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Lindsay S, Kelly M, Smith S, Kagan R, Ramsey D, Yoo J. The Multiplicative Effects of Individual Risk Factors in the Development of Osteonecrosis of the Femoral Head. J Arthroplasty 2024:S0883-5403(24)00635-1. [PMID: 38959988 DOI: 10.1016/j.arth.2024.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND While individual risk factors, including chronic corticosteroid use, alcohol abuse, and smoking, are implicated in osteonecrosis (ON) of the femoral head (ONFH), the degree to which multiple risk factors increase risk is unknown. This study aimed to: (1) identify demographic characteristics of patients with ONFH; (2) quantify the effects of individual risk factors on ONFH development; (3) quantify the effects of combined risk factors on ONFH development; and (4) determine the prognostic implications of combined risk factors on ONFH development. METHODS This was a retrospective cohort study. A national insurance database was used to study a population of 2,612,383 adult patients who had a 10-year follow-up period. There were 10,233 patients identified who had a diagnosis of ONFH. We identified patients who had chronic corticosteroid use, tobacco use, and/or alcohol abuse and assessed the risk of developing of ONFH over a 10-year period. Patients with individual and multiple risk factors were grouped for comparison, and Chi-square analyses were performed. RESULTS Higher proportions of patients who had each individual risk factor developed ONFH compared to proportions of patients who did not have risk factors. Patients who had combined risk factors were at greater risk of developing ONFH compared to patients who had no risk factors and those who had single risk factors. Combined risk factors demonstrated multiplicative effects on the development of ONFH: tobacco-alcohol risk ratio (RR) 5.25, corticosteroid-alcohol RR 10.20, tobacco-corticosteroid RR 8.69, and corticosteroid-tobacco-alcohol RR 12.54. Patients who had combined risk factors developed ONFH at younger ages than those who had single risk factors. Kaplan-Meier curve analyses demonstrated worse 10-year hip survival in the setting of combined risk factors. CONCLUSION Combined risk factors have a multiplicative effect on the risk of developing of atraumatic ONFH. Orthopaedic surgeons may care for at-risk individuals through modulation of risk factors.
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Affiliation(s)
- Sarah Lindsay
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Mackenzie Kelly
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Spencer Smith
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Duncan Ramsey
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Jung Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon.
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Yang J, Sun P, Liu Z, Li Y, Zhang J, Liu Y, Zou G. Mid-term Clinical Outcomes of "Light Bulb" Core Decompression with Arthroscopic Assistance in Peri-collapse Osteonecrosis of the Femoral Head: A Retrospective Comparative Study. Orthop Surg 2024; 16:1399-1406. [PMID: 38714345 PMCID: PMC11144504 DOI: 10.1111/os.14058] [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: 10/20/2023] [Revised: 03/17/2024] [Accepted: 03/24/2024] [Indexed: 05/09/2024] Open
Abstract
OBJECTIVE Nontraumatic osteonecrosis of the femoral head (ONFH) is commonly encountered in orthopedics. Without early clinical intervention, most patients with peri-collapse of the ONFH will develop femoral head necrosis and eventually require hip replacement surgery. The aim of this study is to evaluate clinical outcomes in patients with ONFH who underwent "light bulb" core decompression (CD) with arthroscopic assistance and to compare them with the outcomes of those treated with traditional procedures. METHODS A retrospective review of patients with Stage II and IIIA (Peri-collapse) radiographic findings based on the Association Research Circulation Osseous (ARCO) stage for ONFH who underwent "light bulb" CD with or without arthroscopic assistance by a single-surgeon team between March 2014 and December 2018 was performed. All patients were followed up for a minimum of 2 years. The visual analogue scale (VAS) pain score, Harris hip score (HHS), and radiological imaging were evaluated. The categorical parameters were analyzed by chi-square test and the continuous variables conforming to a normal distribution were analyzed by Student's t-test. RESULTS The study included a total of 39 patients (18 and 21 patients in the with and without arthroscopic assistance groups, respectively), with a mean age of 40.3 years and a mean follow-up of 22.2 months. Overall, there was a better VAS score in the arthroscopic assistance group than in the control group (p < 0.05), There was a significant difference in HHS (80.1 ± 9.2 vs 75.1 ± 12.7) at the last follow-up (p < 0.05). The rate of good and excellent outcomes was 94%. Similarly, there was no significant difference in the total rate of complications or conversion to THA. CONCLUSION With arthroscopic assistance, "light bulb" CD could be achieved via hip arthroscopy with less trauma, and it offered the opportunity for more precise evaluation and monitoring for therapy and yielded better VAS scores after surgery and better hip function outcomes at the last follow-up.
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Affiliation(s)
- Jibin Yang
- Department of Orthopedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Pengpeng Sun
- Department of Orthopedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Ziming Liu
- Beijing Key Laboratory of Sports Injuries, Department of Sports MedicineInstitute of Sports Medicine of Peking University, Peking University Third HospitalBeijingChina
| | - Yuwan Li
- Beijing Key Laboratory of Sports Injuries, Department of Sports MedicineInstitute of Sports Medicine of Peking University, Peking University Third HospitalBeijingChina
| | - Jun Zhang
- Department of OrthopedicsThe First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical UniversityChongqingChina
| | - Yi Liu
- Department of Orthopedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Gang Zou
- Department of Orthopedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiChina
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Liu W, Yue J, Guo X, Wang R, Fu H. Epidemiological investigation and diagnostic analysis of osteonecrosis of the femoral head in three northeastern provinces of China. J Orthop Surg Res 2024; 19:292. [PMID: 38735955 PMCID: PMC11089743 DOI: 10.1186/s13018-024-04768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND In this retrospective case investigation, we analysed the data of patients with osteonecrosis of the femoral head (ONFH) to reveal demographic and clinical diagnostic features of ONFH in three northeastern provinces of China and provide a reference for its prevention, diagnosis, and treatment. METHODS We collected data from patients in Beijing Orthopaedic Hospital of Liaoning, focusing on the aetiology and diagnosis of ONFH. Medical records and self-designed questionnaires were used to collect information for statistical analysis, including age, aetiology, reason for glucocorticoid use, hospital level at first visit, and diagnosis. RESULTS In total, 906 patients with complete medical records were included in the analysis. The mean patient age was 47.65 ± 12.12 years. The peak age distribution was in the 40s for men and the 50s for women. Among the total cohort, 72 patients (7.95%; 40 men and 32 women) had traumatic ONFH, 198 (21.85%; 131 men and 67 women) had steroid-induced ONFH, 230 (25.39%; 121 men and 109 women) had idiopathic ONFH, and 406 (44.81%; 397 men and 9 women) had alcohol-induced ONFH. Six hundred and twenty patients were diagnosed with ONFH at the first visit, while 286 patients were misdiagnosed, with a diagnosis rate of 68.43%. The diagnosis rate at the first visit in tertiary hospitals was 76.14%. The diagnosis rate at the first visit in second-class hospitals was 52.07%.ONFH was most likely to be misdiagnosed as lumbar disc herniation. CONCLUSIONS Most patients with ONFH in three northeastern provinces of China were middle-aged, male, and had alcohol-induced ONFH. The misdiagnosis rate of ONFH at the first visit was very high, especially for misdiagnosis of lumbar disc herniation, indicating that the diagnosis of ONFH requires further improvement.
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Affiliation(s)
- Wangyan Liu
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China
| | - Ju'an Yue
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China.
| | - Xiaozhong Guo
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China
| | - Randong Wang
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China
| | - Hao Fu
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China
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Lu Y, Pei Y, Gao Y, Zhao F, Wang L, Zhang Y. Unraveling the genetic basis of the causal association between inflammatory cytokines and osteonecrosis. Front Endocrinol (Lausanne) 2024; 15:1344917. [PMID: 38745949 PMCID: PMC11091469 DOI: 10.3389/fendo.2024.1344917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
Background Previous studies have reported that the occurrence and development of osteonecrosis is closely associated with immune-inflammatory responses. Mendelian randomization was performed to further assess the causal correlation between 41 inflammatory cytokines and osteonecrosis. Methods Two-sample Mendelian randomization utilized genetic variants for osteonecrosis from a large genome-wide association study (GWAS) with 606 cases and 209,575 controls of European ancestry. Another analysis included drug-induced osteonecrosis with 101 cases and 218,691 controls of European ancestry. Inflammatory cytokines were sourced from a GWAS abstract involving 8,293 healthy participants. The causal relationship between exposure and outcome was primarily explored using an inverse variance weighting approach. Multiple sensitivity analyses, including MR-Egger, weighted median, simple model, weighted model, and MR-PRESSO, were concurrently applied to bolster the final results. Results The results showed that bFGF, IL-2 and IL2-RA were clinically causally associated with the risk of osteonecrosis (OR=1.942, 95% CI=1.13-3.35, p=0.017; OR=0.688, 95% CI=0.50-0.94, p=0.021; OR=1.386, 95% CI=1.04-1.85, p = 0.026). there was a causal relationship between SCF and drug-related osteonecrosis (OR=3.356, 95% CI=1.09-10.30, p=0.034). Conclusion This pioneering Mendelian randomization study is the first to explore the causal link between osteonecrosis and 41 inflammatory cytokines. It conclusively establishes a causal association between osteonecrosis and bFGF, IL-2, and IL-2RA. These findings offer valuable insights into osteonecrosis pathogenesis, paving the way for effective clinical management. The study suggests bFGF, IL-2, and IL-2RA as potential therapeutic targets for osteonecrosis treatment.
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Affiliation(s)
- Yining Lu
- Department of Orthopedic Research Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yan Pei
- Department of Orthopedic Research Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - YiMing Gao
- Department of Orthopedic Research Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - FeiFei Zhao
- Department of Orthopedic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ling Wang
- Department of Orthopedic Research Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yingze Zhang
- Department of Orthopedic Research Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Ma T, Wang Y, Ma J, Cui H, Feng X, Ma X. Research progress in the pathogenesis of hormone-induced femoral head necrosis based on microvessels: a systematic review. J Orthop Surg Res 2024; 19:265. [PMID: 38671500 PMCID: PMC11046814 DOI: 10.1186/s13018-024-04748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Hormonal necrosis of the femoral head is caused by long-term use of glucocorticoids and other causes of abnormal bone metabolism, lipid metabolism imbalance and blood microcirculation disorders in the femoral head, resulting in bone trabecular fracture, bone tissue necrosis collapse, and hip dysfunction. It is the most common type of non-traumatic necrosis of the femoral head, and its pathogenesis is complex, while impaired blood circulation is considered to be the key to its occurrence. There are a large number of microvessels in the femoral head, among which H-type vessels play a decisive role in the "angiogenesis and osteogenesis coupling", and thus have an important impact on the occurrence and development of femoral head necrosis. Glucocorticoids can cause blood flow injury of the femoral head mainly through coagulation dysfunction, endothelial dysfunction and impaired angiogenesis. Glucocorticoids may inhibit the formation of H-type vessels by reducing the expression of HIF-1α, PDGF-BB, VGEF and other factors, thus causing damage to the "angiogenesis-osteogenesis coupling" and reducing the ability of necrosis reconstruction and repair of the femoral head. Leads to the occurrence of hormonal femoral head necrosis. Therefore, this paper reviewed the progress in the study of the mechanism of hormone-induced femoral head necrosis based on microvascular blood flow at home and abroad, hoping to provide new ideas for the study of the mechanism of femoral head necrosis and provide references for clinical treatment of femoral head necrosis.
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Affiliation(s)
- Tiancheng Ma
- Tianjin Hospital of Tianjin University, Tianjin, 300211, China
- Tianjin Orthopedic Institute, Tianjin, 300050, China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, China
| | - Yan Wang
- Tianjin Hospital of Tianjin University, Tianjin, 300211, China
- Tianjin Orthopedic Institute, Tianjin, 300050, China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, China
| | - Jianxiong Ma
- Tianjin Hospital of Tianjin University, Tianjin, 300211, China.
- Tianjin Orthopedic Institute, Tianjin, 300050, China.
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, China.
| | - Hongwei Cui
- Tianjin Hospital of Tianjin University, Tianjin, 300211, China
- Tianjin Orthopedic Institute, Tianjin, 300050, China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, China
| | - Xiaotian Feng
- Tianjin Hospital of Tianjin University, Tianjin, 300211, China
- Tianjin Orthopedic Institute, Tianjin, 300050, China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, China
| | - Xinlong Ma
- Tianjin Hospital of Tianjin University, Tianjin, 300211, China
- Tianjin Orthopedic Institute, Tianjin, 300050, China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, China
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Luo Y, Yang Z, Zhao X, Li D, Li Q, Wei Y, Wan L, Tian M, Kang P. Immune regulation enhances osteogenesis and angiogenesis using an injectable thiolated hyaluronic acid hydrogel with lithium-doped nano-hydroxyapatite (Li-nHA) delivery for osteonecrosis. Mater Today Bio 2024; 25:100976. [PMID: 38322659 PMCID: PMC10846409 DOI: 10.1016/j.mtbio.2024.100976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/11/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
Osteonecrosis is a devastating orthopedic disease in clinic that generally occurs in the femoral head associating with corticosteroid use up to 49 % in patients. In particular, glucocorticoids induced osteonecrosis of the femoral head is closely related to the local immune response that characterized by abnormal macrophage activation and inflammatory cell infiltration at the necrotic site, forming a pro-inflammatory microenvironment dominated by M1 macrophages, and thus leads to failure of bone repair and regeneration. Here, we report a bone regeneration strategy that constructs an immune regulatory biomaterial platform using an injectable thiolated hyaluronic acid hydrogel with lithium-doped nano-hydroxyapatite (Li-nHA@Gel) delivery for osteonecrosis treatment. Li-nHA@Gel achieved a sustain and longterm release of Li ions, which might enhance M2 macrophage polarization through the activation of the JAK1/STAT6/STAT3 signaling pathway, and the following induced pro-repair immune microenvironment mediated the enhancement of the osteogenic and angiogenic differentiation. Moreover, both in vitro and in vivo studies indicated that Li-nHA@Gel enhanced M2 macrophage polarization, osteogenesis, and angiogenesis, and thus promoted the bone and blood vessel formation. Taken together, this novel bone immunomodulatory biomaterial platform that promotes bone regeneration by enhancing M2 macrophage polarization, osteogenesis, and angiogenesis could be a promising strategy for osteonecrosis treatment.
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Affiliation(s)
- Yue Luo
- Department of Orthopedic, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, No. 1 the South of Maoyuan Road, Nanchong, Sichuan, 637000, PR China
| | - Zhouyuan Yang
- Department of Orthopedic, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Xin Zhao
- Department of Orthopedic, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Donghai Li
- Department of Orthopedic, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Qianhao Li
- Department of Orthopedic, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Yang Wei
- Department of Neurosurgery and Neurosurgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Luyao Wan
- Department of Neurosurgery and Neurosurgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Meng Tian
- Department of Neurosurgery and Neurosurgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Pengde Kang
- Department of Orthopedic, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
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Wang C, Liu H, Lin H, Zhong R, Li H, Liu J, Luo X, Tian M. Effect of zwitterionic sulfobetaine incorporation on blood behaviours, phagocytosis, and in vivo biodistribution of pH-responsive micelles with positive charges. J Mater Chem B 2024; 12:1652-1666. [PMID: 38275277 DOI: 10.1039/d3tb02477f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
pH-responsive micelles with positive charges are challenged by their significant effect on the cells/proteins and compromise their final fate due to electrostatic interactions. As one of the promising strategies, zwitterion incorporation in micelles has attracted considerable attention and displayed improved protein adsorption and blood circulation performances. However, previous reports in this field have been mostly limited in hemolysis for studying blood behaviour and lack a comprehensive understanding of their interactions with blood components. Herein, we present a prelimilary study on the effect of zwitterionic sulfobetaine incorporation on blood behaviour, phagocytosis, and in vivo biodistribution of pH-responsive micelles with positive charges. Amphiphilic triblock copolymers, namely poly(ε-caprolactone)-b-poly(N,N-diethylaminoethyl methacrylate)-(N-(3-sulfopropyl-N-methacryloxyethy-N,N-diethylammonium betaine)) (PCL-PDEAPSx, x = 2, 6, 10), containing different numbers of sulfobetaine groups were synthesized through four steps to prepare the pH-responsive micelles with positive charges. The effect of the sulfobetaine incorporation displayed different profiles, e.g., the micelles had no effect on RBC aggregation, thrombin time (TT), and platelet aggregation, while the cytotoxicity, hemolysis, RBC deformability, activated partial thromboplastin time (APTT), prothrombin time (PT), platelet activation, protein (albumin, fibrinogen, plasma) adsorption, phagocytosis, and in vivo biodistribution decreased with the increase in the sulfobetaine number, in which the transition mainly occurred at a sulfobetaine/tertiary amine group ratio of 3/7-1/1 compared to that of the mPEG control. In addition, the micelles displayed a strong inhibitory effect on the intrinsic coagulation pathway, which was associated with a significant decrease in the coagulation factor activity. Based on these findings, the related mechanism is discussed and proposed, which can aid the rational design of pH-responsive micelles for improved therapeutics.
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Affiliation(s)
- Chengwei Wang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
| | - Hao Liu
- Department of Neurosurgery and Neurosurgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China.
| | - Hu Lin
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - Rui Zhong
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, 610052, P. R. China
| | - Hao Li
- Department of Neurosurgery and Neurosurgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China.
| | - Jiaxin Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, 610052, P. R. China
| | - Xianglin Luo
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - Meng Tian
- Department of Neurosurgery and Neurosurgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China.
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Zhao R, Wang M, Hao Y, Xu P, Lu C. Analysis of the natural collapse course of non-traumatic osteonecrosis of the femoral head based on the matrix model. J Orthop Surg Res 2024; 19:100. [PMID: 38297319 PMCID: PMC10832071 DOI: 10.1186/s13018-024-04587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/27/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND There are many predictions about the progression of natural collapse course of osteonecrosis of the femoral head. Here, we aimed to combine the three classical prediction methods to explore the progression of the natural collapse course. METHODS This retrospective study included 127 patients admitted to our hospital from October 2016 to October 2017, in whom the femoral head had not collapsed. Logistic regression analysis was performed to determine the collapse risk factors, and Kaplan-Meier survival curves were used for femoral head survival analysis. The collapse rate of the femoral head was recorded within 5 years based on the matrix model. The specificity of the matrix model was analyzed using the receiver operating characteristic curve. RESULTS A total of 127 patients with a total of 202 hips were included in this study, and 98 hips collapsed during the follow-up period. Multivariate logistics regression analysis showed that the predictive ability of the matrix model was stronger than Association Research Circulation Osseous staging, Japanese Investigation Committee classification, and area (P < 0.05). Kaplan-Meier survival curve showed that the median survival time of femoral head in patients was 3 years. The result of the receiver operating characteristic curve analysis showed that the area under the curve (AUC) of the matrix model had better predictive value (AUC = 0.771, log-rank test: P < 0.001). CONCLUSION We creatively combined the three classical prediction methods for evaluating the progression of the natural collapse course based on the matrix model and found that the higher the score of the matrix model, the higher the femoral head collapse rate. Specifically, the matrix model has a potential value in predicting femoral head collapse and guiding treatment selection.
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Affiliation(s)
- Rushun Zhao
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No.555 Youyi East Road, Nanshaomen, Xi'an, 710054, Shaanxi Province, People's Republic of China
- Shaanxi University of Traditional Chinese Medicine, Xi'an, 712046, Shaanxi Province, People's Republic of China
| | - Mengfei Wang
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No.555 Youyi East Road, Nanshaomen, Xi'an, 710054, Shaanxi Province, People's Republic of China
- Shaanxi University of Traditional Chinese Medicine, Xi'an, 712046, Shaanxi Province, People's Republic of China
| | - Yangquan Hao
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No.555 Youyi East Road, Nanshaomen, Xi'an, 710054, Shaanxi Province, People's Republic of China
| | - Peng Xu
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No.555 Youyi East Road, Nanshaomen, Xi'an, 710054, Shaanxi Province, People's Republic of China
| | - Chao Lu
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No.555 Youyi East Road, Nanshaomen, Xi'an, 710054, Shaanxi Province, People's Republic of China.
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Jiang H, Wang W, Mao Y, Jiang L, Yu J, Zhu X, Fu H, Lin Z, Shen H, Pan X, Xue X. Morroniside-mediated mitigation of stem cell and endothelial cell dysfunction for the therapy of glucocorticoid-induced osteonecrosis of the femoral head. Int Immunopharmacol 2024; 127:111421. [PMID: 38157694 DOI: 10.1016/j.intimp.2023.111421] [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: 07/27/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Prolonged use of glucocorticoids (GCs) potentially lead to a condition known as GCs-induced osteonecrosis of the femoral head (GIONFH). The primary mechanisms underlying this phenomenon lies in stem cells and endothelial cells dysfunctions. Morroniside, an iridoid glycoside sourced from Cornus officinalis, possesses numerous biological capabilities, including combating oxidative stress, preventing apoptosis, opposing ischemic effects, and promoting the regeneration of bone tissue. PURPOSE This study aimed to analyze the impact of Morroniside on Dexamethasone (DEX)-induced dysfunction in stem cells and endothelial cells, and its potential as a therapeutic agent for GIONFH in rat models. METHODS ROS assay, JC-1 assay, and TUNEL assay were used to detect oxidative stress and apoptosis levels in vitro. For the evaluation of the osteogenic capability of bone marrow-derived mesenchymal stem cells, we employed ALP and ARS staining. Additionally, the angiogenic ability of endothelial cells was assessed using tube formation assay and migration assay. Microcomputed tomography analysis, hematoxylin-eosin staining, and immunohistochemical staining were utilized to evaluate the in vivo therapeutic efficacy of Morroniside. RESULTS Morroniside mitigates DEX-induced excessive ROS expression and cell apoptosis, effectively reducing oxidative stress and alleviating cell death. In terms of osteogenesis, Morroniside reverses DEX-induced osteogenic impairment, as evidenced by enhanced ALP and ARS staining, as well as increased osteogenic protein expression. In angiogenesis, Morroniside counteracts DEX-induced vascular dysfunction, demonstrated by an increase in tube-like structures in tube formation assays, a rise in the number of migrating cells, and elevated levels of angiogenic proteins. In vivo, our results further indicate that Morroniside alleviates the progression of GIONFH. CONCLUSION The experimental findings suggest that Morroniside concurrently mitigates stem cell and endothelial cell dysfunction through the PI3K/AKT signaling pathway both in vitro and in vivo. These outcomes suggest that Morroniside serves as a potential therapeutic agent for GIONFH.
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Affiliation(s)
- Hongyi Jiang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Weidan Wang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yiwen Mao
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Liting Jiang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jiachen Yu
- The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xinyi Zhu
- The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Haonan Fu
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhongnan Lin
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Hanting Shen
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiaoyun Pan
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
| | - Xinghe Xue
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
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Qi B, Guo M, Shi X, Li M, Wu Y, Wang Y, Lv Q, Fan X, Li C, Xu Y. A Network Pharmacology Approach and Validation Experiments to Investigate the Mechanism of Wen-Dan Decoction in the Treatment of SINFH. Comb Chem High Throughput Screen 2024; 27:1576-1591. [PMID: 38783679 DOI: 10.2174/0113862073266310231026070703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Steroid-induced necrosis of the femoral head (SINFH) is a femoral head necrotic disease caused by prolonged use of hormones. Wen-Dan decoction is used in Chinese clinical practice for the treatment of steroid-induced necrosis of the femoral head (SINFH). However, the mechanism and active compounds of Wen-Dan decoction used to treat SINFH are not well understood. OBJECTIVES We studied the mechanism of action of Wen-Dan decoction in treating steroidinduced necrosis of the femoral head (SINFH) via network pharmacology and in vivo experiments. METHODS The active compounds of Wen-Dan decoction and SINFH-related target genes were identified through public databases. Then, network pharmacological analysis was conducted to explore the potential key active compounds, core targets and biological processes of Wen-Dan decoction in SINFH. The potential mechanisms of Wen-Dan decoction in SINFH obtained by network pharmacology were validated through in vivo experiments. RESULTS We identified 608 DEGs (differentially expressed genes) (230 upregulated, 378 downregulated) in SINFH. GO analysis revealed that the SINFH-related genes were mainly involved in neutrophil activation and the immune response. KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway analysis showed that the SINFH-related genes were mainly associated with cytokine receptor interactions, lipids, atherosclerosis, and tuberculosis. We identified 147 active ingredients of Wen-Dan decoction; the core ingredient was quercetin, and licorice was an active ingredient. Moreover, 277 target genes in the treatment of SINFH with Wen-Dan decoction were identified, and NCF1, PTGS2, and RUNX2 were selected as core target genes. QRT-PCR of peripheral blood from SINFH patients showed higher levels of PGTS2 and NCF1 and showed lower levels of RUNX2 compared to controls. QRT-PCR analysis of peripheral blood and femoral bone tissue from a mouse model of SINFH showed higher levels of PGTS2 and NCF1 and lower levels of RUNX2 in the experimental animals than the controls, which was consistent with the bioinformatics results. HE, immunohistochemistry, and TUNEL staining confirmed a significant reduction in hormone-induced femoral head necrosis in the quercetintreated mice. HE, immunohistochemistry, and TUNEL staining confirmed significant improvement in hormone-induced femoral head necrosis in the quercetin-treated mice. CONCLUSION We provide new insights into the genes and related pathways involved in SINFH and report that PTGS2, RUNX2, and NCF1 are potential drug targets. Quercetin improved SINFH by promoting osteogenesis and inhibiting apoptosis.
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Affiliation(s)
- Baochuang Qi
- Graduate School, Kunming Medical University, Kunming, 650500, Yunnan, China
- Department of Orthopedics, 920th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, 650032, Yunnan, China
| | - Minzheng Guo
- Graduate School, Kunming Medical University, Kunming, 650500, Yunnan, China
- Department of Orthopedics, 920th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, 650032, Yunnan, China
| | - Xiangwen Shi
- Graduate School, Kunming Medical University, Kunming, 650500, Yunnan, China
| | - Mingjun Li
- Graduate School, Kunming Medical University, Kunming, 650500, Yunnan, China
| | - Yipeng Wu
- Department of Orthopedics, 920th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, 650032, Yunnan, China
| | - Yi Wang
- Department of Orthopedics, 920th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, 650032, Yunnan, China
| | - Qian Lv
- Department of Orthopedics, 920th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, 650032, Yunnan, China
| | - Xinyu Fan
- Department of Orthopedics, 920th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, 650032, Yunnan, China
| | - Chuan Li
- Department of Orthopedics, 920th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, 650032, Yunnan, China
| | - Yongqing Xu
- Department of Orthopedics, 920th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, 650032, Yunnan, China
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Zhang Y, Li C, Wei Q, Yuan Q, He W, Zhang N, Dong Y, Jing Z, Zhang L, Wang H, Cao X. MiRNA320a Inhibitor-Loaded PLGA-PLL-PEG Nanoparticles Contribute to Bone Regeneration in Trauma-Induced Osteonecrosis Model of the Femoral Head. Tissue Eng Regen Med 2024; 21:185-197. [PMID: 37828392 PMCID: PMC10764684 DOI: 10.1007/s13770-023-00580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND This study aimed to explore the effect of a nanomaterial-based miR-320a inhibitor sustained release system in trauma-induced osteonecrosis of the femoral head (TIONFH). METHODS The miR-320a inhibitor-loaded polyethylene glycol (PEG)- Poly(lactic-co-glycolic acid) (PLGA)- Poly-L-lysine (PLL) nanoparticles were constructed using the double emulsion method. The TIONFH rabbit model was established to observe the effects of miR-320a inhibitor nanoparticles in vivo. Hematoxylin-eosin staining and microcomputed tomography scanning were used for bone morphology analysis. Bone marrow mesenchymal stem cells (BMSCs), derived from TIONFH rabbits, were used for in vitro experiments. Cell viability was determined using the MTT assay. RESULTS High expression of miR-320a inhibited the osteogenic differentiation capacity of BMSCs in vitro by inhibiting the expression of the osteoblastic differentiation markers ALP and RUNX2. MiR-320a inhibitor-loaded PEG-PLGA-PLL nanoparticles were constructed with a mean loading efficiency of 1.414 ± 0.160%, and a mean encapsulation efficiency of 93.45 ± 1.24%, which released 50% of the loaded miR-320a inhibitor at day 12 and 80% on day 18. Then, inhibitor release entered the plateau. After treatment with the miR-320a inhibitor nanoparticle, the empty lacunae were decreased in the femoral head tissue of TIONFH rabbits, and the osteoblast surface/bone surface (Ob.S/BS), osteoblast number/bone perimeter (Ob.N/B.Pm), bone volume fraction, and bone mineral density increased. Additionally, the expression of osteogenic markers RUNX2 and ALP was significantly elevated in the TIONFH rabbit model. CONCLUSION The miR-320a inhibitor-loaded PEG-PLGA-PLL nanoparticle sustained drug release system significantly contributed to bone regeneration in the TIONFH rabbit model, which might be a promising strategy for the treatment of TIONFH.
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Affiliation(s)
- Ying Zhang
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital (Orthopedics Hospital of Henan Province), No. 82 Qiming South Road, Luoyang, 471002, Henan, China.
| | - Chuan Li
- Department of Orthopedics, 920Th Hospital of Joint Logistic Support Force, Kunming, 650032, Yunnan, China
| | - Qiushi Wei
- Institute of Orthopaedics of Guangzhou, University of Traditional Chinese Medicine, Guangzhou, 510240, China
- The Third Affiliated Hospital of Guangzhou, University of Traditional Chinese Medicine, Guangzhou, 510240, China
| | - Qiang Yuan
- Henan University of Traditional Chinese Medicine, Zhengzhou, 450046, Henan, China
| | - Wei He
- Institute of Orthopaedics of Guangzhou, University of Traditional Chinese Medicine, Guangzhou, 510240, China
- The Third Affiliated Hospital of Guangzhou, University of Traditional Chinese Medicine, Guangzhou, 510240, China
| | - Ning Zhang
- Hunan University of Traditional Chinese Medicine, Changsha, 410208, Hunan, China
| | - Yiping Dong
- Henan University of Traditional Chinese Medicine, Zhengzhou, 450046, Henan, China
| | - Zhenhao Jing
- Henan University of Traditional Chinese Medicine, Zhengzhou, 450046, Henan, China
| | - Leilei Zhang
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital (Orthopedics Hospital of Henan Province), No. 82 Qiming South Road, Luoyang, 471002, Henan, China
| | - Haibin Wang
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Xiangyang Cao
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital (Orthopedics Hospital of Henan Province), No. 82 Qiming South Road, Luoyang, 471002, Henan, China.
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Jiang H, Lin C, Cai T, Jiang L, Lou C, Lin S, Wang W, Yan Z, Pan X, Xue X. Taxifolin-mediated Nrf2 activation ameliorates oxidative stress and apoptosis for the treatment of glucocorticoid-induced osteonecrosis of the femoral head. Phytother Res 2024; 38:156-173. [PMID: 37846877 DOI: 10.1002/ptr.8031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/27/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023]
Abstract
Glucocorticoid-induced osteonecrosis of the femoral head (GIONFH) is the main complication secondary to long-term or excessive use of glucocorticoids (GCs). Taxifolin (TAX) is a natural antioxidant with various pharmacological effects, such as antioxidative stress and antiapoptotic properties. The purpose of this study was to explore whether TAX could regulate oxidative stress and apoptosis in GIONFH by activating the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway. We conducted qRT-PCR, Western blotting, TUNEL assays, flow cytometry, and other experiments in vitro. Microcomputed tomography analysis, hematoxylin-eosin staining, and immunohistochemical staining were performed to determine the therapeutic effect of TAX in vivo. TAX mitigated the overexpression of ROS and NOX gene expression induced by DEX, effectively reducing oxidative stress. Additionally, TAX could alleviate DEX-induced osteoblast apoptosis, as evidenced by qRT-PCR, Western blotting, and other experimental techniques. Our in vivo studies further demonstrated that TAX mitigates the progression of GIONFH in rats by combating oxidative stress and apoptosis. Mechanistic exploration revealed that TAX thwarts the progression of GIONFH through the activation of the Nrf2 pathway. Overall, our research herein reports that TAX-mediated Nrf2 activation ameliorates oxidative stress and apoptosis for the treatment of GIONFH.
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Affiliation(s)
- Hongyi Jiang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, China
- The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Chihao Lin
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, China
- The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Tingwen Cai
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, China
- The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Liting Jiang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, China
- The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Chao Lou
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, China
- The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Shida Lin
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, China
- The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Weidan Wang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, China
- The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zijian Yan
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, China
- The Second Clinical School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xiaoyun Pan
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinghe Xue
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Yu WX, Hao YQ, Lu C, Li H, Cai YZ. Efficacy and risk factors for anxiety and depression after mini-incision hip arthroplasty for femoral head osteonecrosis. World J Psychiatry 2023; 13:1016-1026. [PMID: 38186734 PMCID: PMC10768488 DOI: 10.5498/wjp.v13.i12.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a prevalent orthopedic issue, leading to the collapse and fragmentation of the femoral head in its advanced stages, which can severely impair patients' quality of life. Total hip arthroplasty (THA) is a clinical intervention frequently used to alleviate ONFH symptoms and reinstate hip functionality. The conventional surgical technique is invasive and comes with an extended recuperation period, posing significant challenges for patients. With the progression of medical technology, the use of the mini-incision technique in minimally invasive THA (MITHA) has become more prevalent. However, comparative studies examining the effectiveness of these two surgical procedures in treating ONFH remain scarce. Furthermore, understanding patients' psychological well-being is crucial given its profound influence on postoperative recuperation. AIM To evaluate the impact of mini-incision MITHA on ONFH treatment and to identify the risk factors associated with postoperative anxiety and depression. METHODS A retrospective study was conducted on 125 patients treated for ONFH at Xi'an Hong Hui Hospital between February 2020 and January 2022, with the term "consecutive" indicating that these patients were treated in an unbroken sequence without any selection. Among these, 60 patients (control group) underwent traditional THA, while 65 patients (observation group) were treated with mini-incision MITHA. Variations in the visual analog scale (VAS) score and the Harris hip score were monitored. Additionally, shifts in pre- and posttreatment Hamilton anxiety (HAMA) and Hamilton depression (HAMD) scale scores were recorded. Patients with both postoperative HAMA and HAMD scores of ≥ 8 were identified as those experiencing negative emotions. Logistic regression was utilized to analyze the determinants influencing these negative emotional outcomes. Comparative analyses of surgical and postoperative metrics between the two groups were also conducted. RESULTS Posttreatment results indicated a significantly higher VAS score in the control group than in the observation group, while the Harris score was considerably lower (P < 0.0001). The observation group benefited from a notably shorter operation duration, reduced blood loss, diminished incision size, and a decreased postoperative drainage time (P < 0.0001), accompanied by a reduced hospital stay and lower treatment costs (P < 0.0001). The control group had elevated posttreatment HAMA and HAMD scores in comparison to the observation group (P < 0.0001). Multivariate logistic regression revealed that being female [odds ratio (OR): 4.394, 95%CI: 1.689-11.433, P = 0.002], having a higher postoperative VAS score (OR: 5.533, 95%CI: 2.210-13.848, P < 0.0001), and having higher treatment costs (OR: 7.306, 95%CI: 2.801-19.057, P < 0.0001) were significant independent determinants influencing postoperative mood disturbances. CONCLUSION Compared to conventional THA, mini-incision MITHA offers advantages such as reduced operation time, minimal bleeding, and a shorter incision in ONFH patients. Moreover, factors such as sex, postoperative pain (reflected in the VAS score), and treatment costs significantly impact postoperative anxiety and depression.
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Affiliation(s)
- Wen-Xing Yu
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Yang-Quan Hao
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Chao Lu
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Hui Li
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Yuan-Zhen Cai
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
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Davulcu CD, Karaismailoğlu B, Ozsahin MK, Davutluoglu E, Akbaba D, Terzi E, Ünlü MC. Autologous bone plug-sliding with core decompression and bone marrow aspirate concentrate application: a joint-preserving surgical technique for corticosteroid-induced osteonecrosis of femoral head. Acta Orthop Belg 2023; 89:603-608. [PMID: 38205748 DOI: 10.52628/89.4.10669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
This study aimed to describe a surgical procedure for the management of corticosteroid-induced osteonecrosis of the femoral head (ONFH) and report its clinical results. The technique included harvesting a bone plug from the lateral femoral neck, core decompression, and bone marrow aspirate concentrate (BMAC) application; the procedure was completed by press-fit insertion of the autologous bone plug in the debrided area. Autologous bone plug-sliding with core decompression and bone marrow concentrate aspirate application provides good clinical outcomes in the management of ONFH. A retrospective review was performed using records of patients operated on between October 2019 and June 2021. Only patients with Ficat-Arlet stage-2 ONFH, who underwent the procedure described, were included. Twenty- nine hips (18 patients) were included and evaluated clinically and radiologically. Clinical evaluation included the Harris hip score (HHS) and Visual analogue scale (VAS) for pain, while radiological evaluation included direct radiographs. The average age was 39.8 years (± 11.7, range: 24-65 years). The average follow-up was 13.5 months (± 3.4, range: 8-19 months). There were improvements in the VAS pain and Harris hip scores in all patients. Average HHS increased from 61.90 to 87.45 (p < 0.001), while the average VAS pain score decreased from 7.14 to 3.27 (p < 0.001). No complications were encountered in any of the patients during the follow-up. None of the patients had femoral head collapse on the latest radiograph or required total hip replacement. The combination of the novel autologous bone plug-sliding method with conventional regenerative methods is a successful treatment choice for ONFH.
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Meng X, Zhu H. SOX9 Inhibits the Progression of Osteonecrosis of the Femoral Head via the Activation of the Wnt/Beta-Catenin Pathway. J INVEST SURG 2023; 36:2197054. [PMID: 37076124 DOI: 10.1080/08941939.2023.2197054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Background: In this study, we aimed to explore whether the SRY-box transcription factor 9 (SOX9) can play protective roles against the occurrence and development of osteonecrosis of the femoral head (ONFH) by regulating the proliferation, apoptosis, and osteogenic differentiation of human bone marrow stromal cells (hBMSCs) via the Wnt/β-catenin pathway.Methods: We used 1600 mg of glucocorticoid (GC) to induce hBMSCs to establish an ONFH cell model and performed various experiments. Reverse transcription-quantitative polymerase chain reaction and western blotting assays were used to determine the expression levels of SOX9 and osteoblast markers, such as the RUNX family transcription factor 2 (RUNX2), alkaline phosphatase (ALP), osterix, Wnt3a, and β-catenin. An ALP detection kit was used to measure the ALP activity. Flow cytometry and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays were performed to determine the cell viability.Results: GC treatment decreased the expression levels of RUNX2, ALP, and osterix, suppressed ALP activity, and inhibited SOX9 expression. SOX9 overexpression promoted GC-induced cell proliferation and decreased cell apoptosis. Additionally, hBMSCs were transfected with SOX9-small interfering RNA in GC treatment, and SOX9 knockdown was found to suppress the osteogenic differentiation of cells and decrease their viability.Conclusion: Our results revealed that SOX9 is related to the Wnt/β-catenin pathway in ONFH. Moreover, SOX9 participated in ONFH development by activating the Wnt/β-catenin pathway.
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Affiliation(s)
- Xiangsheng Meng
- Trauma Center, Lianyungang City No.1 People's Hospital, Lianyungang, China
| | - Haiquan Zhu
- Trauma Center, Lianyungang City No.1 People's Hospital, Lianyungang, China
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16
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Di Martino A, Brunello M, Villari E, Cataldi P, D'Agostino C, Faldini C. Bone marrow edema of the hip: a narrative review. Arch Orthop Trauma Surg 2023; 143:6901-6917. [PMID: 37378892 DOI: 10.1007/s00402-023-04961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023]
Abstract
Bone marrow edema (BME) of the hip is a radiological-clinical condition with symptoms ranging from asymptomatic to severe, and it is characterized by increased interstitial fluid within the bone marrow, usually at the femur. Depending on the etiology it can be classified as primary or secondary. The primary cause of BME is unknown, while the secondary forms include traumatic, degenerative, inflammatory, vascular, infectious, metabolic, iatrogenic, and neoplastic etiologies. BME could be classified as reversible or progressive. Reversible forms include transient BME syndrome and regional migratory BME syndrome. Progressive forms include avascular necrosis of the femoral head (AVNH), subchondral insufficiency fracture, and hip degenerative arthritis. The diagnosis can be difficult, because at the beginning, the outbreak of hip pain, typically acute and disabling without any prior trauma or exceptional physical activity, is poorly supported by radiographic findings. MRI is the gold standard, and it shows an area of intermediate signal on T1-weighted MRI scans and a high signal on T2-weighted scans, usually lacking sharps margins. In the reversible form, BME is typically self-limiting, and it can be managed conservatively by means of pharmacological and physical therapy. Surgery is generally required for progressive forms in patients who failed non-operative treatment, and it ranges from femoral head and neck core decompression to total hip arthroplasty.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy.
| | - Matteo Brunello
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Eleonora Villari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Piergiorgio Cataldi
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Claudio D'Agostino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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Xia W, Zhang A, Qiu B, Chen Y, Kong M. Femoral neck fracture after femoral head necrosis: a case report and review of the literature. BMC Musculoskelet Disord 2023; 24:853. [PMID: 37907913 PMCID: PMC10617074 DOI: 10.1186/s12891-023-06992-9] [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: 05/05/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Pathological fractures of the femoral neck caused by necrosis of the femoral head are extremely rare. Here, we report a rare case of bilateral femoral head osteonecrosis extending to the femoral neck, with bilateral pathological fractures of the femoral neck occurring within a short period of time. CASE REPORT A 65-year-old male with a 25-year history of daily consumption of 750 ml of liquor, presented with right hip pain after labor for 1 month. He subsequently sustained a right femoral neck fracture without trauma and underwent a right total hip arthroplasty. Two months later, he suffered a non-traumatic left femoral neck fracture and underwent a left total hip arthroplasty. Histopathological examination revealed osteonecrosis of the femoral head and neck, along with the presence of osteoclasts and granulomatous inflammation. Bone mineral density testing also showed osteoporosis. The bilateral femoral neck fractures were ruled out to be caused by any other pathological factors. DISCUSSION This is the first report of pathological fractures of the bilateral femoral neck caused by femoral head necrosis. During the literature review process, we found that this case conforms to the histological characteristics of rapidly destructive hip disease and analyzed the etiology of femoral head necrosis and the pathogenesis of femoral neck fractures.
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Affiliation(s)
- Wenjie Xia
- General Surgery, Cancer Center, Department of Breast Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou, Zhejiang, China
| | - Aiqi Zhang
- The second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Binsong Qiu
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yuan Chen
- Cancer Center, Department of Pathology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Mingxiang Kong
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Wen M, Liang X, Luo D, Li J, Yan B, Lu B, Guo Y, Xu B, Li G. The Effect of the Hip Flexion Angle in Osteonecrosis of the Femoral Head Based on China-Japan Friendship Hospital Classification - A Finite Element Study. Orthop Surg 2023; 15:2689-2700. [PMID: 37620939 PMCID: PMC10549839 DOI: 10.1111/os.13865] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE The alteration in the mechanical environment of the necrotic area is the primary cause of the collapse observed in osteonecrosis of the femoral head (ONFH). This study aims to evaluate the biomechanical implications of the China-Japan Friendship Hospital (CJFH) classification system and hip flexion angles on the necrotic area in ONFH using finite element analysis (FEA). The goal is to provide valuable guidance for hip preservation treatments and serve as a reference for clinical diagnosis and therapeutic interventions. METHODS Hip tomography CT scan data from a healthy volunteer was used to create a 3D model of the left hip. The model was preprocessed and imported into Solidworks 2018, based on the CJFH classification. Material parameters and boundary conditions were applied to each fractal model in ANSYS 21.0. Von Mises stresses were calculated, and maximum deformation values were obtained to evaluate the biomechanical effects of the load on the necrotic area and post-necrotic femur, as well as assess each fractal model's collapse risk. RESULTS (1) At the same hip flexion angle, maximum deformation followed this order: M Type < C Type < L Type. The L3 type necrotic area experienced the most significant deformation at 0, 60, and 110° angles (1.121, 1.7913, and 1.8239 mm respectively). (2) Under the same CJFH classification, maximum deformation values increased with hip flexion angle (0 < 60 < 110°), suggesting a higher risk of collapse at larger angles. (3) Von Mises stress results showed that the maximum stress was not located in the necrotic area but near the inner and outer edge of the femoral neck, indicating decreased stiffness and strength of the subchondral bone after osteonecrosis. CONCLUSION The study found that femoral head collapse risk was higher when the necrotic area was located in the lateral column under the same stress load and flexion angle. Mechanical properties of the necrotic area changed, resulting in decreased bone strength and stiffness. Large-angle hip flexion is more likely to cause excessive deformation of the necrotic area; thus, ONFH patients should reduce or avoid large-angle hip flexion during weight-bearing training in rehabilitation activities.
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Affiliation(s)
- Ming‐Tao Wen
- The First Clinical Medical SchoolShandong University of Traditional Chinese MedicineJinanChina
| | - Xue‐Zhen Liang
- The First Clinical Medical SchoolShandong University of Traditional Chinese MedicineJinanChina
- Orthopaedic MicrosurgeryAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanChina
| | - Di Luo
- The First Clinical Medical SchoolShandong University of Traditional Chinese MedicineJinanChina
| | - Jia‐Cheng Li
- The First Clinical Medical SchoolShandong University of Traditional Chinese MedicineJinanChina
- Orthopaedic MicrosurgeryAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanChina
| | - Bo‐Zhao Yan
- The First Clinical Medical SchoolShandong University of Traditional Chinese MedicineJinanChina
| | - Bo‐Wen Lu
- The First Clinical Medical SchoolShandong University of Traditional Chinese MedicineJinanChina
| | - Yan‐Bo Guo
- The First Clinical Medical SchoolShandong University of Traditional Chinese MedicineJinanChina
| | - Bo Xu
- The First Clinical Medical SchoolShandong University of Traditional Chinese MedicineJinanChina
- Orthopaedic MicrosurgeryAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanChina
| | - Gang Li
- The First Clinical Medical SchoolShandong University of Traditional Chinese MedicineJinanChina
- Orthopaedic MicrosurgeryAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanChina
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Chen Z, Feng F, Su X, Xu Y, Zhang Y, Tan H. Experimental study of a 3D-printing technique combined with biphasic calcium phosphates to treat osteonecrosis of the femoral head in a canine model. J Orthop Surg Res 2023; 18:693. [PMID: 37716998 PMCID: PMC10504695 DOI: 10.1186/s13018-023-04185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/10/2023] [Indexed: 09/18/2023] Open
Abstract
OBJECTIVE This study was aimed to use a digital design of 3D-printing technology to create a surgical navigation template. At the same time, biphasic calcium phosphate (BCP) was applied to treat osteonecrosis of the femoral head (ONFH) in animal models, based on accurate positioning of necrotic lesions in the navigation templates and observation of its therapeutic effect. METHODS Fifteen healthy adult male and female beagle dogs weighing 20 + 2 kg were randomly divided into three groups (n = 5) after establishing a model of ONFH using the liquid nitrogen freezing method. Each model underwent necrotic lesion creation and BPC implantations on one side of the femoral head and only necrotic lesion creation on the other side of the femoral head. Each group underwent CT examination, gross observation, histological examination and immunohistochemical staining at 6 weeks, 12 weeks and 18 weeks postoperatively. RESULTS At weeks 6, 12, and 18, CT and gross examination showed that the necrotic area in the experimental group was basically intact and had been completely raised by BCP material. In the control group, there were signs of bone repair in the femoral head, but there were still large bone defects and cavities. At week 18, extensive collapse of the cartilage surface was observed. Through histological examination, in the experimental group at 12 and 18 weeks, a large number of new and reconstructed bone trabeculae containing a large amount of collagen fibres were observed (P < 0.05), while in the control group, there was extensive necrosis of the bone trabeculae without cellular structural areas. Immunohistochemical examination observation: A large number of CD31-positive cells were observed in the experimental group at 6 weeks, gradually decreasing at 12 and 18 weeks (P < 0.05), while a small number of CD31-positive cells were observed in the control group at 18 weeks. CONCLUSION The 3D-printed navigation template can accurately locate ONFH lesions. Implantation of BCP material can effectively play a supporting role, prevent the collapse of the loading surface, and induce bone formation and angiogenesis to some extent.
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Affiliation(s)
- Zhian Chen
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Fanzhe Feng
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Xixiong Su
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Yongqing Xu
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Ying Zhang
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China.
| | - Hongbo Tan
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China.
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Gharanizadeh K, Sharifi AM, Tayyebi H, Heidari R, Amiri S, Noorigaravand S. Core decompression combined with local DFO administration loaded on polylactic glycolic acid scaffolds for the treatment of osteonecrosis of the femoral head: a pilot study. BMC Pharmacol Toxicol 2023; 24:44. [PMID: 37670365 PMCID: PMC10478340 DOI: 10.1186/s40360-023-00682-x] [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: 01/14/2023] [Accepted: 08/01/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Deferoxamine (DFO) angiogenesis induction potential has been demonstrated in earlier studies, but not in the osteonecrosis of the femoral head (ONFH). In this study, we evaluated the outcome of ONFH treated with combined core decompression and local DFO administration loaded on Polylactic Glycolic Acid (PLGA). PATIENTS AND METHODS In a pilot experimental study, six patients (10 hips) with early-stage non-traumatic ONFH were treated by core decompression, and concurrent injection of local DFO loaded on PLGA scaffold into the subchondral femoral head. Outcome measures were evaluated before the surgery and 12 and 24 months after the surgery and included visual analog scale (VAS) for pain, modified Merle d'Aubigné-Postel (MAP) score for hip function by MRI, and rate of osteonecrosis assessed by the modified. RESULTS The mean MPA score was 14.7 ± 1.16 before the surgery and 16.7 ± 1.41 one year after the surgery (P = 0.004). The mean VAS for pain was 4.7 ± 1.25 before the surgery and 1.8 ± 1.03 one year after the surgery (P = 0.005). The mean Kerboul angle was 219 ± 58.64 before the operation and 164.6 ± 41.82 one year after the operation (P < 0.001). Osteonecrosis progression or collapse was not seen in any of the patients at the final follow-up. No postoperative side effect attributed to the DFO was noticed, as well. CONCLUSION In short-term follow-up, combined core decompression and local DFO administration not only prevent the progression of ONFH but also reduces the rate of osteonecrosis significantly. However, future controlled studies are required to confirm the present results. TRIAL REGISTRATION IRCT20161121031003N3, 16/04/2019.
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Affiliation(s)
- Kaveh Gharanizadeh
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammad Sharifi
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Tayyebi
- Shohadaye Haftom-e-Tir Hospital, School of medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Heidari
- Department of Radiology, Iran University of Medical Sciences, Tehran, Iran
| | - Shayan Amiri
- Shohadaye Haftom-e-Tir Hospital, School of medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sajad Noorigaravand
- Shohadaye Haftom-e-Tir Hospital, School of medicine, Iran University of Medical Sciences, Tehran, Iran.
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Li M, Chen D, Ma Y, Zheng M, Zheng Q. Stem cell therapy combined with core decompression versus core decompression alone in the treatment of avascular necrosis of the femoral head: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:560. [PMID: 37533122 PMCID: PMC10398910 DOI: 10.1186/s13018-023-04025-8] [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] [Received: 04/25/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Accumulated clinical trials had been focused on stem cell therapy in combination of core decompression (CD) in the treatment of avascular necrosis of the femoral head (ANFH). Nonetheless, the results were inconclusive. Here, we performed a systematic review and meta-analysis of previous randomized controlled trials (RCTs) and retrospective studies to assess whether combined stem cell augmentation with CD improved the outcomes of ANFH compared with CD alone. METHODS The current study included 11 RCTs and 7 retrospective studies reporting the clinical outcomes of a total of 916 patients and 1257 hips. 557 and 700 hips received CD and CD plus stem cell therapy, respectively. To compare CD with CD plus stem cell therapy, we examined the clinical evaluating scores, the occurrence of the femoral head, radiologic progression and conversion to total hip arthroplasty (THA). RESULTS Only 10 studies reported significantly greater improvement in hip functions while combining stem cell procedure with CD. The pooled results in subgroup analysis indicated that stem cell group had a lower collapse rate on a mid-term basis (P = 0.001), when combined with mechanical support (P < 0.00001), and with extracted stem cells (P = 0.0002). Likewise, stem cell group had a lower radiographic progression rate at 2- to 5-year follow-up [P = 0.003], when combined with structural grafting (P < 0.00001), and with extracted stem cells (P = 0.004). Stem cell therapy resulted in an overall lower THA conversion rate (P < 0.0001) except that at a follow-up longer than 5 years. CONCLUSION Stem cell therapy combined with core decompression was more effective in preventing collapse, radiographic progression and conversion to THA. Trial Registration The current protocol has been registered in PROSPERO with the registration number: CRD42023417248.
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Affiliation(s)
- Mengyuan Li
- Division of Joint Osteopathy and Traumatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, People's Republic of China
| | - Duanyong Chen
- Division of Joint Osteopathy and Traumatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, People's Republic of China
| | - Yuanchen Ma
- Division of Joint Osteopathy and Traumatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, People's Republic of China
| | - Minghao Zheng
- Centre for Orthopaedic Translational Research, School of Surgery, The University of Western Australia, M Block, QE2 Medical Centre, Monash Ave., Nedlands, WA, 6009, Australia.
| | - Qiujian Zheng
- Division of Joint Osteopathy and Traumatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, People's Republic of China.
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22
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Tang L, Li B, Su Q, Chen X, He R. Identification of hub genes and therapeutic drugs in osteonecrosis of the femoral head through integrated bioinformatics analysis and literature mining. Sci Rep 2023; 13:11972. [PMID: 37488209 PMCID: PMC10366127 DOI: 10.1038/s41598-023-39258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/22/2023] [Indexed: 07/26/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a multifactorial disease leading to severely limited function. By far, the etiology and pathogenesis of ONFH are not fully understood, and surgery is the only effective way to treat ONFH. This study aims to identify hub genes and therapeutic drugs in ONFH. Two gene expression profiles were downloaded from the gene expression omnibus database, and the hub genes and candidate drugs for ONFH were identified through integrated bioinformatics analysis and cross-validated by literature mining. A total of 159 DEGs were identified. PTGS2, LRRK2, ANXA5, IGF1R, MCL1, TIMP2, LYN, CD68, CBL, and RUNX2 were validated as 10 hub genes, which has considerable implications for future genetic research and related research fields of ONFH. Our findings indicate that 85 drugs interact with ONFH, with most drugs exhibiting a positive impact on ONFH by promoting osteogenesis and angiogenesis or inhibiting microcirculation embolism, rather than being anti-inflammatory. Our study provides novel insights into the pathogenesis, prevention, and treatment of ONFH.
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Affiliation(s)
- Lan Tang
- Department of Orthopedic, The Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou City, 310001, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China
| | - Bin Li
- Department of Orthopedic, The Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou City, 310001, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China
| | - Qiuming Su
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Kunming, Calmette Hospital, Kunming City, Yunnan Province, China
| | - Xi Chen
- Department of Orthopedic, The Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou City, 310001, Zhejiang Province, People's Republic of China
- Department of Epidemiology and Statistics, School of Public Health, Medical College, Zhejiang University, Hangzhou City, Zhejiang Province, China
| | - Rongxin He
- Department of Orthopedic, The Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou City, 310001, Zhejiang Province, People's Republic of China.
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China.
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Garcia-Lopez E, Anigwe C, Wong SE, Zhang AL, Lansdown DA. Age is predictive of higher rate of conversion to total hip arthroplasty after core decompression for osteonecrosis of the hip. J Orthop 2023; 41:79-83. [PMID: 37362960 PMCID: PMC10285448 DOI: 10.1016/j.jor.2023.06.002] [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: 05/17/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Background Core decompression may be performed for early osteonecrosis with a goal of improving symptoms and potentially delaying the need for total hip arthroplasty. The effectiveness and complication rate of this procedure is not well understood given the relatively rare nature of hip osteonecrosis. Purpose The purpose of this study is to determine time to total hip arthroplasty (THA) after core compression, assess predictors of early conversion to THA, and to examine complications after hip core decompressions. Methods Using Current Procedural Terminology (CPT) codes, we queried the Mariner PearlDiver dataset for patients who underwent hip core decompression. Patient demographics were recorded and subsequent THA conversion within 2 years after surgery were tracked. Patient demographic factors, including age, sex, obesity, diabetes, prior fractures, steroid use, tobacco use, or alcohol use, were evaluated as possible predictors of early conversion to THA. International Classification of Diseases (ICD) codes were used to identify complications at 90 days after core decompression. Multiple linear regression was used to test if the patient demographics significantly predicted conversion to THA and complications after core decompression. Results Between 2010 and 2020, 555 patients underwent hip core decompression. Within 2 years of core decompression, 226 patients converted to THA (40.7%). Age was the only significant risk factor for conversion to THA. The highest proportion of patients (61.1%, 138/226) who converted to THA were between age 40-59. The 90-day complication rate was 2.9% (16/555). The most common complication was femoral neck fracture (11/16 of all complications). Discussion There is a high failure rate following core decompression for hip osteonecrosis with over one third of patients converting to THA within 2 years. Age was the only variable predictive of conversion to THA. The overall complication rate after core decompression is low at 90 days. Conclusion Patients should be counseled regarding the risk of early conversion to THA if over 40 and the potential risk of femoral neck fracture.
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Affiliation(s)
- Edgar Garcia-Lopez
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Christopher Anigwe
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Stephanie E. Wong
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Alan L. Zhang
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Drew A. Lansdown
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA
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Wei J, Ou Z, Tong B, Liao Z, Yang C. Engineered extracellular vesicles as therapeutics of degenerative orthopedic diseases. Front Bioeng Biotechnol 2023; 11:1162263. [PMID: 37362216 PMCID: PMC10289007 DOI: 10.3389/fbioe.2023.1162263] [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: 02/09/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Degenerative orthopedic diseases, as a global public health problem, have made serious negative impact on patients' quality of life and socio-economic burden. Traditional treatments, including chemical drugs and surgical treatments, have obvious side effects and unsatisfactory efficacy. Therefore, biological therapy has become the focus of researches on degenerative orthopedic diseases. Extracellular vesicles (EVs), with superior properties of immunoregulatory, growth support, and drug delivery capabilities, have emerged as a new cell-free strategy for the treatment of many diseases, including degenerative orthopedic diseases. An increasing number of studies have shown that EVs can be engineered through cargo loading, surface modification, and chemical synthesis to improve efficiency, specificity, and safety. Herein, a comprehensive overview of recent advances in engineering strategies and applications of engineered EVs as well as related researches in degenerative orthopedic diseases, including osteoarthritis (OA), osteoporosis (OP), intervertebral disc degeneration (IDD) and osteonecrosis of the femoral head (ONFH), is provided. In addition, we analyze the potential and challenges of applying engineered EVs to clinical practice.
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Affiliation(s)
| | | | | | | | - Cao Yang
- *Correspondence: Zhiwei Liao, ; Cao Yang,
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Schleder JSEL, Ramello DCDS, Caron MD, Cliquet Junior A. Biomechanical Gait Analysis in Patients with Osteonecrosis of the Femoral Head. Rev Bras Ortop 2023; 58:500-506. [PMID: 37396090 PMCID: PMC10310420 DOI: 10.1055/s-0042-1747975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/18/2022] [Indexed: 07/04/2023] Open
Abstract
Objectives Although osteonecrosis of the femoral head is a prevalent condition, its effects on gait parameters have not been thoroughly studied and are not well-established in the current literature. The primary aim of the present study is to describe gait in patients with a diagnosis of osteonecrosis. Methods This is a cross-sectional study. Nine patients diagnosed with osteonecrosis of the femoral head who were regularly followed-up at an outpatient clinic were selected for the present study and underwent gait analysis using Vicon Motion Capture Systems. Spatiotemporal data was obtained, and joint angles were calculated using an Euler angle coordinate system. Distal coordinate systems were used to calculate joint moments and force plates to obtain ground reaction forces. Results Patients with osteonecrosis presented with slower velocity (0.54 m/s ± 0.19) and smaller cadence (83.01 steps/min ± 13.23) than healthy patients. The pelvic obliquity range of motion was of 10.12° ± 3.03 and rotation was of 18.23° ± 9.17. The mean hip flexion was of 9.48° ± 3.40. Ground reaction forces showed reduced braking and propelling forces. Joint moments were reduced for flexion and adduction (0.42 Nm/kg ± 0.2 and 0.30 Nm/kg ± 0.11, respectively) but the abduction moment was increased (0.42 Nm/kg ± 0.18). Conclusions The present study showed that osteonecrosis of the femoral head presents compensatory gait mechanisms, with increased pelvic motion and decreased knee flexion to protect the hip joint. Decreased moments for hip flexion and adduction were also identified and muscle weakness for those groups may be correlated to the disease.
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Affiliation(s)
- Julia Silva e Lima Schleder
- Departamento de Ortopedia, Reumatologia e Traumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Danielly Caroline de Souza Ramello
- Departamento de Ortopedia, Reumatologia e Traumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Mauro Duarte Caron
- Departamento de Ortopedia, Reumatologia e Traumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Alberto Cliquet Junior
- Departamento de Ortopedia, Reumatologia e Traumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
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Yang X, Shi L, Li A, Gao F, Sun W, Li Z. Phase-contrast imaging with synchrotron hard X-ray reveals the effect of icariin on bone tissue morphology and microstructure in rabbits with early glucocorticoid-induced osteonecrosis of the femoral head. Front Cell Dev Biol 2023; 11:1155532. [PMID: 37215078 PMCID: PMC10192577 DOI: 10.3389/fcell.2023.1155532] [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: 01/31/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Background: Phase-contrast imaging (PCI) with synchrotron hard X-ray was used to observe the changes in bone tissue morphology and microstructure in rabbit models of early glucocorticoid-induced osteonecrosis of the femoral head (ONFH), and to evaluate the intervention effect of Icariin. Methods: Fifty mature New Zealand rabbits (weighing 2.5-3.0 kg) were randomly divided into a control group (n = 10), a glucocorticoid group (n = 20), and an Icariin group (n = 20). The glucocorticoid group and the Icariin group were sequentially injected with lipopolysaccharide (LPS) and methylprednisolone (MPS) to establish a glucocorticoid-induced ONFH animal model. The Icariin group was given Icariin solution when methylprednisolone was injected for the first time, and the control group and glucocorticoid group were given the same amount of normal saline. Animals were sacrificed after 6 weeks, and bilateral femoral head specimens were taken for research. The right femoral head was observed by PCI with synchrotron hard X-ray technology, and the left femoral head was verified by Micro-CT scanning and HE staining. Results: Forty-three animals (nine in the control group, sixteen in the glucocorticoid group, and eighteen in the Icariin group) were included in the study. PCI with synchrotron hard X-ray revealed that the trabecular bone in the glucocorticoid group was thinned, broken, and structurally damaged, whereas the trabecular bone in the Icariin group had normal volume, thickness, and a relatively intact structure. Micro-CT scan reconstruction and HE staining were used to verify the reliability of this technique in identifying osteonecrosis. Conclusion: The effects of Icariin were observed in an early glucocorticoid-induced ONFH rabbit model using PCI with synchrotron hard X-ray. Icariin weakens the destructive effect of glucocorticoids on bone tissue structure, improves bone tissue morphology, and stabilizes bone microstructure. This technique may provide a definitive, non-invasive alternative to histological examination for the diagnosis of early ONFH.
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Affiliation(s)
- Xu Yang
- Department of Orthopedics, Peking University China-Japan Friendship Clinical Hospital, Beijing, China
- Health Science Centre, Peking University, Beijing, China
| | - Lijun Shi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Aifeng Li
- Department of Nephrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fuqiang Gao
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Beijing, China
| | - Wei Sun
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Beijing, China
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Zirong Li
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Beijing, China
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Baimukhamedov C, Botabekova A, Lessova Z, Abshenov B, Kurmanali N. Osteonecrosis amid the COVID-19 pandemic. Rheumatol Int 2023; 43:1377-1378. [PMID: 37097328 PMCID: PMC10126548 DOI: 10.1007/s00296-023-05332-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Chokan Baimukhamedov
- South Kazakhstan Medical Academy, Shymkent, Kazakhstan.
- Shymkent Medical Centre of Joint Diseases, Shymkent, Kazakhstan.
| | - Aliya Botabekova
- South Kazakhstan Medical Academy, Shymkent, Kazakhstan
- Shymkent Medical Centre of Joint Diseases, Shymkent, Kazakhstan
| | - Zhanyl Lessova
- Shymkent Medical Centre of Joint Diseases, Shymkent, Kazakhstan
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Ji Q, Li X, Luo S, Geng L, Ren P, Ni M, Zheng Q, Xin P, Wang Y, Zhang G. Long-term outcomes of arthroscopic synovectomy and core decompression through multiple small bone holes for early-stage avascular necrosis of the femoral head. ARTHROPLASTY 2023; 5:17. [PMID: 37004129 PMCID: PMC10067189 DOI: 10.1186/s42836-023-00181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE This study described a minimally invasive approach for the management of early-stage avascular necrosis of the femoral head, which integrated arthroscopic intra-articular decompression and core decompression by drilling multiple small holes. METHOD A total of 126 patients with 185 hip avascular necrosis were included between March 2005 and January 2008, and the hips were classified, based on the Association Research Circulation Osseous staging system, into stage I (n = 43), stage II (n = 114), and stage III (n = 28). Arthroscopic intra-articular inspection and debridement, along with drilling of multiple small holes for core decompression, were performed. The Modified Harris hip score system and radiographs were used to assess the pre- and post-surgery outcomes. RESULTS One hundred and three patients (involving 153 hips) were followed up successfully for an average of 10.7 ± 3.4 years (range: 9-12 years). After surgery, the overall survival rate was 51.6% (79 hips), and the clinical survival rates were 79%, 72%, 52%, 32%, and 10% for patients with stage I, IIa, IIb, IIc, and III, respectively. The outcomes of patients with Association Research Circulation Osseous Stages I or IIA were better than those of other stages, while hips with a large necrotic area had poor results. This approach preserved the original biomechanical strength of the femoral head after core decompression and eliminated arthritis factors in the hip joint. CONCLUSION The core decompression with multiple small-size holes is an effective method for treating early-stage avascular necrosis of the femoral head, particularly in those with pathological changes in the hip joint. LEVEL OF EVIDENCE Therapeutic study, Level IV.
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Affiliation(s)
- Quanbo Ji
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Xiaoya Li
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Song Luo
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Lei Geng
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Peng Ren
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Ming Ni
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Qingyuan Zheng
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Peng Xin
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Yan Wang
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Guoqiang Zhang
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China.
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Li G, Ji F, Guo W, Wei B. Decreased serum MMP-9 levels in patients with nontraumatic osteonecrosis of the femoral head. BMC Musculoskelet Disord 2023; 24:240. [PMID: 36991363 PMCID: PMC10053116 DOI: 10.1186/s12891-023-06342-9] [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: 11/12/2022] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinases-1 (TIMP-1) are involved in the pathological mechanism of osteonecrosis of the femoral head (ONFH). This study aimed to investigate the relationship of serum MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio with disease severity in patients with nontraumatic ONFH. METHODS Serum levels of MMP-9 and TIMP-1 among 102 nontraumatic ONFH patients and 96 healthy individuals were determined by enzyme-linked immunosorbent assay (ELISA). Imaging severity was determined using the FICAT classification system. The Harris hip score (HHS) and visual analogue scale (VAS) were used to evaluate clinical progress. The correlations of serum MMP-9 and TIMP-1 levels with imaging severity and clinical progress was evaluated statistically. The diagnostic value of MMP-9 for NONFH disease severity was evaluated by examining receiver operating characteristic (ROC) curves. RESULTS The serum MMP-9 levels and the MMP-9/TIMP-1 ratio were significantly increased in patients with ONFH compared to normal controls, and TIMP-1 levels did not differ between the two groups. Serum MMP-9 levels and the MMP-9/TIMP-1 ratio were positively correlated with FICAT stage and VAS and were negatively correlated with the HHS score. The ROC curve results indicated that MMP-9 could be used as a potential marker of nontraumatic ONFH imaging progression. CONCLUSIONS We hypothesize that increased MMP-9 expression and an imbalance in the MMP-9/TIMP-1 ratio play a role in the development of ONFH and are correlate with the severity of ONFH. The determination of MMP-9 can be a useful tool to assess the severity of the disease in patients with nontraumatic ONFH.
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Affiliation(s)
- Guopeng Li
- Weifang Medical University, Weifang, Shandong Province, China
- Department of Orthopedics, Linyi People's Hospital, Jie Fang Road East, No.27, Linyi, 276003, Shandong, China
| | - Fengxuan Ji
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Wenchao Guo
- Weifang Medical University, Weifang, Shandong Province, China
| | - Biaofang Wei
- Department of Orthopedics, Linyi People's Hospital, Jie Fang Road East, No.27, Linyi, 276003, Shandong, China.
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Wen Q, Gu F, Su Z, Zhang K, Xie X, Li J, Sui Z, Yu T. Gamma Nail Combined with One Cannulated Compression Screw Fixation for Treating Pauwels Type III Femoral Neck Fractures in Young and Middle-Aged Adults: Clinical Follow-Up and Biomechanical Studies. Orthop Surg 2023; 15:1045-1052. [PMID: 36846936 PMCID: PMC10102304 DOI: 10.1111/os.13683] [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: 05/15/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE Recently, some clinical studies have reported the use of an intramedullary nailing system for treating unstable femoral neck fractures or femoral neck fractures combined with femoral shaft fractures in young adults, and the results have indicated certain advantages. However, no study has investigated the mechanical properties of this method. We aimed to evaluate the mechanical stability and clinical efficacy of the Gamma nail combined with one cannulated compression screw (CCS) fixation for treating Pauwels type III femoral neck fracture in young and middle-aged adults. METHODS This study consists of two parts: a clinical retrospective study and randomized controlled biomechanical test. Twelve adult cadaver femora were used to test and compare the biomechanical properties among three fixation methods: three parallel CCS (group A), Gamma nail (group B), and Gamma nail combined with one cannulated compression screw (group C). The single continuous compression test, cyclic load test, and ultimate vertical load test were used to evaluate the biomechanical performance of the three fixation methods. We also conducted a retrospective study of 31 patients with Pauwels type III femoral neck fractures, including 16 patients with fractures fixed with three parallel CCS (CCS group) and 15 patients with fractures fixed with Gamma nail combined with one CCS (Gamma nail + CCS group). The patients were followed up for at least 3 years, and all were evaluated for surgical time (from skin incision to closure), surgical blood loss, hospital stay, and the Harris hip score. RESULTS In mechanical experiments, we have found that the mechanical advantages of Gamma nail fixation are not as good as those of conventional CCS fixation. However, the mechanical properties of Gamma nail fixation combined with one cannulated screw perpendicular to the fracture line are much better than those of Gamma nail fixation and CCS fixation. No significant difference was found in the incidence of femoral head necrosis and nonunion between the CCS and Gamma nail + CCS groups. Moreover, there was no statistically significant difference in the Harris hip scores between the two groups. One patient in the CCS group showed significant withdrawal of cannulated screws at 5 months after surgery, whereas in the Gamma nail + CCS group, all patients, including those with femoral neck necrosis, showed no loss of stability of the fixation. CONCLUSION Among the two fixation methods evaluated in this study, Gamma nail combined with one CCS fixation showed better biomechanical properties and may reduce complications associated with unstable fixation devices.
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Affiliation(s)
- Qiangqiang Wen
- Department of Orthopedics, First Hospital of Jilin University, changchun, jilin, China.,Department of Orthopedics, Xi'an No.3 Hospital, the Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
| | - Feng Gu
- Department of Orthopedics, First Hospital of Jilin University, changchun, jilin, China
| | - Zilong Su
- Department of Orthopedics, First Hospital of Jilin University, changchun, jilin, China
| | - Ke Zhang
- Department of Orthopedics, First Hospital of Jilin University, changchun, jilin, China
| | - Xiaoping Xie
- Department of Orthopedics, First Hospital of Jilin University, changchun, jilin, China
| | - Jiangbi Li
- Department of Orthopedics, First Hospital of Jilin University, changchun, jilin, China
| | - Zhenjiang Sui
- Department of Orthopedics, First Hospital of Jilin University, changchun, jilin, China
| | - Tiecheng Yu
- Department of Orthopedics, First Hospital of Jilin University, changchun, jilin, China
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Wang D, Gu L, Zheng J, Zhang Q, Xu Q, Li R, Song D, Ha C, Zhang Q, Yin H, Xu M, Wang H, Li W, Yuan Z, Yang C, Gu M. Germline VWF/MPRIP and somatoplasm FGA variants synergically confer susceptibility to non-traumatic osteonecrosis of the femoral head. Sci Rep 2023; 13:3112. [PMID: 36813871 PMCID: PMC9946931 DOI: 10.1038/s41598-023-30260-4] [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: 08/10/2022] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Non-traumatic osteonecrosis of the femoral head (ONFH) relies on multiple pathogenic factors, including intravascular coagulation, osteoporosis and lipid metabolism disorders. Despite extensively explored from various aspects, genetic mechanism underlying non-traumatic ONFH has not been fully elucidated. We randomly collected blood and necrotic tissue samples from 32 patients with non-traumatic ONFH as well as blood samples from 30 healthy individuals for whole exome sequencing (WES). Germline mutation and somatic mutation were analyzed to identify new potential pathogenic genes responsible for non-traumatic ONFH. Three genes might correlate with non-traumatic ONFH: VWF, MPRIP (germline mutations) and FGA (somatic mutations). Germline or somatic mutations in VWF, MPRIP and FGA correlate with intravascular coagulation, thrombosis, and consequently, ischemic necrosis of the femoral head.
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Affiliation(s)
- Dawei Wang
- Department of Orthopedic Surgery, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China.
| | - Longchao Gu
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Juan Zheng
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Qiang Zhang
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Qi Xu
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Rongrong Li
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Da Song
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Chengzhi Ha
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Qianqian Zhang
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Han Yin
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Mingtao Xu
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Hongmin Wang
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Wei Li
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Zhengfeng Yuan
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Cuncun Yang
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Mingliang Gu
- Joint Laboratory for Translational Medicine Research, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China.
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Li Z, Shao W, Lv X, Wang B, Han L, Gong S, Wang P, Feng Y. Advances in experimental models of osteonecrosis of the femoral head. J Orthop Translat 2023; 39:88-99. [PMID: 36819298 PMCID: PMC9931935 DOI: 10.1016/j.jot.2023.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/02/2023] [Accepted: 01/08/2023] [Indexed: 02/05/2023] Open
Abstract
Background Osteonecrosis of the femoral head (ONFH) is a devastating disease affecting young adults, resulting in significant pain, articular surface collapse, and disabling dysfunction. ONFH can be divided into two broad categories: traumatic and non-traumatic. It has been established that ONFH results from an inadequate blood supply that causes the death of osteocytes and bone marrow cells. Nonetheless, the precise mechanism of ONFH remains to be elucidated. In this regard, preclinical animal and cell models to study ONFH have been established to assess the efficacy of various modalities for preventing and treating ONFH. Nevertheless, it should be borne in mind that many models do not share the same physiologic and metabolic characteristics as humans. Therefore, it is necessary to establish a reproducible model that better mimics human disease. Methods We systematically reviewed the literatures in regard to ONFH experimental models over the past 30 years. The search was performed in PubMed and Web of Science. Original animal, cell studies with available full-text were included. This review summarizes different methods for developing animal and cell experimental models of ONFH. The advantages, disadvantages and success rates of ONFH models are also discussed. Finally, we provide experimental ONFH model schemes as a reference. Results According to the recent literatures, animal models of ONFH include traumatic, non-traumatic and traumatic combined with non-traumatic models. Most researchers prefer to use small animals to establish non-traumatic ONFH models. Indeed, small animal-based non-traumatic ONFH modeling can more easily meet ethical requirements with large samples. Otherwise, gradient concentration or a particular concentration of steroids to induce MSCs or EPCs, through which researchers can develop cell models to study ONFH. Conclusions Glucocorticoids in combination with LPS to induce ONFH animal models, which can guarantee a success rate of more than 60% in large samples. Traumatic vascular deprivation combines with non-traumatic steroids to induce ONFH, obtaining success rates ranging from 80% to 100%. However, animals that undergo vascular deprivation surgery may not survive the glucocorticoid induction process. As for cell models, 10-6mol/L Dexamethasone (Dex) to treat bone marrow stem cells, which is optimal for establishing cell models to study ONFH. The translational potential of this article This review aims to summarize recent development in experimental models of ONFH and recommended the modeling schemes to verify new models, mechanisms, drugs, surgeries, and biomaterials of ONFH to contribute to the prevention and treatment of ONFH.
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Affiliation(s)
- Zilin Li
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenkai Shao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Lv
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Wang
- Department of Rehabilitation, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lizhi Han
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Gong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Feng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Corresponding author.
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Li J, Mo L, Bai G, Wang Z, Zhang H, Li J. One in five patients require conversion to arthroplasty after non-vascularized bone grafts in patients with osteonecrosis of the femoral head: a systematic review. J Orthop Surg Res 2023; 18:77. [PMID: 36721188 PMCID: PMC9887751 DOI: 10.1186/s13018-023-03544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/15/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Non-vascularized bone grafting (NVBG) has demonstrated to treat osteonecrosis of the femoral head (ONFH). There are a number of articles updating the use of NVBG to treat the ONFH, but the percentage of patients subsequently undergoing a total hip arthroplasty (THA) is controversial. METHODS Several electronic databases, including PubMed, Embase, Web of Science, and Cochrane databases, were searched to find studies using NVBG to treat ONFH. The pooled rate and 95% confidence interval (CI) were used to assess the conversion rate to THA after NVBG. In addition, we performed subgroup, sensitivity, and publication bias analysis. RESULTS A total of 37 studies describing 2599 hips were included. The mean weighted follow-up time was 50.5 months and the mean age at surgery was 36.3 years. The conversion rate to THA after NVBG was 21% (95%CI: 17% to 25%), and subgroup analyzes indicated lightbulb, trapdoor and Phemister techniques incidences with THA of 15%, 19%, and 24%, respectively. CONCLUSIONS This study preliminarily obtained the general trend of the survival rate of NVBG patients, but these results should be interpreted cautiously. Pooled results from 2599 hips and of these nearly 80% with early stage of osteonecrosis, showed that approximately 21% of patients underwent a THA following NVBG. NVBG treatment for patient with ONFH appears to defer or at least delay the need for THA.
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Affiliation(s)
- Jianxiong Li
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Liang Mo
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Guowen Bai
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Zhangzheng Wang
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Hua Zhang
- grid.412595.eThe First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Jie Li
- grid.412595.eThe First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
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Yu X, Zhang S, Zhang B, Dai M. Relationship of idiopathic femoral head necrosis with blood lipid metabolism and coagulation function: A propensity score-based analysis. Front Surg 2023; 9:938565. [PMID: 36684312 PMCID: PMC9852306 DOI: 10.3389/fsurg.2022.938565] [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: 05/07/2022] [Accepted: 11/10/2022] [Indexed: 01/09/2023] Open
Abstract
Background Nontraumatic osteonecrosis of the femoral head (ONFH) can be corticosteroid-induced, alcohol-induced, and idiopathic ONFH (IONFH). Although corticosteroid- and alcohol-induced ONFH has been investigated extensively regarding its relationship with blood lipids and coagulation factor levels. However, the effect of blood lipid metabolism and coagulation function on IONFH has rarely been studied. Therefore, this study aimed to analyse the relationship of IONFH with blood lipid and coagulation indicators. Methods Total 680 patients diagnosed with IONFH in our institution during January 2011-June 2019 who met the inclusion criteria composed the case group; 613 healthy persons who underwent physical examination at our institution during the same period composed the control group. Propensity scores were used for baseline feature matching, and two matching groups each with 450 patients were established. After the matching, blood lipid and coagulation factor levels of both groups were comparatively analysed. Results The case group showed significantly higher total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) levels, low-density/high-density lipoprotein (LDL/HDL) ratio, and apolipoprotein B (Apo-B) levels than the control group (p < 0.05). Conversely, the HDL and apolipoprotein A (Apo-AI) levels in the case group were significantly lower than those in the control group (p < 0.05). Regarding coagulation indicators, the activated partial thromboplastin time and prothrombin time were lower in the case group than in the control group; however, the differences were insignificant (p > 0.05). Furthermore, fibrinogen (FIB) levels and thrombin time (TT) in the case group were higher than those in the control group. There were significant differences between the two groups only in terms of FIB levels (p < 0.05), while TT was not significantly different (p > 0.05). Conclusions IONFH has strong associations with blood lipid metabolism and coagulation function, which provide an avenue for exploring the mechanism of IONFH.
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Cuenca-Gómez JÁ, Ocaña-Losada C, Crujeiras P, Rodrigues D, Martínez-Espinosa M. Etiology of avascular necrosis of the hip and shoulder. Screening for Gaucher disease. Rev Clin Esp 2023; 223:17-24. [PMID: 36457211 DOI: 10.1016/j.rceng.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Avascular necrosis (AON) of the hip and shoulder is a little studied disease and the predisposing risk factors for its development are not well known. A high percentage of patients are diagnosed with idiopathic osteonecrosis. This study aims to investigate the prevalence of potential etiological factors for AON and to screen for Gaucher disease among patients with idiopathic AON. MATERIAL AND METHODS This retrospective, single-center, observational study was conducted on patients who had at least one episode of AON of the hip or shoulder at the Hospital de Poniente (Almería, Spain) from January 2010 to December 2019. Clinical and analytical data were collected. Patients whose medical record described no etiological factors for this disease were screened for Gaucher disease. RESULTS The study sample consisted of 81 patients, of whom 58 were male. The mean age at presentation of AON was 45.9 years. They presented with unilateral hip necrosis (n=43), bilateral hip necrosis (n=34), bilateral hip and unilateral shoulder necrosis (n=3), and unilateral shoulder necrosis (n=1). The most frequent potential etiological factors were smoking (46.9%) and obesity (17.3%). Screening for Gaucher disease was performed in ten patients, all of whom tested negative. CONCLUSIONS In our study population, the main potential etiological factors the onset of AON of the shoulder or hip were smoking and obesity. A high percentage of patients were diagnosed with idiopathic AON. We believe that a more exhaustive study of less frequent risk factors should be carried out in these cases.
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Affiliation(s)
- J Á Cuenca-Gómez
- Servicio de Medicina Interna, Hospital de Poniente, El Ejido, Almería, Spain.
| | - C Ocaña-Losada
- Servicio de Medicina Interna, Hospital de Poniente, El Ejido, Almería, Spain
| | - P Crujeiras
- Unidad de Diagnóstico y Tratamiento para Enfermedades Metabólicas Congénitas, Servicio de Neonatología, Departamento de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Instituto de Investigaciones Sanitarias of Santiago de Compostela (IDIS), Santiago de Compostela, La Coruña, Spain
| | - D Rodrigues
- Unidad de Diagnóstico y Tratamiento para Enfermedades Metabólicas Congénitas, Servicio de Neonatología, Departamento de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Instituto de Investigaciones Sanitarias of Santiago de Compostela (IDIS), Santiago de Compostela, La Coruña, Spain
| | - M Martínez-Espinosa
- Servicio de Traumatología y Cirugía Ortopédica, Hospital de Poniente, El Ejido, Almería, Spain
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Zheng J, Yao Z, Xue L, Wang D, Tan Z. The role of immune cells in modulating chronic inflammation and osteonecrosis. Front Immunol 2022; 13:1064245. [PMID: 36582244 PMCID: PMC9792770 DOI: 10.3389/fimmu.2022.1064245] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
Osteonecrosis occurs when, under continuous stimulation by adverse factors such as glucocorticoids or alcohol, the death of local bone and marrow cells leads to abnormal osteoimmune function. This creates a chronic inflammatory microenvironment, which interferes with bone regeneration and repair. In a variety of bone tissue diseases, innate immune cells and adaptive immune cells interact with bone cells, and their effects on bone metabolic homeostasis have attracted more and more attention, thus developing into a new discipline - osteoimmunology. Immune cells are the most important regulator of inflammation, and osteoimmune disorder may be an important cause of osteonecrosis. Elucidating the chronic inflammatory microenvironment regulated by abnormal osteoimmune may help develop potential treatments for osteonecrosis. This review summarizes the inflammatory regulation of bone immunity in osteonecrosis, explains the pathophysiological mechanism of osteonecrosis from the perspective of osteoimmunology, and provides new ideas for the treatment of osteonecrosis.
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Affiliation(s)
- Jianrui Zheng
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zhi Yao
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lixiang Xue
- Center of Basic Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China,*Correspondence: Lixiang Xue, ; Deli Wang, ; Zhen Tan,
| | - Deli Wang
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China,*Correspondence: Lixiang Xue, ; Deli Wang, ; Zhen Tan,
| | - Zhen Tan
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China,*Correspondence: Lixiang Xue, ; Deli Wang, ; Zhen Tan,
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Zhang Y, Li M, Liu S, Liu B, Wu X, Han Y, Wu T. Comparison of minimally-invasive fibular supporting of T-type with traditional bloody iliac flap metastasis for osteonecrosis of the femoral head at ARCO stage II. Heliyon 2022; 8:e12212. [PMID: 36561685 PMCID: PMC9764185 DOI: 10.1016/j.heliyon.2022.e12212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/26/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose Our research mainly evaluates the clinical efficacy of two surgical methods in the treatment of osteonecrosis of the femoral head (ONFH) at ARCO stage II, aiming to provide optimal hip-preserving treatment of ONFH. Method From October 2018 to September 2020, 48 patients (59 hips) met the inclusion criteria and randomized. 24 cases (29 hips) in experimental group were treated with minimally-invasive fibular supporting of T-type; 24 cases (30 hips) in control group were treated with traditional bloody iliac flap metastasis. We will compare some intraoperative and postoperative conditions. Result The operation time in experimental group was 37 (6) minutes, in control group was 130 (21.75) minutes; the length of surgical incision in two groups was 3.7 (0.7) cm and 12.85 (2.68) cm. The intraoperative blood loss in two groups was 69 (21) ml and 363 (87) ml; the postoperative VAS score of the experimental group on day 1, day 3, day 7 after surgery was 5.5 (2), 3.5 (1), 0 (1); the control group was 6 (1.75), 4 (1), 3 (1). The data differences between above groups have statistically significant. The follow-up time of two groups was (33.86 ± 5.66) months and (35.67 ± 4.69) months. The bone graft healing time in two groups was (14.21 ± 1.93) months and (13.83 ± 2.34) months. The Harris hip scores of two groups at the last follow-up were 90 (7.5) and 86.5 (8.5). The survival rates of two groups were 79.31% (23/29) and 76.67% (23/30). The difference was no statistically significant in above groups (P > 0.05). Conclusion The two different bone graft implantation showed satisfactory early outcomes. Compared to the control group, the experimental group has the advantages of lesser pain, lesser blood loss, lesser trauma and shorter operation time. It may be a choice as bone graft for the treatment of ONFH at early stage.
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Cuenca-Gómez J, Ocaña-Losada C, Crujeiras P, Rodrigues D, Martínez-Espinosa M. Etiología de la osteonecrosis avascular de cadera y hombro. Cribado de la enfermedad de Gaucher. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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[Clinical study of a new biodegradable magnesium internal fixation screw in treatment of osteonecrosis of the femoral head]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1343-1350. [PMID: 36382450 PMCID: PMC9681592 DOI: 10.7507/1002-1892.202206055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the safety and efficacy of a new biodegradable magnesium internal fixation screw for vascularized iliac bone flap grafting in treatment of osteonecrosis of the femoral head (ONFH). METHODS Patients with ONFH admitted between July 2020 and February 2021 were selected as the research objects, and 20 patients (20 hips) met the selection criteria and were included in the study. The patients were divided into two groups ( n=10) by central random method. The iliac bone flap was fixed with a new biodegradable magnesium internal fixation screw in the trial group, and the iliac bone flap was wedged directly in the control group. There was no significant difference ( P>0.05) in gender, age, and side, type, Association Research Circulation Osseous (ARCO) stage, and disease duration of ONFH between the two groups. The operation time and intraoperative blood loss of the two groups were recorded. Laboratory tests were performed at each time point before and after operation, including white blood cell (WBC), electrolytes (K, Ca, P, Mg), blood urea nitrogen (BUN), serum creatinine (Scr), glomerular filtration rate (eGFR), lymphocyte ratio (CD4/CD8), immunoglobulin G (IgG), IgM, alanine transaminase (ALT), aspartate aminotransferase (AST). After operation, Harris score was used to evaluate the hip joint function. CT of the hip joint and X-ray films in anteroposterior and frog positions of the pelvis were used to review the iliac bone flap position, fusion, and screw biodegradation in the trial group. RESULTS The vital signs of the two groups were stable, the incisions healed by first intention, and no adverse events occurred after operation. One patient in the control group refused to return to the hospital for follow-up at 3 months after operation, and 1 patient in the trial group refused to return to the hospital for follow-up at 1 year after operation. The rest of the patients completed the follow-up at 2 weeks, 3 months, 6 months, and 1 year after operation. Laboratory tests showed that there was no significant difference in WBC, electrolytes (K, Ca, P, Mg), BUN, Scr, eGFR, CD4/CD8, IgG, IgM, ALT, and AST between the two groups at each time point before and after operation ( P>0.05). The operation time and intraoperative blood loss of the trial group were significantly less than those of the control group ( P<0.05). The Harris scores of the two groups at 1 year significantly increased when compared with the values before operation and at 6 months after operation ( P<0.05). There was no significant difference in Harris score between the two groups at each time point ( P>0.05). Postoperative CT of hip joint and X-ray films of pelvis showed that the iliac bone flap reached osseous fusion with the fenestration of the head and neck junction of femoral head in the two groups at 1 year after operation, and no loosening or shedding of iliac bone flap was observed during follow-up. In the trial group, there were signs of dissolution and absorption of the new biodegradable magnesium internal fixation screws after operation, and the diameter of the screws gradually decreased ( P<0.05); no screw breakage or detachment occurred during follow-up. CONCLUSION In the treatment of ONFH with vascularized iliac bone flap grafting, the new biodegradable magnesium internal fixation screws can fix the iliac bone flap firmly. Compared with the traditional iliac bone flap wedging directly, it has a shorter operation time, less intraoperative blood loss, and can obtain similar joint function.
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Ha AS, Chang EY, Bartolotta RJ, Bucknor MD, Chen KC, Ellis HB, Flug J, Leschied JR, Ross AB, Sharma A, Thomas JM, Beaman FD. ACR Appropriateness Criteria® Osteonecrosis: 2022 Update. J Am Coll Radiol 2022; 19:S409-S416. [PMID: 36436966 DOI: 10.1016/j.jacr.2022.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Osteonecrosis is defined as bone death due to inadequate vascular supply. It is sometimes also called "avascular necrosis" and "aseptic necrosis" when involving epiphysis, or "bone infarct" when involving metadiaphysis. Common sites include femoral head, humeral head, tibial metadiaphysis, femoral metadiaphysis, scaphoid, lunate, and talus. Osteonecrosis is thought to be a common condition most commonly affecting adults in third to fifth decades of life. Risk factors for osteonecrosis are numerous and include trauma, corticosteroid therapy, alcohol use, HIV, lymphoma/leukemia, blood dyscrasias, chemotherapy, radiation therapy, Gaucher disease, and Caisson disease. Epiphyseal osteonecrosis can lead to subchondral fracture and secondary osteoarthritis whereas metadiaphyseal cases do not, likely explaining their lack of long-term sequelae. Early diagnosis of osteonecrosis is important: 1) to exclude other causes of patient's pain and 2) to allow for possible early surgical prevention to prevent articular collapse and need for joint replacements. Imaging is also important for preoperative planning. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington.
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Roger J Bartolotta
- Division Chief, Musculoskeletal Imaging, Weill Cornell Medical College, New York, New York
| | - Matthew D Bucknor
- Associate Chair, Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Karen C Chen
- Musculoskeletal Radiology Section Chief, VA San Diego Healthcare System, San Diego, California
| | - Henry B Ellis
- Medical Director, Clinical Research, Texas Scottish Rite Hospital for Children, Dallas, Texas; American Academy of Orthopaedic Surgeons; Board of Directors, Pediatric Research in Sports Medicine; Board of Directors, Texas Orthopaedic Association; Council of Delegates, Texas Representative, AAOS
| | - Jonathan Flug
- Committee Chair, Radiology Quality Oversight, Mayo Clinic Arizona, Phoenix, Arizona
| | - Jessica R Leschied
- Committee on Emergency Radiology-GSER, Henry Ford Health System, Detroit, Michigan
| | - Andrew B Ross
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - Akash Sharma
- Chair, Research Committee, Radiology and Chair, PET-MRI Workgroup, Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging
| | - Jonelle M Thomas
- Vice-Chair, Clinical Affairs and Director, Radiology Informatics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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SIRT6 Prevents Glucocorticoid-Induced Osteonecrosis of the Femoral Head in Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:6360133. [PMID: 36275897 PMCID: PMC9584736 DOI: 10.1155/2022/6360133] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022]
Abstract
Objective Glucocorticoid-induced osteonecrosis of the femoral head is one of the most common causes of nontraumatic osteonecrosis of the femoral head, but its exact pathogenesis remains unclear. The aim of this study was to investigate the role of SIRT6 in the maintenance of bone tissue morphology and structure, intravascular lipid metabolism, and its potential molecular mechanism in glucocorticoid-induced osteonecrosis of the femoral head. Methods SIRT6 adenovirus was transfected into GIONFH in rats. The microstructure of rat bone was observed by micro-CT and histological staining, and the expression of bone formation-related proteins and angiogenesis-related factors was determined through western blot and immunohistochemistry. Alkaline phosphatase activity, alizarin red staining, and the expression levels of Runx2 and osteocalcin were used to evaluate the osteogenic potential. And in vitro tube formation assay and immunofluorescence were used to detect the ability of endothelial cell angiogenesis. Results Dexamethasone significantly inhibited osteoblast differentiation, affected bone formation, and destroyed microvessel formation, increased the intracellular Fe2+ and ROS levels and induced the occurrence of ferroptosis. SIRT6 can inhibit ferroptosis and restore the ability of bone formation and angiogenesis. Conclusion SIRT6 can inhibit the occurrence of ferroptosis, reduce the damage of vascular endothelium, and promote osteogenic differentiation, so as to prevent the occurrence of osteonecrosis of the femoral head.
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Wang J, Zhang Y, Zhao C, Zhang Q. Femoral Head Necrosis Due to Brucella Infection in China: Case Series and Literature Review. Infect Drug Resist 2022; 15:5857-5865. [PMID: 36237293 PMCID: PMC9553233 DOI: 10.2147/idr.s383584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction The causes of femoral head necrosis mainly include trauma, corticosteroid, and alcohol, among which Brucella is highly unusual. Patients and Methods This paper reported three rare cases of femoral head necrosis due to Brucella, summarizing and analyzing the epidemiological history, clinical manifestations, laboratory examinations, imaging findings, individualized therapy, and biopsy results of patients with this disease. A literature review related to brucellosis and femoral head necrosis was conducted. Results All three patients had an epidemic history of brucellosis. They suffered from hip pain and limitation of movement for months, and femoral head necrosis was confirmed by magnetic resonance imaging (MRI). Pathological Giemsa staining or real-time polymerase chain reaction (real-time PCR) confirmed Brucella melitensis (B. melitensis) as the cause of osteonecrosis. Each patient received individualized therapy according to the degree of osteonecrosis, which was based on anti-brucellosis medications and hip puncture and irrigation decompression. They were followed up for more than two years and rehabilitated well. Conclusion Brucella infection should always be considered the cause of femoral head necrosis for patients with hip pain, especially for those with an epidemic history; early diagnosis and individual stepwise therapy can prevent the progression of osteonecrosis.
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Affiliation(s)
- Jie Wang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Yao Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Changsong Zhao
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China,Correspondence: Qiang Zhang, Email
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Sustich SJ, Stronach BM, Stambough JB, Barnes CL, Mears SC. Considerations in the Sickle Cell Patient Undergoing Hip Reconstructive Surgery. Orthop Clin North Am 2022; 53:421-430. [PMID: 36208885 DOI: 10.1016/j.ocl.2022.06.006] [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] [Indexed: 02/02/2023]
Abstract
Sickle cell disease (SCD) is a hemoglobinopathy that commonly has musculoskeletal effects including osteonecrosis of major joints (most often the hip) and medullary infarcts with resultant pain, functional limitations, and decreased quality of life. Patients with SCD may require surgical intervention, including total hip arthroplasty, frequently at a young age. The underlying pathologic process of SCD creates unique medical and surgical challenges that place these patients at increased risk of complications. This necessitates a multidisciplinary approach for providing surgical care to patients with SCD.
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Affiliation(s)
- Sara J Sustich
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR 72205, USA
| | - Benjamin M Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR 72205, USA
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR 72205, USA
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR 72205, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR 72205, USA.
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Zhao P, Zhao S, Zhang J, Lai M, Sun L, Yan F. Molecular Imaging of Steroid-Induced Osteonecrosis of the Femoral Head through iRGD-Targeted Microbubbles. Pharmaceutics 2022; 14:pharmaceutics14091898. [PMID: 36145646 PMCID: PMC9505504 DOI: 10.3390/pharmaceutics14091898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/15/2022] [Accepted: 06/25/2022] [Indexed: 11/16/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a disease that is commonly seen in the clinic, but its detection rate remains limited, especially at the early stage. We developed an ultrasound molecular imaging (UMI) approach for early diagnosis of ONFH by detecting the expression of integrin αvβ3 during the pathological changes in steroid-induced osteonecrosis of the femoral head (SIONFH) in rat models. The integrin αvβ3-targeted PLGA or lipid microbubbles modified with iRGD peptides were fabricated and characterized. Their adhesion efficiency to mouse brain microvascular endothelial cells in vitro was examined, and the better LIPOiRGD was used for further in vivo molecular imaging of SIONFH rats at 1, 3 and 5 weeks; revealing significantly higher UMI signals could be observed in the 3-week and 5-week SIONFH rats but not in the 1-week SIONFH rats in comparison with the non-targeted microbubbles (32.75 ± 0.95 vs. 0.17 ± 0.09 for 5 weeks, p < 0.05; 5.60 ± 1.31 dB vs. 0.94 ± 0.81 dB for 3 weeks, p < 0.01; 1.13 ± 0.13 dB vs. 0.73 ± 0.31 dB for 1 week, p > 0.05). These results were consistent with magnetic resonance imaging data and confirmed by immunofluorescence staining experiments. In conclusion, our study provides an alternative UMI approach to the early evaluation of ONFH.
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Affiliation(s)
- Ping Zhao
- Department of Ultrasound, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Shuai Zhao
- Department of Ultrasound, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
- Department of Ultrasound, Suzhou Hospital of Anhui Medical University (Suzhou Municipal Hospital of Anhui Province), Suzhou 234000, China
| | - Jiaqi Zhang
- Department of Ultrasound, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Manlin Lai
- Department of Ultrasound, The Second People’s Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen 518061, China
| | - Litao Sun
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou 310014, China
- Correspondence: (L.S.); (F.Y.); Tel.: +86-755-8639-2284 (F.Y.); Fax: +86-755-9638-2299 (F.Y.)
| | - Fei Yan
- Center for Cell and Gene Circuit Design, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Correspondence: (L.S.); (F.Y.); Tel.: +86-755-8639-2284 (F.Y.); Fax: +86-755-9638-2299 (F.Y.)
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Jang BY, Guo SB, Bai R, Liu WL, Gong YL, Zhao ZQ. Methylprednisolone Inhibits Autophagy of Vascular Endothelial Cells in Rat Femoral Head Via PI3K/Akt/mTOR Pathway. Orthop Surg 2022; 14:2669-2681. [PMID: 36052745 PMCID: PMC9531065 DOI: 10.1111/os.13369] [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: 12/29/2020] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To study the relationship between vascular endothelial cells (VEC) and autophagy, and its regulatory mechanism in steroid‐induced avascular necrosis of the femoral head (SANFH). Methods In cell experiment, VEC were isolated and cultured from the femoral head of Sprague–Dawley rats and divided into three groups: blank control group (Ctrl), methylprednisolone group (MP), and methylprednisolone+mTOR‐shRNA group (MP + shmTOR). The autophagy formation was observed by transmission electron microscope. The mRNA expression of PI3K, Akt, mTOR, Beclin1 and MAP1LC3 was detected by RT‐PCR and the protein expression was detected by Western blot and immunofluorescence. Expression of the damage marker 6‐keto‐PGF1α was detected by the ELISA method. In vivo experiment, after establishing the model, the grouping method was the same as cell experiment. Autophagosomes were observed by same method, and the expression of related factors was detected by the same method in cell experiment. Results In the cell experiment, autophagosomes in the MP group were significantly lower than in the Ctrl group, and the autophagosomes in the MP + shmTOR group were intermediate between two groups (P < 0.05). The mRNA expression levels of PI3K, Akt and mTOR in the MP group were significantly higher than in the Ctrl group, while the MP+ shmTOR group presented intermediate levels between these groups (average gray value were 3837.90, 2996.30, 3005.60, F = 428.64, P < 0.05). MRNA expression levels of Beclin1 and MAP1LC3 in the MP group were significantly lower than that in Ctrl group (P < 0.05). The content of 6‐keto‐PGF1α in the MP + shmTOR group was higher than in the Ctrl group and lower than in the MP group at the evaluated time intervals (average absorbance value were 104.98, 206.83, 145.91, F = 352.83, P < 0.01). In vivo experiment, the content of 6‐Keto‐PGF1α in the hormone group increased as time went on; the mTOR‐si group was higher than that in control group, but lower than that in the hormone group (P < 0.01). The mRNA expressions of Beclin1 and MAP1LC3 in the control group were higher than those in the hormone group, while the mRNA expressions of PI3K, Akt and mTOR were lower than those in the mTOR‐si group (P < 0.05). Conclusion The steroid inhibited the physiological protective effect of autophagy on SANFH by increasing the expression of PI3K/Akt/mTOR signaling pathway related factors and decreasing the expression of Beclin1 and MAP1LC3 in the femoral head VEC.
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Affiliation(s)
- Bo-Yong Jang
- Graduate School of Inner Mongolia Medical University, Hohhot, China
| | - Shi-Bing Guo
- Department of Bone Tumor, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Rui Bai
- Department of Pediatric Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Wan-Lin Liu
- Department of Pediatric Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yu-Lin Gong
- Department of Rheumatology and Immunology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Zhen-Qun Zhao
- Department of Pediatric Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Motta F, Timilsina S, Gershwin ME, Selmi C. Steroid-induced osteonecrosis. J Transl Autoimmun 2022; 5:100168. [PMID: 36213422 PMCID: PMC9535426 DOI: 10.1016/j.jtauto.2022.100168] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Osteonecrosis associated with the use of glucocorticoids is a severe, potentially debilitating complication. In broader terms, it commonly involves the femoral head with secondary hip osteoarthritis. Osteonecrosis can also be caused by trauma and other non-traumatic factors besides steroid treatment. Nonetheless, glucocorticoid use is frequently observed in clinical settings in which this represents a common therapeutic option, including general practice, rheumatology and clinical immunology, among others. The pathogenesis involves genetic components, vascular impairment, adipocyte hypertrophy, and increased intraosseous pressure, ultimately leading to marrow and bone ischemia and necrosis and the process rapidly becomes irreversible. Osteonecrosis manifests with pain and impaired motility while the diagnosis is usually made with magnetic resonance imaging allowing early detection and potentially (dependent on the patient's needs for steroids and stage) timely management with conservative options, followed by joint replacement at late stages. In this review we discuss the pathogenesis, risk factors, diagnosis, staging, and management of this complication associated with glucocorticoid treatment.
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Konarski W, Poboży T, Śliwczyński A, Kotela I, Krakowiak J, Hordowicz M, Kotela A. Avascular Necrosis of Femoral Head-Overview and Current State of the Art. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127348. [PMID: 35742595 PMCID: PMC9223442 DOI: 10.3390/ijerph19127348] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022]
Abstract
Avascular necrosis (AVN) of the femoral head is caused by disruption of the blood supply to the proximal femur. The alterations in the blood supply may occur following a traumatic event or result from a non-traumatic cause. Femoral neck fracture and hip dislocation and associated surgical procedures, corticosteroid therapy, and alcohol abuse frequently lead to AVN development. Type of fracture (displaced or undisplaced) and time between injury and surgery are the most critical factors in assessing the risk of developing AVN. Diagnosis of AVN can be established based on patients’ complaints, medical history, and radiographic findings. There is no consensus on the treatment of patients with AVN to date. Non-surgical methods are dedicated to patients in the early pre-collapse stages of the disease and consist of pharmacotherapy and physiotherapy. Surgery is recommended for patients with advanced disease.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
- Correspondence: ; Tel.: +48-(50)-2110863
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Andrzej Śliwczyński
- Department of Social and Preventive Medicine, Social Medicine Institute, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland;
| | - Jan Krakowiak
- Department of Social and Preventive Medicine, Social Medicine Institute, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Martyna Hordowicz
- General Psychiatry Unit III, Dr Barbara Borzym’s Independent Public Regional Psychiatric Health Care Center, 26-600 Radom, Poland;
| | - Andrzej Kotela
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Woycickiego 1/3, 01-938 Warsaw, Poland;
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The protective effect of icariin on glucocorticoid-damaged BMECs explored by microfluidic organ chip. CHINESE CHEM LETT 2022. [DOI: 10.1016/j.cclet.2021.11.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Su Q, Zhang Y, Zhang Y, Zhao B, Ge H, Wu P, Li J, Cheng B. Rapid and Severe Idiopathic Aseptic Necrosis of the Contralateral Femoral Head after Unilateral Total Hip Arthroplasty. Orthop Surg 2022; 14:1251-1259. [PMID: 35524630 PMCID: PMC9163970 DOI: 10.1111/os.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/09/2022] [Accepted: 04/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a multifactorial disease, and agnogenic ONFH, otherwise known as idiopathic ONFH, is rare in clinic. Idiopathic ONFH that exhibits severe necrosis and progresses extremely rapidly is called rapidly destructive hip disease (RDHD). RDHD greatly affects patients but is rarely reported in clinical practice and literature. CASE PRESENTATION In this study, a 64-year-old male patient with complete collapse and necrosis of the right femoral head complicated with severe bone destruction at 10 months after left total hip arthroplasty (THA) was reported. The period from the intact structure of the right femoral head to the first discovery of its complete collapse, according to imaging results, was 7 months. The duration from the occurrence of symptoms in the right hip joint to the first discovery of complete collapse and necrosis of the femoral head was only 5 months. At present, the cause has not been determined based on medical history, symptoms, signs, imaging evaluation results, laboratory examination results, and pathological examination results, though it has been identified as severe idiopathic aseptic necrosis of the femoral head with rapid progression, or RDHD. Finally, right THA was performed, and a good outcome was observed in the patient at present. CONCLUSIONS As a rare hip joint disease, RDHD greatly influences the normal life of patients. RDHD of the contralateral side after unilateral THA is even scarcer. Left THA may be one of the important factors accelerating the necrosis of the right femoral head. Hopefully, with this case report, more attention will be paid to the contralateral hip joint in patients undergoing unilateral THA by clinicians and rehabilitation physicians, and a clinical reference will be provided for the research on RDHD.
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Affiliation(s)
- Qihang Su
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yi Zhang
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yuanzhen Zhang
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Bin'an Zhao
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Heng'an Ge
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Peng Wu
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Jun Li
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Biao Cheng
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
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Lin X, Zhu D, Wang K, Luo P, Rui G, Gao Y, Liu F, Yu H. Activation of aldehyde dehydrogenase 2 protects ethanol-induced osteonecrosis of the femoral head in rat model. Cell Prolif 2022; 55:e13252. [PMID: 35567426 PMCID: PMC9201375 DOI: 10.1111/cpr.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/24/2022] [Accepted: 04/24/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Osteonecrosis of the femoral head (ONFH) is a devastating disease characterized by destructive bone structures, enlarged adipocyte accumulation and impaired vascularization. The aldehyde dehydrogenase 2 (ALDH 2) is the limiting enzyme for ethanol metabolism with many physiological functions. The aim was investigated the potential protective role of activated ALDH 2 by Alda-1 for ethanol-induced ONFH. MATERIALS AND METHODS The ethanol-induced ONFH in rat was performed to explore the protective of Alda-1 by various experimental methods. Subsequently, the effect of Alda-1 and ethanol on the osteogenic and adipogenic differentiation was investigated via multiple cellular and molecular methods. Finally, the effect of Alda-1 and ethanol on the neo-vascularization was detected in Human umbilical vein endothelial cells (HUVECs) and ONFH model. RESULTS Firstly, radiographical and pathological measurements indicated that alda-1 protected ethanol-induced ONFH. Moreover, ethanol significantly inhibited the proliferation and osteogenic differentiation of BMSCs, whereas Alda-1 could distinctly rescue it by PI3K/AKT signalling. Secondly, ethanol remarkably promoted the lipid vacuoles formation of BMSCs, while Alda-1 significantly retarded it on BMSCs by AMPK signalling pathway. Finally, ethanol significantly inhibited proliferation and growth factor level resulting in reduced angiogenesis, whereas Alda-1 could rescue the effect of ethanol. Additionally, Alda-1 significantly reduced the occurrence of ONFH and promoted vessel number and distribution in alcoholic ONFH. CONCLUSIONS Alda-1 activation of ALDH 2 was highly demonstrated to protect ethanol-induced ONFH by triggering new bone formation, reducing adipogenesis and stimulating vascularization.
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Affiliation(s)
- Xiaoyi Lin
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Daoming Zhu
- Department of Medical Imaging, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, People's Republic of China
| | - Kaiyang Wang
- Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Pengbo Luo
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Gang Rui
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Youshui Gao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fuan Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Hongping Yu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
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