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Shimizu J, Fujita H, Tateda K, Kosukegawa I, Teramoto A. Revascularization of a Necrotic Femoral Head in Severely Slipped Capital Femoral Epiphysis With a Modified Dunn Procedure: A Case Report. Cureus 2024; 16:e53530. [PMID: 38445159 PMCID: PMC10912781 DOI: 10.7759/cureus.53530] [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] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
Avascular necrosis, a serious slipped capital femoral epiphysis (SCFE) complication, is difficult to treat. We report a rare case of revascularization of the necrotic femoral head in a 12-year-old male patient with a severe SCFE (posterior tilting angle, 87°). We performed the modified Dunn procedure (MDP), followed by long-term unloading therapy. Blood flow to the epiphysis had partially resumed 2.3 years postoperatively. At the final 4.5-year follow-up, blood flow had been restored, leading to epiphyseal closure without significant femoral head deformity or hip pain. The patient could walk unassisted, with a flexion range of 120°. These findings support the use of the MDP with long-term unloading therapy as a potential treatment option for severe SCFE.
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Affiliation(s)
- Junya Shimizu
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo, JPN
| | - Hiroki Fujita
- Department of Orthopedic Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, JPN
| | - Kenji Tateda
- Department of Orthopedic Surgery, Sapporo Kojinkai Memorial Hospital, Sapporo, JPN
| | - Ima Kosukegawa
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo, JPN
| | - Atsushi Teramoto
- Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, JPN
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Chen H, He S, Xi H, Xue P, Sun G, Du B, Liu X. Prognosis and risk prediction of bone impaction grafting through femoral head-neck fenestration: a retrospective cohort study. J Hip Preserv Surg 2023; 10:244-252. [PMID: 38162275 PMCID: PMC10757408 DOI: 10.1093/jhps/hnad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 01/03/2024] Open
Abstract
The bone impaction grafting through femoral head-neck fenestration was a favorable hip preservation procedure but without prognosis estimation. This study retrospectively reviewed 79 patients' clinical data (114 hips) with osteonecrosis of the femoral head (ONFH) who underwent this procedure from June 2009 to June 2019. By the end of June 2022, the median survival time of the hip was (74.13 ± 44.88) months, and the success rate of hip preservation was 68.42%. Lateral reserved angle (LPA) and combined reserved angle (CPA) had statistically significant differences (P < 0.001) both in univariate analysis and a multivariate logistic regression model. The multivariate logistic regression model of area under curve (AUC) area of the receiver operating characteristic (ROC) curve was 0.931(sensitivity = 95.00%, specificity = 88.40%, log-rank test: P < 0.01), and the calibration curve indicated good prediction accuracy. The ROC analysis and Cox proportional hazards regression model revealed that the cutoff point of LPA was 50.95° (sensitivity = 95.00%, specificity = 72.09%, log-rank test: P < 0.05) and the cutoff point of CPA was 90.51° (sensitivity = 90.00%, specificity = 90.70%, log-rank test: P < 0.05). A nomogram plot to predict the risk of failure (C-index = 0.873, 95% CI: 0.785 to 0.961) and nomograms for predicting the survival probability at 1, 2 or 3 years whose calibration curves showed excellent prediction accuracy were available for the clinician. Preserved angles (PAs) are valuable in the prediction of prognosis in surgical treatment. The bone impaction grafting through femoral head-neck fenestration can achieve better clinical efficacy, especially for patients with LPA >50.95° and CPA >90.51°.
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Affiliation(s)
- Hao Chen
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Shuai He
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Hongzhong Xi
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Peng Xue
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Guangquan Sun
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Bin Du
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Xin Liu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
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Zhu J, Chen K, Peng J, Li Y, Shen C, Chen X. Femoral neck rotational osteotomy: a modified method for treating necrotic femoral heads with large and laterally located lesions. J Hip Preserv Surg 2021; 7:713-720. [PMID: 34377514 PMCID: PMC8349588 DOI: 10.1093/jhps/hnab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/12/2022] Open
Abstract
In this study, we retrospectively investigated the short-term outcome of femoral neck rotational osteotomy (FNRO) for treating necrotic femoral heads with large and laterally located lesions. Twelve necrotic femoral heads (ARCO stage II or III) with an average Kerboul angle of 210° underwent FNRO through surgical hip dislocation. By circumferential release of capsule and retinaculum, femoral neck osteotomy was performed at the base of femoral neck just 1.5 cm above lesser trochanter. The severed femoral neck was rotated with a mean angle of 120.4° and fixed with a mean varus angulation of 10.2°. Both Harris hip score and International hip outcome tool improved at a mean follow-up of 29 months. The average post-operative intact rate was 55.3%. Subsequent collapse or progression to osteoarthritis was found in four hips but only one hip failed with a Harris hip score of 44 and converted to hip replacement. Post-operative leg length discrepancy was 1.1 cm. Limp presented in seven hips. Six hips had osteophyte formation. FNRO through surgical hip dislocation had the advantages of safe exposure, direct visualization of necrotic lesion and high reorientation of healthy bone and articular cartilage on femoral head. We observed satisfactory short-term survivorship and improved patient-reported outcomes in necrotic femoral heads treated with FNRO.
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Affiliation(s)
- Junfeng Zhu
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Kangming Chen
- Department of Orthopaedics, Huashan Hospital, Fudan University, No. 12, Wulumuqizhong Road, Shanghai 200040, China
| | - Jianping Peng
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Yang Li
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Chao Shen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai 200092, China
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Xie P, Deng Y, Tan J, Wang M, Yang Y, Ouyang H, Huang W. The effect of rotational degree and routine activity on the risk of collapse in transtrochanteric rotational osteotomy for osteonecrosis of the femoral head-a finite element analysis. Med Biol Eng Comput 2020; 58:805-814. [PMID: 32016806 PMCID: PMC7156356 DOI: 10.1007/s11517-020-02137-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 01/22/2020] [Indexed: 11/24/2022]
Abstract
To explore the mechanical mechanism and provide preoperative planning basis for transtrochanteric rotational osteotomy (TRO) procedure, a joint-preserving procedure for osteonecrosis of the femoral head. Eleven TRO finite element femurs with the most common types of necrosis were analyzed under multi-loading conditions. Thereafter, we made a comprehensive evaluation by considering the anatomy characters, daily activities, and risk indicators contain necrosis expansion trend, necrotic blood supply pressure, and the risk of fracture. The risk of fracture (ROF) is the lowest when standing on feet and increases gradually during normal walking and walking upstairs and downstairs. Compared with posterior rotation, rotating forward keeps more elements at low risk. Additionally, the correlation analysis shows it has a strong negative correlation (R2 = 0.834) with the average modulus of the roof. TRO finally decreased the stress and energy effectively. However, the stress and strain energy arise when rotated posteriorly less than 120°. The comprehensive evaluation observed that rotating forward 90°could reduce the total risks to 64%. TRO is an effective technique to prevent collapse. For the anterior and superior large necrosis, we recommend to rotate forward 60° to 90° (more efficient) or backward 180°. The methodology followed in this study could provide accurate and personalize preoperative planning. Graphical Abstract A proximal femur was reconstructed and modified using Mimics from a series of computed tomography. The models were meshed after solidified and performed different osteotomy, and then assigned material based on the Hounsfield Unit from CT images. Finally, 44 different TRO finite element femurs were analyzed under multi-loading conditions and evaluated comprehensively.
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Affiliation(s)
- Pusheng Xie
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Yuping Deng
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Jinchuan Tan
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Mian Wang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Yang Yang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Hanbin Ouyang
- Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524002 People’s Republic of China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524002 People’s Republic of China
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Fernandez FF, Eberhardt O, Wirth T. [Early and late complications and their management in slipped capital femoral epiphysis]. DER ORTHOPADE 2019; 48:677-684. [PMID: 31025044 DOI: 10.1007/s00132-019-03729-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) remains a challenge for the treating surgeon. First of all, SCFE should be diagnosed as early as possible. The earlier the diagnosis is made in adolescents, the lower the slip angle will be. Mild slips show more favourable long-term courses than moderate and severe SCFE. COMPLICATIONS With increasing slip angle, the risk of complications increases. The complications of SCFE are diverse, the most severe of which are avascular necrosis (AVN) and chondrolysis. AVN is more common in surgically treated than in non-operatively managed patients and unstable SCFE bears the highest risk of AVN. THERAPY Adequate treatment of AVN is still controversial. For surgical treatments, variable rates of AVN have been reported. There is a wide spectrum of surgeries for treating AVN, from hip joint-preserving techniques to total hip replacement. In central Europe there is wide consensus in favour of treating the contralateral side, but this is not without complications. Surgical treatment with in-situ pinning must be carried out with great care to take into consideration the morphology of the femoral head and not to perforate it. It should always be ensured that no osteosynthesis material penetrates the hip joint.
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Affiliation(s)
- F F Fernandez
- Kinder- und Jugendtraumatologie, Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergsstr. 62, 70174, Stuttgart, Deutschland.
| | - O Eberhardt
- Kinder- und Jugendtraumatologie, Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergsstr. 62, 70174, Stuttgart, Deutschland
| | - T Wirth
- Kinder- und Jugendtraumatologie, Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergsstr. 62, 70174, Stuttgart, Deutschland
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Tanaka R, Yasunaga Y, Fujii J, Yamasaki T, Shoji T, Adachi N. Transtrochanteric rotational osteotomy for various hip disorders. J Orthop Sci 2019; 24:463-468. [PMID: 30554936 DOI: 10.1016/j.jos.2018.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/27/2018] [Accepted: 10/28/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Joint-preserving procedures should be considered as much as possible for hip disorders in pediatric and young patients. However, in patients with extensive osteonecrosis (ON) of the femoral head combined with severe collapse and advanced secondary osteoarthritis (OA), the optimal procedure has not been elucidated. This retrospective study aimed to investigate the postoperative outcomes of 11 patients who underwent transtrochanteric rotational osteotomy (TRO) alone or with a combination treatment for various hip disorders in young patients and to evaluate the usefulness of TRO. METHODS Eleven patients (11 hips) with a mean age at operation of 22 years were included. The mean follow-up duration was 9.4 years. Preoperative diagnosis was secondary OA in 6 patients (pigmented villonodular synovitis, 2; after rotational acetabular osteotomy, 1; pyogenic arthritis, 1; femoroacetabular impingement, 1; acetabular dysplasia, 1) and ON in 5 patients (slipped capital femoral epiphysis, 4; femoral neck fracture, 1). Combination treatment was performed in 2 patients with distraction arthroplasty and in 6 patients with intra-articular procedures (mosaicplasty, 1; drilling, 1; microfracture, 4; cam resection, 1). Clinical evaluation was performed by using the Merle d'Aubigne and Postel score (MDPS). Joint congruency and progression of osteoarthritic change in all cases, and progression of collapse in the ON patients were evaluated radiographically. RESULTS The mean MDPS improved from 10.3 to 14.2 in the OA patients and from 9.4 to 14.8 in the ON patients. The OA grade was maintained or improved in 10 hips (91%). Progressive collapse was prevented in all ON patients, and good remodeling was demonstrated. CONCLUSION Even in the highly degenerative cases, TRO enabled repair and prevention of the progression of OA. This procedure might be a useful salvage operation for treating secondary OA and ON of the hip even if the clinical condition is advanced, especially in young patients.
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Affiliation(s)
- Ryuji Tanaka
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi Saijo, Higashi-Hiroshima, 739-0036, Japan.
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi Saijo, Higashi-Hiroshima, 739-0036, Japan
| | - Jiro Fujii
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi Saijo, Higashi-Hiroshima, 739-0036, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takeshi Shoji
- Department of Orthopaedic Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Hao YQ, Guo H, Zhu T, Xu ZC, Qi HD, Lu C, Yuan PW. Core decompression, lesion clearance and bone graft in combination with Tongluo Shenggu decoction for the treatment of osteonecrosis of the femoral head: A retrospective cohort study. Medicine (Baltimore) 2018; 97:e12674. [PMID: 30313059 PMCID: PMC6203527 DOI: 10.1097/md.0000000000012674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate the clinical effect of core decompression (CD), lesion clearance, and bone graft in combination with Tongluo Shenggu decoction for the treatment of osteonecrosis of the femoral head (ONFH).A total of 75 patients (92 hips), with ONFH at Association Research Circulation Osseous (ARCO) stages II to IIIA, were studied and divided into treatment group and control group. In control group, patients were treated with the CD in combination with autologous or artificial ceramic bone graft. In treatment group, patients were treated with the above method combined with Tongluo Shenggu decoction. Patients were followed-up at 1 month, 6 months, and 24 months after surgery. The visual analogue scale (VAS) scores, Harris Hip Score (HSS), and total effective rates were measured and recorded.The total effective rate of the treatment group was significantly higher than that of the control group (97.2% vs. 89.9%, P < .05). Compared with preoperative, the VAS and HSS scores were both improved at final follow-up, and there was significant difference between 2 groups (P < .01).The combination of CD, lesion clearance, and the bone graft with Tongluo Shenggu decoction is safe and effective for the treatment of ONFH, owing to which it can provide higher postoperative functional outcomes, reduce pain, and achieve smaller osteonecrosis area and better bone changes.
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Affiliation(s)
- Yang-Quan Hao
- Department of osteonecrosis and joint reconstruction, Honghui Hospital, Xi’an Jiaotong University, Xi’an
| | - Hao Guo
- Department of osteonecrosis and joint reconstruction, Honghui Hospital, Xi’an Jiaotong University, Xi’an
| | - Tian Zhu
- Graduate School, Shaanxi university of Chinese medicine, Shiji Ave, Xi’an-xianyang New Ecomic Zone
| | - Zhao-Chen Xu
- Graduate School, Shaanxi university of Chinese medicine, Shiji Ave, Xi’an-xianyang New Ecomic Zone
| | - Han-Deng Qi
- Graduate School, Shaanxi university of Chinese medicine, Shiji Ave, Xi’an-xianyang New Ecomic Zone
| | - Chao Lu
- Department of osteonecrosis and joint reconstruction, Honghui Hospital, Xi’an Jiaotong University, Xi’an
| | - Pu-Wei Yuan
- Department of Orthopedics, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shanxi Province, P.R. China
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Jafarian AA, Farhoodi A, Momeni M, Babaei MR, Kazemikhoo N. Clinical and Radiographic Alterations in Bilateral Avascular Necrosis of the Femoral Head Following Laser Acupuncture: A Case Report. J Lasers Med Sci 2018; 9:149-153. [PMID: 30026902 DOI: 10.15171/jlms.2018.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Introduction: Avascular necrosis (AVN) of the femoral head is an increasingly common cause of musculoskeletal disability with unknown etiology. Traumatic and non-traumatic factors can be effective in its occurrence. About 50% of cases are bilateral. The underlying treatment is prosthetic replacement surgical procedure. Case Presentation: We report a case of bilateral AVN of femoral heads who was a candidate for prosthetic replacement surgery but improved significantly, using laser acupuncture. The patient was a 55-year-old woman with a diagnosis of bilateral osteonecrosis of the femoral head for five years. As the patient declined the surgical option, laser acupuncture was started for pain control. Regarding the signs of bilateral femoral head recovery (according to the MRI scan criteria), a total of 3 courses of laser acupuncture (each course was 20 sessions) with 2 months intervals was performed. Ten acupuncture points: Li4, Li11, St36, SP6, LIV3, GB4, GB5, GB6, GB13, GB14, GB20, GB30, GB31, GB34, were irradiated bilaterally using red 650 nm laser, 100 mW, 1505 Hz frequency, duty cycle 50 3 J/point and near infrared 810 nm laser, 100 mW, 1705 Hz frequency, duty cycle 50 3 J/point, for 2 minutes. The patient received 3 laser therapy courses. During the first-course, laser therapy was done every other day to reduce pain. For the second and third courses, according to pain decrease, therapy was done every week. Results: The results of the MRI scans and x-ray studies show progressive regeneration of the right femoral head from VI to B II and of the left from V to C II (based on the standard table of Pennsylvania). Conclusion: It seems that this procedure may be mentioned in future research projects, especially in cases with high risks of surgery.
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Affiliation(s)
- Ali Akbar Jafarian
- Department of Anesthesiology and Pain, Shahid Motahhari Hospital of Trauma and Burning Center, Iran University of Medical Sciences and Health Services, Tehran, Iran
| | - Ali Farhoodi
- Burn Plastic Surgery, Shahid Motahhari Hospital of Trauma and Burning Center, Iran University of Medical Sciences and Health Services,Tehran, Iran
| | - Mahnoush Momeni
- Burn Research Center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Babaei
- Interventional Fellowship of Radiology, Firoozgar Hospital, Iran University of Medical Sciences and Health Services, Tehran, Iran
| | - Nooshafarin Kazemikhoo
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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