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Jih-Yang Ko
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (R.-W.W.); (J.-Y.K.)
| | - Feng-Sheng Wang
- Department of Medicine; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (W.-S.L.); (C.-W.K.); (Y.-S.C.)
- Core Laboratory for Phenomics & Diagnostics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Correspondence:
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Liu GB, Li R, Lu Q, Ma HY, Zhang YX, Quan Q, Liang XZ, Peng J, Lu SB. Three-dimensional distribution of cystic lesions in osteonecrosis of the femoral head. J Orthop Translat 2019; 22:109-115. [PMID: 32440506 PMCID: PMC7231955 DOI: 10.1016/j.jot.2019.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to investigate the location characteristics of cystic lesions in a three-dimensional context and discuss the mechanism of formation. Methods A total of 155 femoral head computed tomography images from 94 patients diagnosed with stage II and III osteonecrosis of the femoral head were retrospectively reviewed. Three-dimensional structures of the femoral head including the cystic lesions and necrotic area were reconstructed. We divided each femoral head into eight regions to observe the positional relationship of the cystic lesions, normal areas, and necrotic areas. Results The regional distribution revealed 14 (13%), 35 (32%), 9 (8%), 25 (23%), 6 (6%), 15 (14%), 4 (4%), and 0 (0%) cystic lesions in regions Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ, Ⅵ, Ⅶ, and Ⅷ, respectively. The anteromedial zone, A (Ⅰ + Ⅲ), contained 22% of the lesions, anterolateral zone, B (Ⅱ + Ⅳ), contained 54%, posteromedial zone, C (Ⅴ +Ⅶ), contained 9% of the lesions, and posterolateral zone, D (Ⅵ + Ⅷ), contained 15% of the lesions. Most of the cystic lesions (78%) were located between the normal and necrotic areas; 18% of cystic lesions were in the necrotic area and 4% were in the normal area. Conclusions Cystic lesions most often occur at the junction of the necrotic and normal areas and are most commonly located in the anterolateral femoral head, which is similar to the distribution of the stress concentration region. The translational potential of this article The study showed the location characteristics of cystic lesions in osteonecrosis of femoral head, which suggested that the formation of cystic lesions may be related to stress and could accelerate the collapse of femoral head. The results can support further research on cystic lesions and provide a reference for doctors' treatment strategies for patients with osteonecrosis of femoral head.
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Affiliation(s)
- Guang-Bo Liu
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Rui Li
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Qiang Lu
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hai-Yang Ma
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yu-Xuan Zhang
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Qi Quan
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xue-Zhen Liang
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Shandong, 250355, China
| | - Jiang Peng
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
- Corresponding author.
| | - Shi-Bi Lu
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
- Corresponding author.
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Luo D, Liang XZ, Xu B, Liu JB, Wei CF, Li G. Rapid Discovery of Potential Drugs for Osteonecrosis of Femoral Head Based on Gene Expression Omnibus Database and Connectivity Map. Orthop Surg 2019; 11:1209-1219. [PMID: 31692295 PMCID: PMC6904644 DOI: 10.1111/os.12533] [Citation(s) in RCA: 4] [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: 01/07/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 01/16/2023] Open
Abstract
Objective To use Gene Expression Omnibus (GEO) database coupled with Connectivity Map (CMap) databases to screen potential therapeutic drugs for osteonecrosis of femoral head (ONFH) rapidly. Methods Raw genetic data with accession number GSE74089 that contained eight hip articular cartilage specimens from four ONFH patients and four healthy controls were obtained from the Gene Expression Omnibus (GEO) database and were then integrated using R to identify differentially expressed genes (DEGs). Subsequently, to identify several potential small molecular compounds that were most strongly negatively correlated with ONFH, a search query of DEGs was explored by using CMap. Results Filtering revealed 1937 DEGs with log (fold‐change) ≥1 and adjust P value < 0.001. Finally, a network of candidate targets for ONFH with 135 nodes and 660 edges was constructed through network topology analysis, including 96 up‐regulated genes and 39 down‐regulated genes. Several significant gene functions and signaling pathways associated with pathological processes of ONFH were identified via gene enrichment analysis. Based on the CMap database, some potential small molecular components that may be possible to counteract the effects of molecular signal imbalance for ONFH were identified. Neostigmine bromide with low CMap score and P value and specificity score was predicted to be the most candidate compound, involved in the “positive regulation of stem cell proliferation,” “regulation of protein autophosphorylation,” “VEGF signaling pathway,” and “ECM‐receptor interaction.” Conclusions The GEO and CMap databases can be effectively used in understanding the molecular changes in ONFH and provide a systematic manner to identify potential drugs for ONFH prevention and treatment. However, additional clinical and experimental research of the candidate compound is warranted.
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Affiliation(s)
- Di Luo
- Department of Orthopedics, The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xue-Zhen Liang
- Department of Orthopedics, The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Bo Xu
- Department of Orthopedics, The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.,Orthopaedic Microsurgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jin-Bao Liu
- Department of Orthopedics, The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.,Orthopaedic Microsurgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Chuan-Fu Wei
- Orthopaedic Microsurgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Gang Li
- Department of Orthopedics, The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.,Orthopaedic Microsurgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Utsunomiya T, Motomura G, Ikemura S, Kubo Y, Sonoda K, Hatanaka H, Baba S, Kawano K, Yamamoto T, Nakashima Y. Effects of sclerotic changes on stress concentration in early-stage osteonecrosis: A patient-specific, 3D finite element analysis. J Orthop Res 2018; 36:3169-3177. [PMID: 30098226 DOI: 10.1002/jor.24124] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/06/2018] [Indexed: 02/04/2023]
Abstract
Stress distribution remains unclear in early-stage osteonecrosis of the femoral head (ONFH). To clarify this issue, we generated patient-specific finite element models (FEMs) from 51 patients with ONFH. Patients' hips were classified into three groups: ONFH without a sclerotic boundary (Stage 1, n = 6), ONFH with a sclerotic boundary (Stage 2, n = 10), and ONFH with both a sclerotic boundary and <2 mm collapse (Stage 3, n = 35). Four hips without ONFH were used as controls. Stress distribution in each FEM was compared with magnetic resonance imaging (MRI) and computed tomography (CT) results. Fifteen wholly resected femoral heads in Stage 3 hips were assessed by micro-CT. Furthermore, we histologically examined three Stage 2 femoral heads that subsequently developed subchondral fractures after FEM analyses. In all FEMs of both control and Stage 1 hip, stress was equally distributed on the femoral head surface. However, in all FEMs of both Stages 2 and 3 hips, stress was concentrated at the lateral boundary of the femoral head surface, corresponding to both a low-intensity band on T1-weighted MRI images and sclerotic changes on CT. On micro-CT, subchondral fractures consistently began at the lateral boundary with sclerotic changes, in which bone volume fraction was increased. Histology showed breakage of subchondral plates at the junction between necrotic and reparative zones. In early-stage ONFH, sclerotic changes caused stress concentration, which can trigger subchondral fractures at the lateral boundary. Clinical Significance: Our results will clarify the pathogenic mechanism of collapse in ONFH. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3169-3177, 2018.
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Affiliation(s)
- Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yusuke Kubo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Hatanaka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shoji Baba
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koichiro Kawano
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takuaki Yamamoto
- Faculty of Medicine, Department of Orthopaedic Surgery, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Lin D, Wang L, Yu Z, Luo D, Zhang X, Lian K. Lantern-shaped screw loaded with autologous bone for treating osteonecrosis of the femoral head. BMC Musculoskelet Disord 2018; 19:318. [PMID: 30185196 PMCID: PMC6123930 DOI: 10.1186/s12891-018-2243-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/24/2018] [Indexed: 12/23/2022] Open
Abstract
Background Treatment for osteonecrosis of the femoral head (ONFH) in young individuals remains controversial. We developed a lantern-shaped screw, which was designed to provide mechanical support for the femoral head to prevent its collapse, for the treatment of ONFH. The purpose of this study was to investigate the efficacy and safety of the lantern-shaped screw loaded with autologous bone for the treatment of pre-collapse stages of ONFH. Methods Thirty-two patients were randomly divided into two groups: the lantern-shaped screw group (core decompression and lantern-shaped screw loaded with autogenous bone) and the control group (core decompression and autogenous bone graft). During 36 months follow-up after surgery, treatment results in patients were assessed by X-ray and computed tomography (CT) scanning as well as functional recovery Harris hip score (HHS). Results Successful clinical results were achieved in 15 of 16 hips (94%) in the lantern-shaped screw group compared with 10 of 16 hips (63%) in the control group (p = 0.0325). Successful radiological results were achieved in 14 of 16 hips (88%) in the lantern-shaped screw group compared with 8 of 16 hips (50%) in the control group (P = 0.0221). Conclusion The lantern-shaped screw loaded with autologous bone for the treatment of pre-collapse stages of ONFH is effective and results in preventing progression of ONFH and reducing the risk of femoral head collapse. Trial registration The trial registration number: ChiCTR-TRC-13004078 (retrospectively registered at 2013-11-28).
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Affiliation(s)
- Dasheng Lin
- Orthopaedic Center of People's Liberation Army, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, 363000, China. .,Department of Surgery, Experimental Surgery and Regenerative Medicine, Ludwig-Maximilians-University (LMU), 80336, Munich, Germany.
| | - Lei Wang
- Orthopaedic Center of People's Liberation Army, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, 363000, China
| | - Zhaoliang Yu
- Weigao Orthopaedic Device Co., Ltd, Weihai, 264200, China
| | - Deqing Luo
- Orthopaedic Center of People's Liberation Army, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, 363000, China
| | - Xigui Zhang
- Double Engine Medical Material Co., Ltd, Xiamen, 361000, China
| | - Kejian Lian
- Orthopaedic Center of People's Liberation Army, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, 363000, China
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Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. Radiographics 2018; 38:1478-1495. [PMID: 30118392 DOI: 10.1148/rg.2018180044] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Several pathologic conditions may manifest as an osteochondral lesion of the knee that consists of a localized abnormality involving subchondral marrow, subchondral bone, and articular cartilage. Although understanding of these conditions has evolved substantially with the use of high-spatial-resolution MRI and histologic correlation, it is impeded by inconsistent terminology and ambiguous abbreviations. Common entities include acute traumatic osteochondral injuries, subchondral insufficiency fracture, so-called spontaneous osteonecrosis of the knee, avascular necrosis, osteochondritis dissecans, and localized osteochondral abnormalities in osteoarthritis. Patient demographics, the clinical presentation, and the role of trauma are critical for differential diagnosis. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. MRI features that aid in diagnosis include the location and extent of bone marrow edema, the presence of a fracture line, a hypointense area immediately subjacent to the subchondral bone plate, and deformity of the subchondral bone plate. These findings are essential in diagnosis of acute traumatic injuries, subchondral insufficiency fracture, and its potentially irreversible form, spontaneous osteonecrosis of the knee. If the lesion consists of a subchondral region demarcated from the surrounding bone, the demarcation should be examined for completeness and the presence of a "double-line sign" that is seen in avascular necrosis or findings of instability, which are important for proper evaluation of osteochondritis dissecans. Subchondral bone plate collapse, demonstrated by the presence of a depression or a fluid-filled cleft, can be seen in advanced stages of both avascular necrosis and subchondral insufficiency fracture, indicating irreversibility. Once the diagnosis is established, it is important to report pertinent MRI findings that may guide treatment of each condition. ©RSNA, 2018 An earlier incorrect version of this article appeared online. This article was corrected on August 23, 2018.
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Affiliation(s)
- Tetyana Gorbachova
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
| | - Yulia Melenevsky
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
| | - Micah Cohen
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
| | - Brett W Cerniglia
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
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Differential expression of miR-195-5p in collapse of steroid-induced osteonecrosis of the femoral head. Oncotarget 2018; 8:42638-42647. [PMID: 28498798 PMCID: PMC5522094 DOI: 10.18632/oncotarget.17333] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/11/2017] [Indexed: 12/11/2022] Open
Abstract
Background Femoral head collapse is a key reference point for determining a treatment regimen of femoral head osteonecrosis. However, there are no effective preventive measures and the efficacy of hip-preserving surgery is unsatisfactory due to the unclear mechanism of collapse. This study aimed to identify and validate miRNAs differentially expressed in collapse and non-collapse areas of the osteonecrotic femoral head, and to predict the target genes and pathways of these miRNAs. Results Nine samples passed the quality control test. A total of 2085 differentially expressed miRNAs were detected, among which 433 miRNAs showed differential expression in the T1 group compared to the W1 group; 344 miRNAs showed differential expression in the T2 group compared to the W2 group; 107 miRNAs showed differential expression in the T3 group compared to the W3 group. After combining data from all three patients, 10 miRNAs showed differential expression in the collapse area (T1+T2+T3) compared to the non-collapse area (W1+W2+W3). Compared to the normal area, has-miR-195-5p showed the most significant downregulation. Expression results from RT-PCR revealed that the expression of hsa-miR-195-5p in the collapse area (T1+T2+T3) was significantly lower than that in the non-collapse area (W1+W2+W3) and normal area (Z1+Z2+Z3). 157 genes were perdicted as the target gene of hsa-miR-195-5p. Materials and Methods Femoral heads of three patients (2 males and 1 female) treated by total hip arthroplasty surgery for steroid-induced femoral head osteonecrosis were selected based on inclusion and exclusion criteria. Bone tissue samples were obtained from the collapse area (T), non-collapse area (W), and normal area (Z) according to the anatomical structure of osteonecrotic femoral heads. Total RNA was extracted from the samples and the microarray chip was scanned. miRNAs showing differential expressions of more than 1.5-fold were selected and was validated by RT-PCR. TargetScan, mirBase and miRanda bioinformatics software was used to predict target genes and identify possible pathways involving these genes. Conclusions miR-195-5p showed the most significant difference in the collapse area of osteonecrotic femoral heads, suggesting that collapse may be related to the downregulation of miR-195-5p.
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Hamada H, Takao M, Sakai T, Sugano N. Subchondral fracture begins from the bone resorption area in osteonecrosis of the femoral head: a micro-computerised tomography study. INTERNATIONAL ORTHOPAEDICS 2018. [PMID: 29541811 DOI: 10.1007/s00264-018-3879-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE For successful joint preservation in osteonecrosis of the femoral head (ONFH), it is important to understand the mechanism of collapse. The purpose of this study was to investigate the initiation of subchondral fracture in ONFH by using micro-CT imaging of the whole femoral head, focusing on the three-dimensional relationship between the subchondral fracture and the bone resorption area. METHODS A total of 40 femoral heads from 37 patients retrieved during total hip arthroplasty for stage 3A or 3B ONFH by Japanese Investigation Committee criteria were scanned using micro-CT with a 0.146-mm thickness cuts. We divided the cohort into early and late collapsed stages according to a threshold of 3 mm of collapse as measured by micro-CT. RESULTS According to the analysis on multiple radial plane views in the whole femoral head, there were two interesting findings. First, the initial fracture cracks ran between separated bone resorption areas at the anterosuperior portions of all 18 femoral heads in the early collapsed stage. Second, fractures of the necrotic bone at the sclerotic boundary and a fibrous, granulation-like, low-density tissue along the necrotic side of the sclerotic boundary were seen in 19 of the 22 in the late collapsed stage. After bone resorption around the retinaculum and teres insertion initiates the subchondral fracture, bone resorption expanding at the anterosuperior portion of the femoral head may result in the spread of fracture and the potential for massive collapse. CONCLUSIONS Three-dimensional micro-CT showed bone resorption around the reparative zone initiates the subchondral fracture in ONFH.
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Affiliation(s)
- Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Kubo Y, Motomura G, Ikemura S, Sonoda K, Hatanaka H, Utsunomiya T, Baba S, Nakashima Y. The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head. INTERNATIONAL ORTHOPAEDICS 2018; 42:1449-1455. [PMID: 29455348 DOI: 10.1007/s00264-018-3836-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/08/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The location of the necrotic lesion is one of the important factors for collapse in osteonecrosis of the femoral head (ONFH). The significance of anterior localization has been little studied. This study evaluated the effects of anterior boundary of a necrotic lesion on collapse. METHODS We reviewed the outcomes of 113 consecutive non-collapsed asymptomatic hips in 98 ONFH patients with mean follow-up of 4.7 years (2.0-11.8) after the initial magnetic resonance (MR) imaging. The presence or absence of collapse was investigated using follow-up radiographs. The location of the anterior boundary of a necrotic lesion was assessed using the anterior necrotic angle between the midline of the femoral neck shaft and the line passing from the femoral head centre to the anterior boundary on mid-oblique MR imaging. Multivariate analysis was performed to identify risk factors for collapse, and further analyses were executed according to the lateral boundary of the necrotic lesion. RESULTS During the follow-up period, collapse was confirmed in 61 hips (54.0%). Multivariate analysis revealed that the anterior necrotic angle was independently associated with collapse as well as the lateral boundary of the necrotic lesion. When the lateral boundary was located at the middle third of weight-bearing portion (32 hips), that was generally categorized as a low risk of collapse, all five cases with anterior necrotic angle ≥ 79° developed collapse, whereas only one of 27 cases (3.7%) with an anterior necrotic angle < 79° developed collapse (p < 0.0001). CONCLUSIONS This study indicates that ONFH patients with anterior localization of a necrotic lesion can develop collapse even if the necrotic lesion is medially located.
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Affiliation(s)
- Yusuke Kubo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Hatanaka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shoji Baba
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Chen L, Hong G, Fang B, Zhou G, Han X, Guan T, He W. Predicting the collapse of the femoral head due to osteonecrosis: From basic methods to application prospects. J Orthop Translat 2017; 11:62-72. [PMID: 29662770 PMCID: PMC5866406 DOI: 10.1016/j.jot.2016.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/28/2016] [Accepted: 11/10/2016] [Indexed: 12/25/2022] Open
Abstract
Collapse of the femoral head is the most significant pathogenic complication arising from osteonecrosis of the femoral head. It is related to the disruption of the maintenance of cartilage and bone, and results in an impaired function of the vascular component. A method for predicting the collapse of the femoral head can be treated as a type of clinical index. Efforts in recent years to predict the collapse of the femoral head due to osteonecrosis include multiple methods of radiographic analysis, stress distribution analysis, finite element analysis, and other innovative methods. Prediction methods for osteonecrosis of the femoral head complications originated in Western countries and have been further developed in Asia. Presently, an increasing number of surgeons have chosen to focus on surgical treatments instead of prediction methods to guide more conservative interventions, resulting in a growing reliance on the more prevalent and highly effective total hip arthroplasty, rather than on more conservative treatments. In this review, we performed a literature search of PubMed and Embase using search terms including "osteonecrosis of femoral head," "prediction," "collapse," "finite element," "radiographic images," and "stress analysis," exploring the basic prediction method and prospects for new applications.
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Affiliation(s)
- Leilei Chen
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - GuoJu Hong
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China.,School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, WA, Australia
| | - Bin Fang
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Guangquan Zhou
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Xiaorui Han
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Tianan Guan
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Wei He
- Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China.,Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
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