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Desai VM, Syed AN, Batley M, Wells L, Williams BA. Management of osteonecrosis of the humeral head in the pediatric population: A systematic review. J Child Orthop 2024; 18:432-440. [PMID: 39100979 PMCID: PMC11295367 DOI: 10.1177/18632521241254708] [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: 03/06/2024] [Accepted: 04/25/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose Humeral head osteonecrosis in the pediatric patients most often occurs in patients with underlying hemoglobinopathies, exposure to chronic corticosteroids, or after trauma. The purpose of this study was to perform a systematic review evaluating the prevalence, clinical characteristics, and management of humeral head osteonecrosis in the pediatric population. Methods PubMed, Ovid MEDLINE, and Scopus were screened with the terms "osteonecrosis," "avascular necrosis," "pediatric," and "proximal humerus" on January 10, 2024. A total of 218 studies were screened, and 74 studies were evaluated for eligibility. Studies that reported on the prevalence and/or management of pediatric humeral head osteonecrosis were included. The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Results Twelve studies met inclusion criteria: four retrospective case series, three prospective case series, one retrospective cohort study, one retrospective case-control study, and three case reports. A majority of the studies (67%) discussed chemotherapy-induced osteonecrosis of the humeral head. A total of 77 patients (106 shoulders) with humeral head osteonecrosis were identified. The overall prevalence of osteonecrosis of the humeral head across eight studies examining at-risk populations (underlying hemoglobinopathies or undergoing chemotherapy) was 2%. Intra-articular steroid injections, physical therapy, and activity modification are effective conservative management strategies. Additionally, core decompression and hemiarthroplasty are surgical treatment options. Conclusions The prevalence of osteonecrosis of the humeral head is low even among at-risk populations with associated medical conditions. A variety of conservative and surgical treatment options have been described, but no comparative evaluations of these modalities has been conducted. Level of evidence IV.
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Affiliation(s)
- Vineet M Desai
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Harvard Medical School, Boston, MA, USA
| | - Akbar N Syed
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Morgan Batley
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lawrence Wells
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brendan A Williams
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Dhital R, Singh NC, Spiker AM, Poudel DR, Pedersen B, Bartels CM. Trends in avascular necrosis and related arthroplasties in hospitalized patients with systemic lupus erythematosus and rheumatoid arthritis. Semin Arthritis Rheum 2024; 66:152444. [PMID: 38604118 DOI: 10.1016/j.semarthrit.2024.152444] [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: 01/02/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Avascular necrosis (AVN) is a devastating complication often necessitating arthroplasty, particularly common in systemic lupus erythematosus (SLE). Limited research exists on arthroplasty trends since new steroid-sparing agents. We analyzed trends and characteristics associated with AVN and AVN-related arthroplasties among SLE and RA hospitalizations using two decades of data from the U.S. National Inpatient Sample (NIS). METHODS This cross-sectional study used NIS (2000-2019) to identify hospitalized adults with SLE and RA, with or without AVN, using ICD codes. AVN was further grouped by arthroplasty status. Primary outcomes were AVN and AVN-related arthroplasty rates and time trends in SLE and RA. Baseline sociodemographics and comorbidities were compared. Analyses used STATA and Joinpoint regression to calculate annual percent change (APC). RESULTS Overall, 42,728 (1.3 %) SLE and 43,600 (0.5 %) RA hospitalizations had concomitant AVN (SLE-AVN and RA-AVN). Of these, 16,724 (39 %) and 25,210 (58 %) underwent arthroplasties, respectively. RA-AVN increased (APC: 0.98*), with a decrease in arthroplasties (APC: -0.82*). In contrast, SLE-AVN initially increased with a breakpoint in 2011 (APC 2000-2011: 1.94* APC 2011-2019 -2.03), with declining arthroplasties (APC -2.03*). AVN hospitalizations consisted of individuals who were younger and of Black race; while arthroplasties were less likely in individuals of Black race or Medicaid coverage. CONCLUSION We report a breakpoint in rising SLE-AVN after 2011, which may relate to newer steroid-sparing therapies (i.e., belimumab). AVN-associated arthroplasties decreased in SLE and RA. Fewer AVN-associated arthroplasties were noted for Black patients and those with Medicaid, indicating potential disparities. Further research should examine treatment differences impacting AVN and arthroplasty rates.
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Affiliation(s)
- Rashmi Dhital
- Department of Medicine, Division of Rheumatology, Autoimmunity and Inflammation, School of Medicine, University of California San Diego, La Jolla, CA.
| | - Neha Chiruvolu Singh
- Department of Medicine, Division of Rheumatology, Autoimmunity and Inflammation, School of Medicine, University of California San Diego, La Jolla, CA
| | - Andrea M Spiker
- Department of Orthopedic Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Dilli Ram Poudel
- Department of Medicine, Indiana Regional Medical Center, Indiana, PA
| | - Brian Pedersen
- Department of Medicine, Division of Rheumatology, Autoimmunity and Inflammation, School of Medicine, University of California San Diego, La Jolla, CA
| | - Christie M Bartels
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
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Talbott HG, Wilkins RA, Brockett CL, Mengoni M. Incorporating pathological gait into patient-specific finite element models of the haemophilic ankle. Biomech Model Mechanobiol 2024:10.1007/s10237-024-01857-z. [PMID: 38763978 DOI: 10.1007/s10237-024-01857-z] [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: 01/24/2024] [Accepted: 04/28/2024] [Indexed: 05/21/2024]
Abstract
Haemarthrosis is an inherent clinical feature of haemophilia, a disease characterised by an absence or reduction in clotting proteins. Patients with severe haemophilia experience joint bleeding leading to blood-induced ankle arthropathy (haemarthropathy). Altered biomechanics of the ankle have been reported in people with haemophilia; however, the consequence of this on joint health is little understood. The aim of this study was to assess the changes in joint contact due to haemophilia disease-specific gait features using patient-specific modelling, to better understand the link between biomechanics and joint outcomes. Four, image-based, finite element models of haemophilic ankles were simulated through consecutive events in the stance phase of gait, using both patient-specific and healthy control group (n = 36) biomechanical inputs. One healthy control FE model was simulated through the healthy control stance phase of the gait cycle for a point of comparison. The method developed allowed cartilage contact mechanics to be assessed throughout the loading phase of the gait cycle. This showed areas of increased contact pressure in the medial and lateral regions of the talar dome, which may be linked to collapse in these regions. This method may allow the relationship between structure and function in the tibiotalar joint to be better understood.
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Affiliation(s)
- Harriet G Talbott
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
- School of Engineering, University of Hull, Hull, HU6 7RX, UK
| | - Richard A Wilkins
- NIHR Leeds BRC, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Claire L Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
- NIHR Leeds BRC, University of Leeds, Leeds, UK
- Department of Mechanical Engineering, Insigneo Institute, University of Sheffield, Sheffield, UK
| | - Marlène Mengoni
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK.
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Mousavian A, Abdollahi M, Haddadan N. Talus Avascular Necrosis as a Rare Complication of Cushing's Disease: A Case Report. Cureus 2024; 16:e57531. [PMID: 38707157 PMCID: PMC11067996 DOI: 10.7759/cureus.57531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Avascular necrosis (AVN), also called osteonecrosis, stems from blood supply interruption to the bone and is often idiopathic. It has risk factors like trauma, alcohol, and corticosteroids. AVN in the talus (AVNT) is less common than in the femoral head. Most cases of talar osteonecrosis are associated with trauma, while a smaller proportion is linked to systemic conditions such as sickle cell disease or prolonged prednisone use. Glucocorticoids are a key nontraumatic cause. We report a middle-aged woman with Cushing's syndrome symptoms, such as hypertension and moon face, since her youth. A few years ago, she experienced pain and swelling in her ankle, which was diagnosed as atraumatic AVNT and treated with hindfoot fusion. Years later, she was diagnosed with Cushing's disease caused by an adrenocorticotropic hormone (ACTH)-producing pituitary adenoma in laboratory tests and imaging, which was resected in 2020. She experienced significant weight loss, and her Cushing's syndrome symptoms were relieved after tumor resection. Mechanisms behind AVN in hypercortisolism involve fat cell hypertrophy, fat embolization, osteocyte apoptosis, and glucocorticoid-induced hypertension. Traditional X-rays may miss early AVN changes; MRI is preferred for early detection. Although there are some cases of femoral AVN caused by endogenous hypercortisolism in the literature, as far as we know, this is the first case of AVNT due to Cushing's disease. AVNT treatment includes conservative approaches, hindfoot fusion, and core decompression. Cushing's disease is a rare cause of AVNT, and a multidisciplinary approach aids in the rapid diagnosis of elusive symptoms.
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Affiliation(s)
- Alireza Mousavian
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, IRN
| | - Mohammad Abdollahi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, IRN
| | - Negin Haddadan
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, IRN
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Rammelt S, Walther EJ. Joint-Preserving Osteotomy of the Lateral Tibial Plafond for Posttraumatic Osteonecrosis: A Prospective Cohort Study. Foot Ankle Int 2024; 45:328-337. [PMID: 38389195 DOI: 10.1177/10711007241227928] [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] [Indexed: 02/24/2024]
Abstract
BACKGROUND Posttraumatic osteonecrosis (ON) of the lateral distal tibia is a rare but severe complication of malleolar fractures. Treatment options include ankle fusion, arthroplasty, osteotomy, and drilling but clinical data on outcomes are limited to single case reports. The aim of this study was to prospectively evaluate the outcome following joint-preserving reconstruction. METHODS Over a 10-year period, 10 patients (8 females and 2 males, average age 36 years; range, 27-68 years) with posttraumatic ON were treated with intra-articular osteotomy of the distal tibia and bone grafting. All patients initially sustained a closed pronation injury, 7 with initial tibiotalar subluxation. Chronic syndesmotic instability following initial treatment was present in 4 patients and 5 were smokers. All patients were followed for a median of 68 (range, 12-103) months, 7 returned in person for clinical and radiographic follow-up. RESULTS No immediate postoperative complications were seen. Secondary ankle fusion was necessary in 1 case (10%) because of progressive osteoarthritis. At the time of follow-up, anterior ankle arthritis leading to impingement and requiring cheilectomy was noted in 4 cases, partial graft necrosis, and secondary syndesmotic instability requiring revision surgery was seen in 1 case each. Compared with the preoperative values, significant improvement in the Olerud-Molander Ankle Score (P = .012), EuroQuol-5 Score (P = .008), and Foot Function Index (FFI-D pain, P = .028; FFI-D restriction, P = .038) was seen. Average range of motion at the ankle was 45 degrees. CONCLUSION In our limited series of patients with posttraumatic ON of the lateral distal tibia, we found that joint-preserving reconstruction using an intra-articular distal tibial osteotomy with autologous bone grafting usually provided significant functional improvement and pain relief. In our cohort secondary fusions by a median 5.5-year follow-up were rare, but secondary, joint-sparing surgeries were common. LEVEL OF EVIDENCE Level III, prospective study.
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Affiliation(s)
- Stefan Rammelt
- University Center of Orthopaedics, Trauma and Plastic Surgery, Dresden, Germany
- University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - Eric Jörg Walther
- University Center of Orthopaedics, Trauma and Plastic Surgery, Dresden, Germany
- University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
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Kwan C, Chen YH, Killoran JH, Ferrone M, Marcus KJ, Tanguturi S, Balboni TA, Spektor A, Huynh MA. Clinical Outcomes Among Patients Treated With Stereotactic Body Radiation Therapy to Femur Metastases for Oligometastatic Disease Control or Reirradiation: Results From a Large Single-Institution Experience. Adv Radiat Oncol 2024; 9:101439. [PMID: 38419821 PMCID: PMC10900803 DOI: 10.1016/j.adro.2024.101439] [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: 08/20/2023] [Accepted: 12/29/2023] [Indexed: 03/02/2024] Open
Abstract
Purpose There are limited data regarding outcomes after stereotactic body radiation therapy (SBRT) for femur metastases, which was an exclusion criteria for the Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers (SABR-COMET) trial. We aimed to characterize clinical outcomes from a large single institution experience. Methods and Materials Forty-eight patients with 53 lesions were consecutively treated with femur SBRT from May 2017 to June 2022. The Kaplan-Meier method and Cox proportional hazard models were used to characterize time-to-event endpoints and associations between baseline factors and clinical outcomes, respectively. Local control and locoregional control were defined as the absence of tumor progression within the radiation treatment field or within the treated femur, respectively. Results Most patients had Eastern Cooperative Oncology Group performance status 0 to 1 (90%), prostate (52%) or breast/lung (17%) cancer, and 1 to 3 lesions (100%), including 29 proximal and 5 distal. Fifty-seven percent of the lesions were treated with concurrent systemic therapy. Median planning target volume was 49.1 cc (range, 6.6-387 cc). Planning target volume V100 (%) was 99% (range, 90-100). Fractionation included 18 to 20 Gy/1F, 27 to 30 Gy/3F, and 28.5-40 Gy/5F. Forty-two percent had Mirels score ≥7 and most (94%) did not have extraosseous extension. Acute toxicities included grade 1 fatigue (15%), pain flare (7.5%), nausea (3.8%), and decreased blood counts (1.9%). Late toxicities included fracture (1.9%) at 1.5 years and osteonecrosis (4%) from dose of 40 Gy in 5F and 30 Gy in 5F (after prior 30 Gy/10F). One patient (2%) required fixation postradiation for progressive pain. With median follow-up 19.4 months, 1- and 2-year rates of local control were 94% and 89%, locoregional control was 83% and 67%, progression-free survival were 56% and 25%, and overall survival were 91% and 73%. Fifty percent of local regional recurrence events occurred within 5 cm of gross tumor volume. Conclusions Femur SBRT for oligometastatic disease control in well-selected patients was associated with good outcomes with minimal rates of acute and late toxicity. Patterns of local regional recurrence warrant consideration of larger elective volume coverage. Additional prospective study is needed.
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Affiliation(s)
- Caitlyn Kwan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yu-Hui Chen
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph H. Killoran
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marco Ferrone
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karen J. Marcus
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shyam Tanguturi
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tracy A. Balboni
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander Spektor
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mai Anh Huynh
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Xia C, Xu H, Fang L, Chen J, Yuan W, Fu D, Wang X, He B, Xiao L, Wu C, Tong P, Chen D, Wang P, Jin H. β-catenin inhibition disrupts the homeostasis of osteogenic/adipogenic differentiation leading to the development of glucocorticoid-induced osteonecrosis of the femoral head. eLife 2024; 12:RP92469. [PMID: 38376133 PMCID: PMC10942600 DOI: 10.7554/elife.92469] [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] [Indexed: 02/21/2024] Open
Abstract
Glucocorticoid-induced osteonecrosis of the femoral head (GONFH) is a common refractory joint disease characterized by bone damage and the collapse of femoral head structure. However, the exact pathological mechanisms of GONFH remain unknown. Here, we observed abnormal osteogenesis and adipogenesis associated with decreased β-catenin in the necrotic femoral head of GONFH patients. In vivo and in vitro studies further revealed that glucocorticoid exposure disrupted osteogenic/adipogenic differentiation of bone marrow mesenchymal cells (BMSCs) by inhibiting β-catenin signaling in glucocorticoid-induced GONFH rats. Col2+ lineage largely contributes to BMSCs and was found an osteogenic commitment in the femoral head through 9 mo of lineage trace. Specific deletion of β-catenin gene (Ctnnb1) in Col2+ cells shifted their commitment from osteoblasts to adipocytes, leading to a full spectrum of disease phenotype of GONFH in adult mice. Overall, we uncover that β-catenin inhibition disrupting the homeostasis of osteogenic/adipogenic differentiation contributes to the development of GONFH and identify an ideal genetic-modified mouse model of GONFH.
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Affiliation(s)
- Chenjie Xia
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
- Department of Orthopedic Surgery, the Affiliated Lihuili Hospital of Ningbo UniversityNingboChina
| | - Huihui Xu
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
- The First College of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhouChina
| | - Liang Fang
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Jiali Chen
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Wenhua Yuan
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Danqing Fu
- School of Basic Medical Sciences, Zhejiang Chinese Medical UniversityHangzhouChina
| | - Xucheng Wang
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Bangjian He
- Department of Orthopedic Surgery, the First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Luwei Xiao
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Chengliang Wu
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
| | - Peijian Tong
- Department of Orthopedic Surgery, the First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Di Chen
- Faculty of Pharmaceutical Sciences, Shenzhen Institute of Advanced TechnologyShenzhenChina
| | - Pinger Wang
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
- The First College of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhouChina
| | - Hongting Jin
- Institute of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese MedicineHangzhouChina
- The First College of Clinical Medicine, Zhejiang Chinese Medical UniversityHangzhouChina
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Tantuway V, Jeyaraman M, Nallakumarasamy A, Prikh MB, Sharma AK, Sharma R. Functional Outcome Analysis of Autologous Stromal Vascular Fraction (SVF) (Sahaj Therapy ®) Using Direct Sonication in Osteonecrosis of the Femoral Head (ONFH): A 6-Year Follow-Up Study. Indian J Orthop 2024; 58:68-78. [PMID: 38161400 PMCID: PMC10754810 DOI: 10.1007/s43465-023-01041-y] [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: 05/01/2023] [Accepted: 10/28/2023] [Indexed: 01/03/2024]
Abstract
Introduction We investigated the safety, efficacy, functional, and clinical outcomes of intra-osseous implantation of mechanically isolated, autologous stromal vascular fraction (SVF), an Australian patented direct ultrasonication technology (Sahaj Therapy®) in osteonecrosis of the femoral head (ONFH). Materials and Methods A total of 32 cases of ONFH were enrolled in the study after confirming with an MRI of the affected hip. All cases were treated with an intra-osseous autologous SVF implantation [4-5 cc with the cellular dosage of 8.0 × 107 cells with a viability of > 85% SVF cells] on the same surgical sitting. All the cases were followed up clinically, functionally, and radiologically at regular intervals. A comparison of mean HOOS scores at different follow-ups was done using Paired 't'-test. A P value of < 0.05 was considered significant. Results In our study, male preponderance was seen (53.1%). According to the modified Ficat and Arlet classification, the most common grade of ONFH was grade 2 [right: 25 hips and left: 25 hips]. There was a statistically significant improvement in the mean HOOS score of the right hip (n = 10) and left hip (n = 9) from preoperative time till 72 months (P < 0.05). The follow-up MRI of the affected hips shows improved osteogenesis without any further worsening of the contour of the femoral head. No adverse effects were seen in any of the study participants. Conclusion For individuals with ONFH, treated with intra-osseous autologous SVF implantation in the same surgical procedure is an innovative and promising treatment modality. Even after 6 years of follow-up, the study participants with ONFH have shown good clinical and functional outcomes with autologous SVF.
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Affiliation(s)
- Vinay Tantuway
- Department of Orthopaedics and Traumatology, Index Medical College Hospital and Research Centre, Indore, Madhya Pradesh India
- Sahaj Regenerative Cell Therapeutics, Indore, Madhya Pradesh India
| | - Madhan Jeyaraman
- Sahaj Regenerative Cell Therapeutics, Indore, Madhya Pradesh India
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu India
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh India
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX USA
| | - Arulkumar Nallakumarasamy
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu India
| | - Mittal B. Prikh
- Department of Orthopaedics, Navjivan Hospital, Ahmedabad, Gujarat India
| | - Aashish K. Sharma
- Department of Orthopaedics and Joint Replacement, CK Birla Hospitals, Jaipur, Rajasthan India
| | - Raj Sharma
- Sahaj Regenerative Cell Therapeutics, Indore, Madhya Pradesh India
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Nejadhosseinian M, Haerian H, Tabatabaie Nejad M, Sadeghi K, Aghaghazvini L, Alikhani M, Loghman M, Faezi ST. Who is the convict; COVID-19 or corticosteroid? Late onset avascular necrosis of hips after COVID-19. A case report with literature review. Int J Rheum Dis 2023; 26:2069-2072. [PMID: 37088889 DOI: 10.1111/1756-185x.14703] [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: 01/19/2023] [Revised: 03/23/2023] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
AIM Avascular necrosis (AVN) or osteonecrosis is characterized by death of bone tissue due to endothelial damage and vascular abnormality. Coronavirus can induce endothelial damage and abnormal blood clotting, so that COVID-19 is known as a vascular disease. We aim to evaluate the relationship between AVN and COVID-19. CASE Here we present a 39-year old man with severe COVID-19 and corticosteroid consumption who developed late onset AVN of both hips 20 month after COVID-19. CONCLUSION An awareness of the possible osteonecrosis for all physicians dealing with patients with musculoskeletal problems following COVID-19 is necessary.
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Affiliation(s)
- Mohammad Nejadhosseinian
- Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Haerian
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Kourosh Sadeghi
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Aghaghazvini
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Alikhani
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Loghman
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Monje A, Roccuzzo A, Buser D, Wang HL. Influence of buccal bone wall thickness on the peri-implant hard and soft tissue dimensional changes: A systematic review. Clin Oral Implants Res 2023; 34 Suppl 26:8-27. [PMID: 37750522 DOI: 10.1111/clr.14177] [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: 09/07/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 09/27/2023]
Abstract
BACKGROUND The significance on the association between the peri-implant bucco-lingual dimension (BLD) at the stage of implant placement and the occurrence of biological and esthetic complications is yet unknown. MATERIAL AND METHODS Systematic screening of electronic sources was carried out to identify clinical and preclinical studies reporting on the baseline BLD and/or buccal bone thickness (BBT) values. A secondary objective was to assess the effect of simultaneous grafting at sites with deficient or no buccal bone wall (BBW) at baseline. The primary outcome variables were BBT, BLD, and buccal vertical bone loss (VBL) at re-evaluation. Moreover, radiographic, clinical, and patient-reported outcome measures (PROMs) were evaluated. RESULTS Overall, 12 clinical and four preclinical studies met the inclusion criteria. Inconsistencies were found in defining the critical BBT across the clinical and preclinical data evaluated. The clinical evidence demonstrated that during healing, dimensional changes occur in the alveolar bone and in the BBW that may compromise the integrity of the peri-implant bone, leading to VBL and mucosal recession (MR), particularly in scenarios exhibiting a thin BBW. The preclinical evidence validated the fact that implants placed in the presence of a thin BBW, are more prone to exhibit major dimensional changes and VBL. Moreover, the clinical data supported that, in scenarios where dehiscence-type defects occur and are left for spontaneous healing, greater VBL and MR together with the occurrence of biologic complications are expected. Furthermore, the augmentation of dehiscence-type defects is associated with hard and soft tissue stability. PROMs were not reported. CONCLUSIONS Dimensional changes occur as result of implant placement in healed ridges that may lead to instability of the peri-implant hard and soft tissues. Sites presenting a thin BBW are more prone to exhibit major changes that may compromise the integrity of the buccal bone and may lead to biologic and esthetic complications.
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Affiliation(s)
- Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, University of Bern, Bern, Switzerland
- Department of Oral Maxillofacial Surgery, Copenaghen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Daniel Buser
- School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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11
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Blanco JF, Garcia-Garcia FJ, Villarón EM, da Casa C, Fidalgo H, López-Parra M, Santos JA, Sánchez-Guijo F. Long-Term Results of a Phase I/II Clinical Trial of Autologous Mesenchymal Stem Cell Therapy for Femoral Head Osteonecrosis. J Clin Med 2023; 12:jcm12062117. [PMID: 36983120 PMCID: PMC10051457 DOI: 10.3390/jcm12062117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: Osteonecrosis of the femoral head (ONFH) is characterized by impaired vascularization with ischemia resulting in bone cell death, leading to the deterioration of the hip joint. Mesenchymal stem/stromal cells (MSCs) are an attractive potential therapeutic approach in this setting. The aim of this study is to evaluate the clinical improvement in terms of pain and quality of life, as well as the safety of the procedure during the follow-up of patients. (2) Methods: A Phase I-II Open-Label Non-Randomized Prospective clinical trial was conducted. Eight patients with idiopathic ONFH and stage < IIC in the ARCO classification were included. Four weeks before therapy, 40 mL of autologous bone marrow was obtained, and MSCs were expanded under Good-Manufacturing-Practice (GMP) standards. Study medication consisted of a suspension of autologous BM-derived MSCs (suspended in a solution of 5-10 mL of saline and 5% human albumin) in a single dose of 0.5-1 × 106 cells/kg of the patient, administered intraosseously with a trocar and under radioscopic control. Per-protocol monitoring of patients included a postoperative period of 12 months, with a clinical and radiological assessment that included the visual analog scale (VAS), the Harris scale, the SF-36, and the radiological evolution of both hips. In addition, all patients were further followed up for eight years to assess the need for long-term total hip replacement (THR) surgery. (3) Results: Median age of patients included was 48.38 ± 7.38 years, and all patients were men. Autologous MSCs were expanded in all cases. There were no adverse effects related to cell administration. Regarding efficacy, both VAS and ODI scores improved after surgery. Radiologically, 12.5% of patients improved at the end of follow-up, whereas 50% improved clinically. No adverse effects related to the procedure were recorded, and none of the patients needed THR surgery within the first year after MSC therapy. (4) Conclusions: The use of autologous MSCs for patients with ONFH disease is feasible, safe in the long term, and potentially effective.
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Affiliation(s)
- Juan F Blanco
- Orthopaedic Surgery and Traumatology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- Regenerative Medicine and Cell Therapy Network Center of Castilla y Leon, Gerencia Regional de Salud, 47011 Valladolid, Spain
- Health Outcomes-Oriented Cooperative Research Networks in Advanced Therapies (RICORS TERAV), Instituto de Salud Carlos III, 28220 Madrid, Spain
- Department of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Francisco J Garcia-Garcia
- Orthopaedic Surgery and Traumatology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Eva M Villarón
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- Regenerative Medicine and Cell Therapy Network Center of Castilla y Leon, Gerencia Regional de Salud, 47011 Valladolid, Spain
- Health Outcomes-Oriented Cooperative Research Networks in Advanced Therapies (RICORS TERAV), Instituto de Salud Carlos III, 28220 Madrid, Spain
- Cell Therapy Unit, Hematology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Carmen da Casa
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Helena Fidalgo
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Miriam López-Parra
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- Regenerative Medicine and Cell Therapy Network Center of Castilla y Leon, Gerencia Regional de Salud, 47011 Valladolid, Spain
- Health Outcomes-Oriented Cooperative Research Networks in Advanced Therapies (RICORS TERAV), Instituto de Salud Carlos III, 28220 Madrid, Spain
- Cell Therapy Unit, Hematology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - José A Santos
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- Radiology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
- Department of Biomedical Sciences and Diagnostics, University of Salamanca, 37007 Salamanca, Spain
| | - Fermín Sánchez-Guijo
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- Regenerative Medicine and Cell Therapy Network Center of Castilla y Leon, Gerencia Regional de Salud, 47011 Valladolid, Spain
- Health Outcomes-Oriented Cooperative Research Networks in Advanced Therapies (RICORS TERAV), Instituto de Salud Carlos III, 28220 Madrid, Spain
- Department of Medicine, University of Salamanca, 37007 Salamanca, Spain
- Cell Therapy Unit, Hematology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
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12
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Ubetagoyena Arrieta M, Montes Medina L, Perez Sukia L. Bilateral hip osteonecrosis and cholelithiasis after eculizumab discontinuation in atypical haemolytic uraemic syndrome. Nefrologia 2023; 43:257-259. [PMID: 37357032 DOI: 10.1016/j.nefroe.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/05/2021] [Indexed: 06/27/2023] Open
Affiliation(s)
| | | | - Leyre Perez Sukia
- Sección de Nefrología Pediátrica, Hospital Donostia, San Sebastián, Spain
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13
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Monje A, Roccuzzo A, Buser D, Wang HL. Significance of buccal bone wall thickness on the fate of peri-implant hard and soft tissues: A systematic review. Clin Oral Implants Res 2023; 34:157-176. [PMID: 36626118 DOI: 10.1111/clr.14029] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The significance of the association between the peri-implant buccolingual dimension (BLD) at the stage of implant placement and the occurrence of biological and esthetic complications is yet unknown. MATERIAL AND METHODS Systematic screening of electronic sources was carried out to identify clinical and preclinical studies reporting on the baseline BLD and/or buccal bone thickness (BBT) values. A secondary objective was to assess the effect of simultaneous grafting at sites with deficient or no buccal bone wall (BBW) at baseline. The primary outcome variables were BBT, BLD, and vertical bone loss (VBL) at re-evaluation. Moreover, radiographic, clinical- and patient-reported outcome measures (PROMs) were evaluated. RESULTS Overall, 12 clinical and four preclinical studies met the inclusion criteria. The clinical evidence demonstrated that during healing, dimensional changes occur in the alveolar bone and in the BBW that may compromise the integrity of bone around a dental implant. The preclinical evidence validated the fact that implants placed in the presence of thin BBW are more prone to exhibit major dimensional changes. Moreover, the clinical and preclinical data supported that in scenarios where dehiscence-type defects are left for spontaneous healing, greater VBL and mucosal recession (MR) together with the occurrence of biologic complications are expected. Furthermore, the augmentation of dehiscence-type defects is associated with hard and soft tissue stability. CONCLUSIONS Dimensional changes occur as a result of implant placement in healed ridges that may lead to VBL and MR. Thin BBW (≲2 mm) are prone to exhibit major postchanges that may compromise the integrity of the buccal bone, biologic and esthetic complications.
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Affiliation(s)
- Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.,Department of Periodontology, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Daniel Buser
- School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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14
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Diri D, Alasaad H, Muhammed H, Ibrahim J. Case report: adipose-derived mesenchymal stem cells combined with core decompression in the treatment of early-stage avascular necrosis of the femoral head. Int J Surg Case Rep 2022; 102:107861. [PMID: 36603496 PMCID: PMC9826853 DOI: 10.1016/j.ijscr.2022.107861] [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: 10/28/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Core decompression is a well-known modality for treating the early stages of avascular necrosis of the femoral head (AVN), however, several methods have been suggested to augment this procedure and improve the outcomes. CASE REPORT A 52 male was diagnosed with a stage I AVN of the femoral head and treated with core decompression (CD) and injection of adipose-derived mesenchymal stem cells (AD-MSCs). The MRI showed full healing of the lesion after 3 months with significant clinical and functional improvement. DISCUSSION AD-MSCs could have the same capabilities as bone marrow-derived stem cells with many advantages, implantation of AD-MSCs in orthopedics and as an augmentation of core decompression has been tried before, but no clear guidelines nor methods of application are well established in the literature. CONCLUSION Implantation of AD-MSCs with Core decompression could be an effective modality to treat osteonecrosis of the femoral head in pre-collapse stages, however, we need bigger clinical studies to determine the actual effectiveness of this method.
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15
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Bellringer SF, MacLean SBM, Bain GI. Preiser's Disease-Current Concepts of Etiology and Management. Hand Clin 2022; 38:469-477. [PMID: 36244714 DOI: 10.1016/j.hcl.2022.03.013] [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] [Indexed: 02/02/2023]
Abstract
The term Preiser's disease typically is used to describe idiopathic avascular necrosis of the scaphoid, but there have been a number of putative etiologies considered. It is rare and the natural history is not fully understood. Management of the condition should be based on patient factors as well as the stage of disease with regard to the scaphoid and the surrounding wrist. This chapter appraises the available evidence and aims to provide the reader with a framework to manage this rare condition.
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Affiliation(s)
- Simon F Bellringer
- Department of Orthopaedic Surgery and Trauma, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Simon B M MacLean
- Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, New Zealand
| | - Gregory I Bain
- Department of Orthopaedic Surgery and Trauma, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia.
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16
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Zhang H, Fletcher AN, Scott DJ, Nunley J. Avascular Osteonecrosis of the Talus: Current Treatment Strategies. Foot Ankle Int 2022; 43:291-302. [PMID: 34753345 DOI: 10.1177/10711007211051013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Avascular osteonecrosis (AVN) of the talus (AVNT) is a painful and challenging clinical diagnosis. AVNT has multiple known risk factors and etiologies and presents at different stages in severity. Given these unique factors, the optimal treatment solution has yet to be determined. Both joint-preserving and joint-sacrificing procedures are available, including core decompression and arthrodeses. Recently, new salvage and replacement techniques have been described including vascularized pedicle bone grafts and total talus replacement using patient-specific prosthesis; however, evidence remains limited. This review examines the current trends AVNT treatment and the emerging data behind these novel techniques.
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Affiliation(s)
- Hanci Zhang
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Amanda N Fletcher
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Daniel J Scott
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - James Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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17
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Ubetagoyena Arrieta M, Montes Medina L, Pérez Sukia L. Bilateral hip osteonecrosis and cholelithiasis after eculizumab discontinuation in atypical hemolytic uremic syndrome. Nefrologia 2021; 43:S0211-6995(21)00139-9. [PMID: 34376310 DOI: 10.1016/j.nefro.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Leyre Pérez Sukia
- Sección de Nefrología Pediátrica, Hospital Donostia, San Sebastián, España
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18
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Salazar D, Esteves C, Ferreira MJ, Pedro J, Pimenta T, Portugal R, Carvalho D. Avascular femoral necrosis as part of Cushing syndrome presentation: a case report. J Med Case Rep 2021; 15:287. [PMID: 34034798 PMCID: PMC8152328 DOI: 10.1186/s13256-021-02882-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Background The clinical characteristics and complications of Cushing syndrome (CS) are well known and described in the literature. Nevertheless, rare, atypical presentations may go unnoticed. Osteonecrosis is a well-documented complication of glucocorticoid therapy. However, endogenous hypercortisolism is a rare, but relevant, cause of bone avascular necrosis. We describe the case of a woman with CS undiagnosed for 2 years after presenting with femoral avascular necrosis. Case presentation A 38-year-old Caucasian woman was referred for evaluation of secondary amenorrhea, associated with oral contraception withdrawal in the context of deep venous thrombosis (DVT). She had a previous right hip arthroplasty for treatment of avascular necrosis of the femoral head, diagnosed after 3 years of progressive right hip pain and limited mobility. She also had high blood pressure (HBP) of 5 years’ duration, and reported weight gain (4 kg in 2 years). There was no history of infertility (gravida 2, para 2). Physical examination revealed buffalo hump, truncal obesity, facial plethora, muscular atrophy and proximal myopathy, and easy bruising (under anticoagulant treatment for DVT). Workup showed abnormal overnight dexamethasone suppression test (DST) (serum cortisol 21.5 µg/dL; normal < 1.8 µg/dL), elevated 24-hour urinary free cortisol (UFC) (728.9 µg/day; reference range 36.0–137.0 µg/day), and suppressed plasma adrenocorticotropic hormone (ACTH) (< 1.0 pg/mL), findings consistent with ACTH-independent CS. Urinary metanephrines and catecholamines were normal, and the remaining analytical study showed no major changes, apart from glycated hemoglobin (HbA1c) of 6.8%. Adrenal computed tomography (CT) scan showed a 25 mm lesion in the left adrenal gland, with density non-suggestive of adenoma. The patient underwent unilateral adrenalectomy and started steroid replacement. Histology revealed an adrenal cortex adenoma. Three months after surgery the patient presented with resolution of HBP and hypercortisolism (UFC 37.4 µg/day; reference range 36.0–137.0 µg/day). Conclusion In some cases, CS signs may go unnoticed and the diagnosis postponed. Avascular necrosis is a rare presenting feature of endogenous hypercortisolism, and, if left untreated, complete collapse of the femoral head may ensue, rendering the need for hip replacement in up to 70% of patients. Suspicion and recognition of atypical features is therefore important in avoiding complications and delay in treatment of CS.
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Affiliation(s)
- Daniela Salazar
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal. .,Faculty of Medicine of University of Porto, Porto, Portugal. .,Institute for Research and Innovation in Health, University of Porto, Porto, Portugal.
| | - César Esteves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal
| | - Maria João Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal.,Faculty of Medicine of University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal.,Faculty of Medicine of University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Tiago Pimenta
- Department of Surgery of Centro Hospitalar, Universitário de São João, Porto, Portugal
| | - Raquel Portugal
- Department of Pathology of Centro Hospitalar, Universitário de São João, Porto, Portugal
| | - David Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal.,Faculty of Medicine of University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
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19
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Cheng S, Liu X, Gong F, Ding X, Zhou X, Liu C, Zhao F, Li X, Shi J. Dexamethasone promotes the endoplasmic reticulum stress response of bone marrow mesenchymal stem cells by activating the PERK-Nrf2 signaling pathway. Pharmacol Res Perspect 2021; 9:e00791. [PMID: 34038621 PMCID: PMC8153378 DOI: 10.1002/prp2.791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/19/2021] [Indexed: 12/20/2022] Open
Abstract
The pathogenesis of steroid-induced avascular necrosis of femoral head (SANFH) is complex, and there is a lack of effective early prevention method. The aim of the present study was to evaluate the effect of dexamethasone (DEX) on the biological behavior of bone marrow mesenchymal stem cells (BMSCs) and to explore the possibility of DEX in the clinical treatment of SANFH. The effect of DEX on the proliferation of BMSCs was evaluated by Counting Kit-8 assay, western blot assay, and enzyme-linked immunosorbent assay. Flow cytometry and western blot assay were performed to detect the effect of DEX on the apoptosis of BMSCs. Quantitative real-time PCR and western blot assay were performed to detect the effect of DEX on the expression of endoplasmic reticulum stress (ERS)-related genes. Immunoblotting analysis was conducted for detecting the nuclear-cytoplasmic distribution of Nrf2. DEX could significantly inhibit the proliferation of BMSCs and promote apoptosis of BMSCs. DEX could increase the expression of PERK, ATF6, and IRE1a, and induce nuclear translocation of Nrf2. The addition of ML385 could reverse the effect of DEX on BMSCs. DEX could activate the PERK-Nrf2 pathway to promote ERS and finally affect the cell proliferation and apoptosis of BMSCs.
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Affiliation(s)
- Suoli Cheng
- Department of Orthopaedics, Ningxia Medical University, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Xueqin Liu
- Department of Obstetrics and Gynecology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Fan Gong
- Department of Orthopaedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Xiaoling Ding
- Department of Digestive System, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Xuebing Zhou
- Department of General Surgery, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Cuiyun Liu
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Fei Zhao
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xiaoliang Li
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jiandang Shi
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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20
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Bergman S, Petit A, Rabarin F, Raimbeau G, Bigorre N. Preiser's disease or avascular osteonecrosis of the scaphoid: An updated literature review. HAND SURGERY & REHABILITATION 2021; 40:359-368. [PMID: 33775889 DOI: 10.1016/j.hansur.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
Avascular necrosis of the scaphoid, often referred to as Preiser's disease, is little known despite the scaphoid being the second most frequently involved location in avascular pathology of the carpal bones after the lunate (Kienböck's disease). Nonetheless, very few cases have been reported in the medical literature over the last century. Its pathophysiology is not completely elucidated although the unique vascularization of the scaphoid and several risk factors seem to be recurrently incriminated. Two new classifications based on modern imaging have appeared in the last decade and are now considered essential supplements to Herbert and Lanzetta's original radiographic classification. Because of the lack of formal treatment guidelines, a wide range of different treatments have been explored over time, contributing to the confusion around this pathology. Adding to this confusion, are the numerous terms used to designate the condition and lack of knowledge concerning its pathophysiology, risk factors, clinical and radiographic presentation. The aim of this review is therefore to explore and clarify Preiser's disease in terms of history, terminology, pathophysiology, clinical considerations and imaging and to propose a simple updated treatment algorithm based on the results provided by a thorough review of literature (53 publications, 170 patients) since Georg Preiser's original and controversial description in 1910.
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Affiliation(s)
- S Bergman
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - A Petit
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - F Rabarin
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - G Raimbeau
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - N Bigorre
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France.
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21
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Zhao J, Yue T, Lu S, Meng H, Lin Q, Ma H, Liu G, Li H, Lu Q, Wang A, Xu W, Feng J, Wan Y, Liao S, Zhou X, Peng J. Local administration of zoledronic acid prevents traumatic osteonecrosis of the femoral head in rat model. J Orthop Translat 2021; 27:132-138. [PMID: 33786320 PMCID: PMC7972932 DOI: 10.1016/j.jot.2020.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 12/05/2022] Open
Abstract
Background Osteonecrosis of the femoral head (ONFH) is a refractory disease due to its unclear pathomechanism. Neither conservative treatment nor surgical treatment during the early stage of ONFH achieves satisfactory results. Therefore, this study aims to explore the available evidence on the effect of zoledronic acid on early-stage ONFH. Methods For groups were established:the Normal group, model group, Normal saline group(NS group) and zoledronic acid-treated group. The blood supply to the femoral head of animals in the model group and zoledronic acid-treated group was interrupted via a surgical procedure, and zoledronic acid was then locally administered to the femoral head. Four weeks after surgery, all the hips were harvested and evaluated by micro-CT and histopathology(H&E staining, TRAP staining, Toluidine blue staining and masson staining). Results The values of BMD, BS/BV and Tb.Th in the Normal group and zoledronic acid-treated group were significantly higher than those in the model group and NS group (p < 0.05). The outcome of H&E staining, Toluidine blue staining and masson staining were consistent with that of micro-CT. Conclusion The local administration of zoledronic acid in the femoral head had positive effects on the bone structure of the femoral head in a modified rat model of traumatic ONFH and offered a promising therapeutic strategy during the early stage of ONFH. The Translational potential of this article This article could provide a choice for treating patients who have osteonecrosis of femora head and can be the basic research for advanced development over this disease
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Affiliation(s)
- Jun Zhao
- Medical School of Chinese PLA, Beijing, 100853, China.,Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Tian Yue
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Shibi Lu
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Haoye Meng
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Qiuxia Lin
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Haiyang Ma
- Medical School of Chinese PLA, Beijing, 100853, China.,Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Guangbo Liu
- Medical School of Chinese PLA, Beijing, 100853, China.,Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Huo Li
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Qiang Lu
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Aiyuan Wang
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Wenjing Xu
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Jing Feng
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Yiqun Wan
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Sida Liao
- Medical School of Chinese PLA, Beijing, 100853, China.,Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
| | - Xuefeng Zhou
- Strategic Support Force Medical Center of chinese PLA, AnxiangBeili, Beijing, 100101, China
| | - Jiang Peng
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory (No BZ0128), Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China
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22
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Hamada H, Ando W, Takao M, Sugano N. Gamma-Glutamyl Transferase: A Useful Marker of Habitual Drinking in Cases of Alcohol-Associated Osteonecrosis of the Femoral Head. Alcohol Alcohol 2021; 56:175-180. [PMID: 33179047 DOI: 10.1093/alcalc/agaa117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Alcohol intake is one of the factors associated with the occurrence of osteonecrosis of the femoral head (ONFH), and its epidemiological information regarding alcohol intake depends on patients' self-reports. Therefore, we analysed the efficacy of laboratory tests as an objective diagnostic tool to indicate habitual drinking in patients with alcohol-associated ONFH. METHODS This study included 109 consecutive patients diagnosed with ONFH who underwent primary hip surgery in our institution between 2010 and 2018. The patients were classified into group AL (alcohol-associated ONFH; n = 26) and group NO (alcohol-unassociated ONFH; n = 83), based on their self-reported information. Serum levels of gamma-glutamyl transferase (GGT), mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol and triglycerides were compared between both groups. The sensitivities and specificities with the optimal cut-off values for detecting alcohol-associated ONFH were compared among these markers. RESULTS The median serum levels of GGT, AST and ALT were significantly higher in the AL group than in the NO group. The receiver operating characteristic curve analysis demonstrated an area under the curve of 0.795 for GGT, 0.731 for AST and 0.709 for ALT. The optimal cut-off level of GGT as a marker for alcohol-associated ONFH was 36.5 units/L, with a sensitivity of 76% and specificity of 80%, and it was found to be the best marker among the other examined laboratory markers. CONCLUSION Serum GGT level is a useful laboratory marker with moderate accuracy that indicates habitual drinking in patients with alcohol-associated ONFH.
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Affiliation(s)
- Hidetoshi Hamada
- Departments of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Wataru Ando
- Departments of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Masaki Takao
- Departments of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Nobuhiko Sugano
- Departments of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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23
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Aseptic osteonecrosis of the shoulder: Etiologies, diagnosis and medical management. Morphologie 2021; 105:148-154. [PMID: 33485780 DOI: 10.1016/j.morpho.2020.12.010] [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: 12/03/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/20/2022]
Abstract
Aseptic osteonecrosis of the humeral head is a multifactorial entity in which the final common pathway results in disrupted blood supply, increased intraosseous pressure, and bone death. It follows a pathologic and radiographic pattern of progression similar to that seen at the hip. Much of the information regarding the disease has been extrapolated from findings in the femoral head. In addition, many treatment modalities have been adapted from techniques used in the hip. The causative underlying factors seem to be multifactorial and can be traumatic or non-traumatic. Although clinical symptoms and the underlying cause of the disease influence the treatment of each patient, staging is the most objective criterion in determining the most appropriate treatment. Earlier identification of osteonecrosis should facilitate the management. MRI is important for asymptomatic humeral head osteonecrosis in patients with poor clinical symptom and risk factor. Conservative treatment can be effective in stages I and II, When symptoms persist and there are signs of collapse despite conservative treatment, surgical intervention is advocated.
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24
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Migliorini F, Maffulli N, Eschweiler J, Tingart M, Baroncini A. Core decompression isolated or combined with bone marrow-derived cell therapies for femoral head osteonecrosis. Expert Opin Biol Ther 2020; 21:423-430. [PMID: 33297783 DOI: 10.1080/14712598.2021.1862790] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives: The regenerative capabilities of bone marrow-derived cell therapies (BMCTs) have been employed in combination with core decompression (CD) in the management of osteonecrosis of the femoral head to prevent or delay the necessity of total hip arthroplasty (THA).Methods: The authors conducted a meta-analysis to compare the results of level of evidence I trials comparing CD with and without BMCTs.Results: Overall, 579 procedures were analyzed: 265 in the CD group and 263 in the CD + BMCTs group. Comparability concerning age and gender, drill size, etiology, and grade of OFNH was found (P > 0.1). At a mean follow up of 82.29 (24 to 360) months, the VAS scored favourably for the CD + BMCTs group (mean difference: -12.88; P < 0.0001), as well the rate of THA (odd ratio: -0.14; P < 0.0001). Time to failure (P = 0.4) and to THA (P = 0.9) was similar between the two groups, as was the rate of failure (P = 0.3).Conclusion: In patients with femoral head osteonecrosis, core decompression combined with BMCTs demonstrated reduced pain and lower rate of total hip arthroplasty compared to core decompression as an isolated procedure.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, England
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Alice Baroncini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
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25
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Lee EJ, Jain M, Alimperti S. Bone Microvasculature: Stimulus for Tissue Function and Regeneration. TISSUE ENGINEERING PART B-REVIEWS 2020; 27:313-329. [PMID: 32940150 DOI: 10.1089/ten.teb.2020.0154] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bone is a highly vascularized organ, providing structural support to the body, and its development, regeneration, and remodeling depend on the microvascular homeostasis. Loss or impairment of vascular function can develop diseases, such as large bone defects, avascular necrosis, osteoporosis, osteoarthritis, and osteopetrosis. In this review, we summarize how vasculature controls bone development and homeostasis in normal and disease cases. A better understanding of this process will facilitate the development of novel disease treatments that promote bone regeneration and remodeling. Specifically, approaches based on tissue engineering components, such as stem cells and growth factors, have demonstrated the capacity to induce bone microvasculature regeneration and mineralization. This knowledge will have relevant clinical implications for the treatment of bone disorders by developing novel pharmaceutical approaches and bone grafts. Finally, the tissue engineering approaches incorporating vascular components may widely be applied to treat other organ diseases by enhancing their regeneration capacity. Impact statement Bone vasculature is imperative in the process of bone development, regeneration, and remodeling. Alterations or disruption of the bone vasculature leads to loss of bone homeostasis and the development of bone diseases. In this study, we review the role of vasculature on bone diseases and how vascular tissue engineering strategies, with a detailed emphasis on the role of stem cells and growth factors, will contribute to bone therapeutics.
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Affiliation(s)
- Eun-Jin Lee
- American Dental Association Science and Research Institute, Gaithersburg, Maryland, USA
| | - Mahim Jain
- Kennedy Krieger Institute, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stella Alimperti
- American Dental Association Science and Research Institute, Gaithersburg, Maryland, USA
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26
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Zhang Y, Bowen TR, Lietman SA, Suk M, Williams MS, Lee MTM. PPARGC1B Is Associated with Nontraumatic Osteonecrosis of the Femoral Head: A Genomewide Association Study on a Chart-Reviewed Cohort. J Bone Joint Surg Am 2020; 102:1628-1636. [PMID: 32701715 DOI: 10.2106/jbjs.19.01335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have demonstrated the influence of heritable factors on the development of nontraumatic osteonecrosis of the femoral head (ONFH). We hypothesized that genetic variation is associated with an increased risk of ONFH, and that variants could be identified by a genomewide association study (GWAS). METHODS Using data collected from the MyCode Community Health Initiative, we identified 118 adult patients with radiographically confirmed nontraumatic ONFH. Study patients were statistically compared with a control population of 56,811 unrelated individuals without a diagnosis of ONFH. A case-control GWAS was performed to identify single nucleotide variants (SNVs) associated with ONFH. Sensitivity analyses were performed to evaluate the association of the top SNVs with (cortico)steroid-associated ONFH and ONFH with femoral head collapse. Gene-based analyses were performed to identify potential causal genes. RESULTS Of the 118 patients, 114 (96.6%) had bilateral ONFH at a median of 5 years of follow-up; 90.7% had at least one 3-week steroid prescription compared with 68.3% in controls. A GWAS identified 4 SNVs reaching genomewide significance. rs116468452 near CACNA1E was significantly associated with ONFH (p = 3.26 × 10, odds ratio [OR] = 5.6, 95% confidence interval [CI] = 3.21 to 9.76). rs10953090 in SAMD9 was significantly associated with ONFH in the steroid-exposed subset (p = 2.96 × 10, OR = 2.57, 95% CI = 1.84 to 3.58). rs112467115 in PI4K1B showed enhanced association in the collapsed subset (p = 7.82 × 10, OR = 4.5, 95% CI = 2.60 to 7.79). Gene-based analyses identified PPARGC1B as the only gene significantly associated with ONFH after Bonferroni correction (p = 1 × 10), with the lead SNV being rs78814834 (OR = 2.86, 95% CI = 1.87 to 4.38). CONCLUSIONS We identified 4 SNVs and 1 gene, PPARGC1B, associated with ONFH. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yanfei Zhang
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania.,Musculoskeletal Institute, Geisinger, Danville, Pennsylvania
| | - Thomas R Bowen
- Musculoskeletal Institute, Geisinger, Danville, Pennsylvania
| | | | - Michael Suk
- Musculoskeletal Institute, Geisinger, Danville, Pennsylvania
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Ming Ta Michael Lee
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania.,Musculoskeletal Institute, Geisinger, Danville, Pennsylvania
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27
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Osteonecrosis of Femoral Head, An Overlooked Long-Term Complication after Paraquat Intoxication: A Retrospective Cohort Study. Sci Rep 2020; 10:8827. [PMID: 32483235 PMCID: PMC7264308 DOI: 10.1038/s41598-020-65756-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/29/2020] [Indexed: 01/04/2023] Open
Abstract
With increasing numbers of patients surviving acute intoxication phase, long-term complication after paraquat intoxication is a topic worth exploring, such as osteonecrosis (ON) of femoral head. We reviewed 86 paraquat-intoxicated survivors between 2000 and 2012 in Chang Gung Memorial Hospital, a 3700-bed tertiary hospital in Taiwan. With all the patients underwent same detoxification protocol in the acute stage, 17.4% of paraquat poisoning survivors developed ON of femoral head requiring surgery during follow up. Most of ON episodes occurred within 2 to 4 years after paraquat intoxication and then plateau after 6 years. ON patients exhibited higher SOFA scores than non-ON patients (2.80 ± 2.14 vs. 1.76 ± 1.52, p = 0.028). Furthermore, AKIN scores are also higher in the ON patients than non-ON patients (0.87 ± 1.13 vs. 0.38 ± 0.74, p = 0.040). Multivariate logistic regression showed higher AKIN score and higher partial pressure of carbon dioxide in the blood 48 hours after admission significantly predicted ON of femoral head after paraquat intoxication (p = 0.002 and p = 0.006 respectively). Larger studies with longer follow-up durations are warranted to confirm our finding.
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28
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Two-sided femoral Campylobacter jejuni osteomyelitis in a patient with acquired hypogammaglobulinemia: a case report. BMC Infect Dis 2020; 20:199. [PMID: 32143636 PMCID: PMC7060648 DOI: 10.1186/s12879-020-4929-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/27/2020] [Indexed: 11/20/2022] Open
Abstract
Background Campylobacter jejuni is a motile, gram-negative rod known for causing self-limiting enterocolitis while rarely causing extraintestinal infections. We report the first case of a patient with Campylobacter jejuni osteomyelitis in both femora. Case presentation A 54-year-old female presented with progressive pain in both upper extremities. Her past medical history mentioned a lymphoplasmacytic lymphoma (LPL) for which she had received dexamethasone, cyclophosphamide and fludarabine and was still receiving maintenance therapy with intravenous rituximab. Two months prior to presentation, she received oral fluoroquinolone for a recurrent enterocolitis with stool cultures positive for Campylobacter jejuni. Palpation of the left quadriceps femoris muscle was remarkably painful during physical examination. Laboratory testing showed elevated C-reactive protein and recent low gamma globulin levels. The presumptive diagnosis at this point was a transformation of LPL to a large B cell lymphoma. In order to determine the preferred site for biopsy, a fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography combined with computed tomography was done. However, blood cultures taken on admission showed growth of Campylobacter jejuni in both aerobic bottles, with a strain resistant to fluoroquinolones. Diagnosis of Campylobacter jejuni osteomyelitis was confirmed with 16S ribosomal RNA gene polymerase chain reaction performed on femoral bone obtained through biopsy. Treatment with intravenous imipenem/cilastatin followed by intravenous and oral doxycycline proved insufficient. Subsequently, the patient was treated successfully with intravenous meropenem for six weeks and concurrent intravenous immunoglobulin. Conclusion We report the first case of Campylobacter jejuni osteomyelitis in both femora in a patient with acquired hypogammaglobulinemia. Diagnosis was confirmed by blood cultures and positive 16S ribosomal RNA gene polymerase chain reaction for Campylobacter spp. on bone biopsy. Treatment was successful with intravenous meropenem and immunoglobulin. Our report showcases an unusual manifestation in a patient with immunodeficiency and discusses failure of initial antibiotic therapy.
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29
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Risk of Venous Thromboembolic Events in Patients with Osteonecrosis of the Femoral Head Undergoing Primary Hip Arthroplasty. J Clin Med 2019; 8:jcm8122158. [PMID: 31817684 PMCID: PMC6947200 DOI: 10.3390/jcm8122158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022] Open
Abstract
Previous data have shown patients with osteonecrosis of the femoral head (ONFH) have increased lifelong risk of unprovoked venous thromboembolic events (VTE) as compared with the general population, according to sharing common pathological mechanism of endothelial dysfunction. However, whether the risk of VTE increases in those ONFH patients undergoing major hip replacement surgery remains unclear. This is a retrospective nationwide Asian population-based study. From 1997 to 2013, a total of 12,232 ONFH patients receiving partial or total hip replacement for the first time and revision surgeries were retrospectively selected from Taiwan Health Insurance surgical files. By 1:1 matching on age, sex, surgical types, and socioeconomic status, 12,232 subjects without ONFH undergoing similar hip surgery were selected as non-ONFH group. The incidence and risk of post-surgery VTE, including deep venous thrombosis (DVT) and pulmonary embolism (PE), were compared between the ONFH and non-ONFH groups. Results showed that 53.8% of ONFH patients were male and the median age was 61.9 years old. During the mean follow-up period of 6.4 years, the incidences of VTE (1.4% vs. 1.2%), DVT (1.1% vs. 0.9%), and PE (0.4% vs. 0.4%) were slightly but insignificantly higher in the ONFH than in the non-ONFH group undergoing the same types of major hip replacement surgery (all p-values > 0.250). Concordantly, we found no evidence that the risk of VTE was increased in the ONFH patients as compared with the non-ONFH counterparts (adjusted HR 1.14; 95% CI 0.91–1.42; p = 0.262). There were also no increased risks for DVT and PE in the ONFH subgroups stratified by comorbidities, drug exposure to pain-killer or steroid, and follow-up duration after surgery, either. In conclusion, hip arthroplasty in Asian patients with ONFH is associated with similar rates of VTE as compared to patients with non-ONFH diagnoses.
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30
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Abstract
In this report, we deliver a concise and up-to-date review of osteonecrosis, a pathologic, painful, and often disabling condition that is believed to result from the temporary or permanent disruption of blood supply to an affected area of bone. We will discuss the epidemiology (disease distribution), pathogenesis (mechanism of development), etiology (associated risk factors, causes, and disorders), clinical manifestations (reported symptoms and physical findings), diagnosis and classification, and treatment options for hip osteonecrosis.
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Affiliation(s)
| | - Nipun Sodhi
- Department of Orthopedic Surgery, Northwell Health Lenox Hill Hospital, New York, NY
| | - Michael A Mont
- Department of Orthopedic Surgery, Northwell Health Lenox Hill Hospital, New York, NY
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31
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Yoon BH, Jones LC, Chen CH, Cheng EY, Cui Q, Drescher W, Fukushima W, Gangji V, Goodman SB, Ha YC, Hernigou P, Hungerford M, Iorio R, Jo WL, Khanduja V, Kim H, Kim SY, Kim TY, Lee HY, Lee MS, Lee YK, Lee YJ, Mont MA, Sakai T, Sugano N, Takao M, Yamamoto T, Koo KH. Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 2: Alcohol-Associated Osteonecrosis. J Arthroplasty 2019; 34:169-174.e1. [PMID: 30348559 DOI: 10.1016/j.arth.2018.09.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/28/2018] [Accepted: 09/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although alcohol is a leading risk factor for osteonecrosis of the femoral head (ONFH) and its prevalence reportedly ranges from 20% to 45%, there are no unified classification criteria for this subpopulation. In 2015, Association Research Circulation Osseous decided to develop classification criteria for alcohol-associated ONFH. METHODS In June of 2017, Association Research Circulation Osseous formed a task force to conduct a Delphi survey. The task force invited 28 experts in osteonecrosis/bone circulation from 8 countries. Each round of the Delphi survey included questionnaires, analysis of replies, and feedback reports to the panel. After 3 rounds of the survey, consensus was reached on the classification criteria. The response rates for the 3 Delphi rounds were 100% (round 1), 96% (round 2), and 100% (round 3). RESULTS The consensus on the classification criteria of alcohol-associated ONFH included the following: (1) patients should have a history of alcohol intake >400 mL/wk (320 g/wk, any type of alcoholic beverage) of pure ethanol for more than 6 months; (2) ONFH should be diagnosed within 1 year after alcohol intake of this dose; and (3) patients should not have other risk factor(s). CONCLUSION ARCO-established classification criteria to standardize clinical studies concerning AA-ONFH.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Center for Metabolism and Obesity Research Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chung-Hwan Chen
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Edward Y Cheng
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Wolf Drescher
- Department of Orthopedic and Trauma Surgery, RWTH Aachen University, Aachen, Germany
| | - Wakaba Fukushima
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Valerie Gangji
- Department of Rheumatology and Physical Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, Hôpital Henri Mondor, Creteil, France
| | - Marc Hungerford
- Department of Orthopedic Surgery, Mercy Medical Center, Baltimore, MD
| | - Richard Iorio
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Vikas Khanduja
- Department of Trauma & Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Harry Kim
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Shin-Yoon Kim
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Tae-Young Kim
- Department of Orthopedic Surgery, KonKuk University Medical Center, Seoul, South Korea
| | - Hee Young Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital and Medical College of Seoul National University, Seongnam, South Korea
| | - Michael A Mont
- Department of Orthopaedic Surgery, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement Sinai Hospital of Baltimore, Baltimore, MD
| | - Takashi Sakai
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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32
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Study of Osteocyte Behavior by High-Resolution Intravital Imaging Following Photo-Induced Ischemia. Molecules 2018; 23:molecules23112874. [PMID: 30400346 PMCID: PMC6278482 DOI: 10.3390/molecules23112874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/26/2018] [Accepted: 10/28/2018] [Indexed: 11/17/2022] Open
Abstract
Ischemic injuries and local hypoxia can result in osteocytes dysfunction and play a key role in the pathogenesis of avascular osteonecrosis. Conventional imaging techniques including magnetic resonance imaging (MRI) and computed tomography (CT) can reveal structural and functional changes within bony anatomy; however, characterization of osteocyte behavioral dynamics in the setting of osteonecrosis at the single cell resolution is limited. Here, we demonstrate an optical approach to study real-time osteocyte functions in vivo. Using nicotinamide adenine dinucleotide (NADH) as a biomarker for metabolic dynamics in osteocytes, we showed that NADH level within osteocytes transiently increase significantly after local ischemia through non-invasive photo-induced thrombosis of afferent arterioles followed by a steady decline. Our study presents a non-invasive optical approach to study osteocyte behavior through the modulation of local environmental conditions. Thus it provides a powerful toolkit to study cellular processes involved in bone pathologies in vivo.
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33
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Cusano J, Curry EJ, Murakami AM, Li X. Fresh Femoral Condyle Allograft Transplant for Knee Osteonecrosis in a Young, Active Patient. Orthop J Sports Med 2018; 6:2325967118798355. [PMID: 30246044 PMCID: PMC6146332 DOI: 10.1177/2325967118798355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Joseph Cusano
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily J Curry
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Akira M Murakami
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
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34
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Cardiovascular and Cerebrovascular Events Are Associated With Nontraumatic Osteonecrosis of the Femoral Head. Clin Orthop Relat Res 2018; 476:865-874. [PMID: 29480889 PMCID: PMC6260086 DOI: 10.1007/s11999.0000000000000161] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endothelial dysfunction has been identified as an etiologic factor for osteonecrosis of the femoral head (ONFH) and major adverse cardiovascular and cerebrovascular events (defined as major cardiovascular disease [CVD] and cerebrovascular accident [CVA]). However, the incidence of major adverse cardiovascular and cerebrovascular events in patients with nontraumatic ONFH and any association between the two diagnoses remain unclear. QUESTIONS/PURPOSES We compared a large cohort of patients with nontraumatic ONFH and a matched control group without this diagnosis and (1) examined the frequency and hazard ratio (HR) of major adverse cardiovascular and cerebrovascular events in both groups adjusted for age, sex, socioeconomic status, and associated comorbidities (which we defined as the adjusted HR), (2) determined whether any association of ONFH and major adverse cardiovascular and cerebrovascular events was stable after adjusting for confounding variables, and (3) compared the occurrence of major adverse cardiovascular and cerebrovascular events with time in both groups. METHODS A population-based cohort with a 14-year dataset period (1997-2010) from the Taiwan National Health Insurance Research Database was used for this retrospective study. The database includes a greater than 99.5% Asian population randomly selected from more than 23 million citizens and foreigners residing in Taiwan for longer than 6 months. A total of 1562 patients with nontraumatic ONFH were identified from a population of one million patients in the database after excluding initially concomitant diagnoses of major CVD and CVA. The comparison group (n = 15,620) without ONFH was analyzed in a one-to-10 ratio by matching the study cohort based on age, sex, income, and urbanization. RESULTS The patients with ONFH had a higher frequency of major adverse cardiovascular and cerebrovascular events than their counterparts without ONFH (19% versus 14%; p < 0.001). The patients with ONFH had 1.34- and 1.27-fold adjusted HRs for occurrence of major CVD and CVA as compared with the normal population (95% CI, 1.11-1.61, p = 0.002, and 95% CI, 1.09-1.47, p = 0.002, respectively). Sensitivity analysis showed a consistent association between ONFH and major adverse cardiovascular and cerebrovascular events after controlling for potentially relevant confounding variables such as hypertension and diabetes. After adjusting for potential confounders including surgery and medications, ONFH remained independently associated with major CVD (adjusted HR, 1.51, 95% CI 1.09-2.03, p = 0.026) and CVA (adjusted HR, 2.44, 95% CI 1.69-3.51, p < 0.001), apart from age older than 65 years and traditional atherosclerotic risk factors. The cumulative incidence of major adverse cardiovascular and cerebrovascular events also was higher in the ONFH group than the non-ONFH group (30.3% vs 23.1% at the end of followup, p < 0.001). CONCLUSIONS Patients with ONFH have a strong association with major adverse cardiovascular and cerebrovascular events as compared with the normal population, suggesting a potential common pathway involving endothelial dysfunction. In view of this association in the relatively young population with ONFH, it is important to closely monitor these patients, treat relevant comorbidities early, and investigate preventative measures for these major adverse events. LEVEL OF EVIDENCE Level III, prognostic study.
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Ryu KJ. CORR Insights®: Cardiovascular and Cerebrovascular Events Are Associated With Nontraumatic Osteonecrosis of the Femoral Head. Clin Orthop Relat Res 2018. [PMID: 29538174 PMCID: PMC6260108 DOI: 10.1007/s11999.0000000000000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Sung PH, Chiang HJ, Yang YH, Chiang JY, Chen CJ, Yip HK, Lee MS. Nationwide study on the risk of unprovoked venous thromboembolism in non-traumatic osteonecrosis of femoral head. INTERNATIONAL ORTHOPAEDICS 2018. [PMID: 29541810 DOI: 10.1007/s00264-018-3866-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Endothelial dysfunction is a risk factor for osteonecrosis of femoral head (ONFH) and venous thromboembolism (VTE) [defined as deep venous thrombosis (DVT) or pulmonary embolism (PE)]. However, the risk of unprovoked VTE in non-traumatic ONFH patients remains unclear. METHODS We investigated the relationship between ONFH and VTE using Taiwan National Health Insurance Research Database (NHIRD). Between 1997 and 2010, a total of 1514 non-traumatic ONFH patients were identified from 1,000,000 general populations after excluding initially concomitant diagnoses of DVT and PE, and subjects undergoing lower limb surgery within one year since enrollment. The comparison group (n = 15,140) without ONFH was set up by matching study cohort with age, gender, income and urbanization in a 1:10 ratio. Subjects diagnosed with VTE within one year after surgery were also excluded. RESULTS The patients with non-traumatic ONFH had significantly higher frequency of unprovoked VTE, including DVT, than general population (1.19 vs. 0.5%, p < 0.0007), whereas the frequency of PE was similar between these two groups (p = 0.4922). The cumulative incidence of VTE and DVT was also remarkably higher in the ONFH than non-ONFH group (all p < 0.001). After adjusting for age, gender, medications and comorbidities with multivariate analysis, the ONFH patients had a 2.3-fold increase in risk of DVT compared with non-ONFH counterparts (95% CI 1.28 to 4.13, p = 0.0053). Apart from ONFH, age > 65 years and hypertension were also identified as risk factors for DVT occurrence. CONCLUSIONS The incidence and risk of unprovoked VTE were significantly increased in the non-traumatic ONFH population.
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Affiliation(s)
- Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist, Kaohsiung city, 83301, Taiwan, Republic of China
| | - Hsin-Ju Chiang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Chung Shan Medical University School of Medicine, Taichung, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Jen Chen
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist, Kaohsiung city, 83301, Taiwan, Republic of China. .,Institute for Translational Research in Biomedicine, Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. .,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan. .,Department of Nursing, Asia University, Taichung, Taiwan.
| | - Mel S Lee
- Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist, Kaohsiung city, 83301, Taiwan, Republic of China.
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Li D, Yang Z, Wei Z, Kang P. Efficacy of bisphosphonates in the treatment of femoral head osteonecrosis: A PRISMA-compliant meta-analysis of animal studies and clinical trials. Sci Rep 2018; 8:1450. [PMID: 29362430 PMCID: PMC5780480 DOI: 10.1038/s41598-018-19884-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 01/10/2018] [Indexed: 02/05/2023] Open
Abstract
This study aimed to determine whether bisphosphonates exert an effect on preventing femoral head collapse after osteonecrosis of the femoral head (ONFH) in an animal model and in clinical trials. A systematic literature search was performed for studies published up to January 2017. Twenty-three articles (16 animal studies, seven clinical trials) were included in the meta-analysis. We found that the bisphosphonate group obtained significant improvement in epiphyseal quotients (MD = 15.32; 95% CI, 9.25-21.39) and provided better performance on bone volume (SMD = 1.57; 95% CI, 0.94-2.20), trabecular number (SMD = 1.30; 95% CI, 0.80-1.79), trabecular thickness (SMD = 0.77; 95% CI, 0.10-1.43) and trabecular separation (SMD = -1.44; 95% CI, -1.70 to -0.58) in the animal model. However, the bisphosphonate group did not achieve better results in pain score, Harris score, the occurrence rate of femoral head collapse, or total hip arthroplasty in the clinical trials. In conclusion, despite bisphosphonates significantly improving bone remodeling outcomes in animal models, no significant efficacy was observed in the treatment of ONFH in the clinical studies. Further studies are required to solve the discordant outcomes between the animal and clinical studies.
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Affiliation(s)
- Donghai Li
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Zhouyuan Yang
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Zhun Wei
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Pengde Kang
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China.
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Tsuchiya M, Ichiseki T, Ueda S, Ueda Y, Shimazaki M, Kaneuji A, Kawahara N. Mitochondrial stress and redox failure in steroid-associated osteonecrosis. Int J Med Sci 2018; 15:205-209. [PMID: 29483810 PMCID: PMC5820848 DOI: 10.7150/ijms.22525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/23/2017] [Indexed: 11/23/2022] Open
Abstract
The purpose of the role of antioxidant enzymes and mitochondria in the developmental mechanism of steroid-associated osteonecrosis in the femur. In the present study Japanese white rabbits (mean weight 3.5kg) were injected into the gluteus with methylprednisolone (MP) 20mg/kg, and killed after 3 days (MP3 group), 5 days (MP5 group), and 14 days (MP14 group) (n=3 each). As a Control group (C group) Japanese white rabbits not administered MP were used. In experiment 1, the expression of the antioxidant enzymes Superoxide dismutade (SOD) and catalase was compared in liver, kidney, heart, humerus, and femur in C group, and the presence/absence of mitochondria transcription factor A (TFAM) expression was determined by Western blotting (WB) and used to evaluate the number of mitochondria and their function. In experiment 2, the presence/absence of necrosis was determined by immunohistochemistry, while changes in the expression of SOD, catalase, and TFAM in the femur after steroid administration were determined by Western blotting (WB). In experiment 1, intense expression of all of SOD, catalase, and TFAM was found in the liver, kidney, and heart as compared to the humerus and femur. In experiment 2, the expression of all of SOD, catalase, and TFAM in MP3 and MP5 groups was decreased on WB as compared with C group, while in MP14 group a tendency to improvement was seen. Accordingly, steroid-associated mitochondrial injury and redox failure are concluded to be important elements implicated in the pathogenesis of osteonecrosis.
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Affiliation(s)
- Masanobu Tsuchiya
- Department of Orthopaedic Surgery,Kanazawa Medical University, Daigaku 1-1,Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Toru Ichiseki
- Department of Orthopaedic Surgery,Kanazawa Medical University, Daigaku 1-1,Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Shusuke Ueda
- Department of Orthopaedic Surgery,Kanazawa Medical University, Daigaku 1-1,Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Yoshimichi Ueda
- Department of Pathology, Kanazawa Medical University, Daigaku 1-1, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Miyako Shimazaki
- Department of Pathology, Kanazawa Medical University, Daigaku 1-1, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery,Kanazawa Medical University, Daigaku 1-1,Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Norio Kawahara
- Department of Orthopaedic Surgery,Kanazawa Medical University, Daigaku 1-1,Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
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Ismail T, Osinga R, Todorov A, Haumer A, Tchang LA, Epple C, Allafi N, Menzi N, Largo RD, Kaempfen A, Martin I, Schaefer DJ, Scherberich A. Engineered, axially-vascularized osteogenic grafts from human adipose-derived cells to treat avascular necrosis of bone in a rat model. Acta Biomater 2017; 63:236-245. [PMID: 28893630 DOI: 10.1016/j.actbio.2017.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Avascular necrosis of bone (AVN) leads to sclerosis and collapse of bone and joints. The standard of care, vascularized bone grafts, is limited by donor site morbidity and restricted availability. The aim of this study was to generate and test engineered, axially vascularized SVF cells-based bone substitutes in a rat model of AVN. METHODS SVF cells were isolated from lipoaspirates and cultured onto porous hydroxyapatite scaffolds within a perfusion-based bioreactor system for 5days. The resulting constructs were inserted into devitalized bone cylinders mimicking AVN-affected bone. A ligated vascular bundle was inserted upon subcutaneous implantation of constructs in nude rats. After 1 and 8weeks in vivo, bone formation and vascularization were analyzed. RESULTS Newly-formed bone was found in 80% of SVF-seeded scaffolds after 8weeks but not in unseeded controls. Human ALU+cells in the bone structures evidenced a direct contribution of SVF cells to bone formation. A higher density of regenerative, M2 macrophages was observed in SVF-seeded constructs. In both experimental groups, devitalized bone was revitalized by vascularized tissue after 8 weeks. CONCLUSION SVF cells-based osteogenic constructs revitalized fully necrotic bone in a challenging AVN rat model of clinically-relevant size. SVF cells contributed to accelerated initial vascularization, to bone formation and to recruitment of pro-regenerative endogenous cells. STATEMENT OF SIGNIFICANCE Avascular necrosis (AVN) of bone often requires surgical treatment with autologous bone grafts, which is surgically demanding and restricted by significant donor site morbidity and limited availability. This paper describes a de novo engineered axially-vascularized bone graft substitute and tests the potential to revitalize dead bone and provide efficient new bone formation in a rat model. The engineering of an osteogenic/vasculogenic construct of clinically-relevant size with stromal vascular fraction of human adipose, combined to an arteriovenous bundle is described. This construct revitalized and generated new bone tissue. This successful approach proposes a novel paradigm in the treatment of AVN, in which an engineered, vascularized osteogenic graft would be used as a germ to revitalize large volumes of necrotic bone.
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Millhouse PW, Miller AJ, Paul J, Conliffe TD, Vaccaro AR, Broyer Z. Delayed Bone Infarct in the Ilium Following a Pelvic Crush Injury and Embolization: A Case Report. JBJS Case Connect 2017; 7:e89. [PMID: 29286972 DOI: 10.2106/jbjs.cc.16.00151] [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: 06/07/2023]
Abstract
CASE We present a case of delayed osteonecrosis of the ilium. After receiving embolization and multiple orthopaedic procedures following a complex pelvic crush injury, the patient subsequently developed posterior pelvic pain and tenderness over the posterior superior iliac spine, along with pain on sacroiliac joint compression. Magnetic resonance imaging of the pelvis demonstrated a bone infarction in the left ilium adjacent to the sacroiliac joint. CONCLUSION The symptoms from osteonecrosis of the ilium may simulate sacroiliitis or other conditions. It is important to keep the differential diagnosis in mind when considering additional management for posterior pelvic pain in the setting of prior trauma and preexisting hardware.
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Affiliation(s)
| | | | | | | | | | - Zach Broyer
- Rothman Institute, Philadelphia, Pennsylvania
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Rupasov A, Cain U, Montoya S, Blickman JG. Imaging of Posttraumatic Arthritis, Avascular Necrosis, Septic Arthritis, Complex Regional Pain Syndrome, and Cancer Mimicking Arthritis. Radiol Clin North Am 2017; 55:1111-1130. [DOI: 10.1016/j.rcl.2017.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Schneider AK, Ek ET. Isolated avascular necrosis of the olecranon. J Shoulder Elbow Surg 2017; 26:e198-e202. [PMID: 28410955 DOI: 10.1016/j.jse.2017.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Adrian K Schneider
- Melbourne Orthopaedic Group, Windsor, VIC, Australia; Department of Orthopedic Surgery and Traumatology, Kantonsspital, St. Gallen, Switzerland.
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Windsor, VIC, Australia; Department of Orthopaedic Surgery, University of Melbourne, Austin Hospital, Melbourne, VIC, Australia
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Abstract
Younger patients are affected more often by osteonecrosis than by osteoarthritis, and osteonecrosis has significantly greater long-term morbidity. Corticosteroids are the most common cause of nontraumatic osteonecrosis. The femoral head is the most common site of osteonecrosis. In rare instances, osteonecrosis of the jaw has been associated with bisphosphonate exposure. This phenomenon is more common with repeated intravenous infusions of bisphosphonates. Case reports of osteonecrosis of the jaw in association with other medications, such as denosumab, have been reported. The final common pathway in the pathogenesis of osteonecrosis is disruption of blood supply to a segment of bone. Abnormalities in lipid metabolism, bone homeostasis, regulation of apoptosis, coagulopathies, innate immunity, and oxidative stress may play a role in the pathogenesis of osteonecrosis. Epigenetics may alter the predisposition to develop osteonecrosis. MRI is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis. Nonsurgical treatment of osteonecrosis does not change the natural history of the disease. Although surgical treatment of femoral head osteonecrosis has many variations, most symptomatic patients eventually require total hip arthroplasty. Knowledge of risk factors and early detection are crucial to the successful management of osteonecrosis. Because of the lack of successful treatment options, new modes of management focus on the prevention of osteonecrosis.
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Galluccio F, Matucci-Cerinic M. Efficacy of Short-term Teriparatide for Hip Osteonecrosis. J Rheumatol 2016; 43:2084-2085. [PMID: 27803352 DOI: 10.3899/jrheum.160190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Felice Galluccio
- Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi (AOUC), University of Florence;
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence, Florence, Italy
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Deleuran T, Overgaard S, Vilstrup H, Jepsen P. Cirrhosis is a risk factor for total hip arthroplasty for avascular necrosis. Acta Orthop 2016; 87:231-4. [PMID: 26900635 PMCID: PMC4900083 DOI: 10.3109/17453674.2016.1151122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - There are limited data on risk factors for avascular necrosis of the hip, but cirrhosis has been proposed as a risk factor. We examined the association between cirrhosis and incidence of total hip arthroplasty for avascular necrosis. Methods - We used nationwide healthcare data to identify all Danish residents diagnosed with cirrhosis in 1994-2011, and matched them 1:5 by age and sex to non-cirrhotic reference individuals from the general population. We excluded people with a previous total hip arthroplasty, a previous hip fracture, or a previous diagnosis of avascular necrosis. We used stratified Cox regression to estimate the hazard ratio (HR) for cirrhosis patients relative to reference individuals, adjusting for potential confounders. We used the cumulative incidence function to compute 5-year risks. Results - We included 25,421 cirrhosis patients and 114,052 reference individuals. Their median age was 57 years, and 65% were men. 45 cirrhosis patients and 44 reference individuals underwent total hip arthroplasty for avascular necrosis. Cirrhosis patients' HR for a total hip arthroplasty for avascular necrosis was 10 (95% CI: 6-17), yet their 5-year risk of avascular necrosis was only 0.2%. For the reference individuals, the 5-year risk was 0.02%. Interpretation - Cirrhosis is a strong risk factor for avascular necrosis of the hip, but it is rare even in cirrhosis patients.
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Affiliation(s)
- Thomas Deleuran
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus,,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus,,Correspondence:
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus,
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus,,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus,
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Does osteonecrosis of the femoral head increase surgical and medical complication rates after total hip arthroplasty? A comprehensive analysis in the United States. Hip Int 2016; 25:237-44. [PMID: 25704263 DOI: 10.5301/hipint.5000224] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 02/04/2023]
Abstract
Total hip arthroplasty (THA) is a definitive option for end-stage osteonecrosis of the femoral head (ONFH). Historically, higher revision rates were observed in this population compared to THA for osteoarthritis (OA). This study provides a comprehensive evaluation of postoperative medical and surgical complications comparing THA in ONFH and OA at 90 days, 1 year, and 2 years after surgery. The PearlDiver database identified 45,002 OA and 8,429 ONFH patients who underwent THA. Mechanical complications (prosthetic loosening and osteolysis, implant failure), dislocation, renal and respiratory complications were significantly increased in the ONFH group within 2 years after THA. Pulmonary embolism rates where increased in younger ONFH patients within 2 years after THA. This data helps clinicians in the postoperative risk assessment of patients with ONFH.
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Yuan HF, Zhang J, Guo CA, Yan ZQ. Clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation: a meta-analysis of seven case-control studies. Clinics (Sao Paulo) 2016; 71:110-3. [PMID: 26934241 PMCID: PMC4760366 DOI: 10.6061/clinics/2016(02)10] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/30/2015] [Indexed: 12/31/2022] Open
Abstract
The purpose of this study was to evaluate the clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation. We searched the PubMed, Embase and Web of Science databases and included all case-control trials that reported on the clinical outcomes of osteonecrosis progression, incidence of total hip arthroplasty and improvement in Harris hip scores. Overall, seven case-control trials were included. Compared with the controls, patients treated with the bone marrow stem cells implantation treatment showed improved clinical outcomes with delayed osteonecrosis progression (odds ratio = 0.17, 95% CI: 0.09 - 0.32; p <0.001), a lower total hip arthroplasty incidence (odds ratio = 0.30, 95% CI: 0.12 - 0.72; p <0.01) and increased Harris hip scores (mean difference = 4.76, 95% CI: 1.24 - 8.28; p<0.01). The heterogeneity, publication bias, and sensitivity analyses showed no statistical difference significant differences between studies. Thus, our study suggests that autologous bone marrow stem cells implantation has a good therapeutic effect on osteonecrosis of the femoral, resulting in beneficial clinical outcomes. However, trials with larger sample sizes are needed to confirm these findings.
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Yuan HF, Guo CA, Yan ZQ. The use of bisphosphonate in the treatment of osteonecrosis of the femoral head: a meta-analysis of randomized control trials. Osteoporos Int 2016; 27:295-9. [PMID: 26370828 DOI: 10.1007/s00198-015-3317-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/04/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED This meta-analysis revealed that bisphosphonates could not provide a better clinical outcome in the treatment of osteonecrosis of the femoral head (ONFH) when compared with placebo. INTRODUCTION Bisphosphonates have been recommended to treat ONFH. However, the exact clinical outcomes after treatment are still controversial. METHODS A comprehensive search of PubMed, Embase, and Web of Science databases was undertaken, and only randomized control trials were included. The clinical outcomes consisted of progression to collapse, total hip arthroplasty (THA) incidence, and improvement of Harris hip score (HHS). The heterogeneities between the trials were assessed with the I (2) statistic, and random effects models were used for the meta-analysis. RESULTS Five eligible trials were identified involving 329 subjects with 920.9 patient-years of follow-up. The clinical outcomes of patients with ONFH was not significantly improved by bisphosphonate therapy (progression to collapse: risk ratio = 0.71 (0.41, 1.24), p = 0.23; THA incidence: risk ratio = 0.61 (0.33, 1.15), p = 0.13; HHS improvement: mean difference = 3.26 (-5.12, 11.64), p = 0.45). The I (2) statistic showed the existence of considerable heterogeneity (all I (2) ≥ 50 %), which was explained by one trial where bisphosphonate alone was used with no additional therapy. However, when this trial was excluded, the clinical outcomes after bisphosphonate therapy were still not significantly improved compared with placebo. CONCLUSIONS The current analysis does not support the use of bisphosphonates for ONFH. As potential serious adverse effects are associated with these drugs, only limited use can be recommended.
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Affiliation(s)
- H-F Yuan
- Department of Orthopedics, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200043, China
| | - C-A Guo
- Department of Orthopedics, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200043, China
| | - Z-Q Yan
- Department of Orthopedics, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200043, China.
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Wang L, Zhang L, Pan H, Peng S, Zhao X, Lu WW. Abnormal subchondral bone microstructure following steroid administration is involved in the early pathogenesis of steroid-induced osteonecrosis. Osteoporos Int 2016; 27:153-9. [PMID: 26156290 DOI: 10.1007/s00198-015-3225-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/26/2015] [Indexed: 01/29/2023]
Abstract
UNLABELLED Loss of bone microstructure integrity is thought to be related to osteonecrosis. But the relationship between the time when bone microstructure integrity loss appears and the onset of osteonecrosis has not yet been determined. Our study demonstrated abnormal changes of subchondral bone microstructure involved in the early pathogenesis of osteonecrosis. INTRODUCTION Using a rabbit model, we investigated the changes of subchondral bone microstructure following steroid administration to identify the onset of abnormal bone microstructure development in steroid-induced osteonecrosis. METHODS Fifty-five adult female Japanese White rabbits (mean body weight 3.5 kg; mean age 24 months) were used and randomly divided among three time points (3, 7, and 14 days) consisting of 15 rabbits each, received a single intramuscular injection of methylprednisolone acetate (MP; Pfizer Manufacturing Belgium NV) at a dose of 4 mg/kg, and a control group consisting of 10 rabbits was fed and housed under identical conditions but were not given steroid injections. A micro-CT scanner was applied to detect changes in the trabecular region of subchondral bone of excised femoral head samples. Parameters including bone volume fraction (BV/TV), bone surface (BS), trabecular bone pattern factor (Tb.Pf), trabecular thickness/number/separation (Tb.Th, Tb.N, and Tb.Sp), and structure model index (SMI) were evaluated using the software CTAn (SkyScan). After micro-CT scans, bilateral femoral heads were cut in the coronal plane at a thickness of 4 μm. The sections were then stained with haematoxylin-eosin and used for the diagnosis of osteonecrosis and the rate of development of osteonecrosis. RESULTS The BV/TV, BS, Tb.Th and Tb.N demonstrated a time-dependent decline from 3, 7, and 14 days compared with the control group, while the Tb.Pf, Tb.Sp and SMI demonstrated an increase at 3, 7, and 14 days compared with the control group. For the histopathology portion, osteonecrosis was not seen 3 days after steroid treatment, but was present 7 days after treatment and was obvious 14 days after treatment. Furthermore, the rate of osteonecrosis appearing between 7 and 14 days was not significantly different. In addition, the presence and variation of BV/TV, BS, Tb.Pf, Tb.Th, Tb.N, and SMI demonstrated significant changes at 7 days compared with the control group except Tb.Sp (at 14 days) and this is the time when osteonecrosis is thought to occur in this model. CONCLUSION This study demonstrated that osteonecrosis in rabbits is chronologically associated with changes in subchondral bone microstructure.
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Affiliation(s)
- L Wang
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, China.
- Department of Orthopedic Surgery, People's Hospital of Hangzhou, Nanjing Medical University, Hangzhou, China.
| | - L Zhang
- Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, China
| | - H Pan
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, China
| | - S Peng
- Department of Orthopedic Surgery, People's Hospital of Shenzhen, Jinan University Second College of Medicine, Shenzhen, China
| | - X Zhao
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, China
| | - W W Lu
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, China.
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, China.
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Proximal Row Carpectomy for Coexisting Kienböck's Disease and Giant Intraosseous Ganglion of the Scaphoid: A Case Report and Review of the Literature. Case Rep Orthop 2014; 2014:834063. [PMID: 25530898 PMCID: PMC4235236 DOI: 10.1155/2014/834063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/18/2014] [Accepted: 10/02/2014] [Indexed: 11/23/2022] Open
Abstract
The etiologies of Keinböck's disease and intraosseous ganglion remain unknown. Both entities are rare and the coexistence of these two pathologies in the same patient and hand is even less frequent. We report the case of a 40-year-old man with a longstanding history of martial arts practice (karate) who developed an avascular necrosis of the lunate concomitant with a giant intraosseous ganglion of the scaphoid bone successfully managed by proximal row carpectomy. We review the literature of these two diseases.
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