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Woerner M, Koehn A, Morris P, Weber M, Renkawitz T, Grifka J, Craiovan B. Influence of avascular necrosis of the femoral head on hip prosthesis integration: a radiological analysis. Acta Radiol 2024; 65:76-83. [PMID: 37376763 DOI: 10.1177/02841851231183707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Avascular osteonecrosis of the femoral head (AVN) often results in total hip arthroplasty (THA). The cause for increased THA revision rates among patients with AVN is not yet fully understood. PURPOSE To perform a comparative radiological analysis of implant integration between patients with AVN and osteoarthritis (OA). MATERIAL AND METHODS After a matched pair analysis of 58 patients, 30 received THA due to OA, 28 due to AVN. X-ray images were evaluated after one week ("baseline") and on average 37.58 months postoperatively ("endline"). The prosthesis was grouped into 10 regions of interest (ROI): seven femoral and three acetabular. Incidence, width, and extent of "radiolucent lines" were measured within each zone. RESULTS Between baseline and endline, width and extent progressed more noticeably in all femoral and acetabular zones among patients with AVN. In femoral ROI 1, the width increased in 40% of AVN cases compared to 6.7% of OA cases. For acetabular ROI 3, the width increased in 26.7% of AVN cases compared to no perceived changes in the OA group. No signs of prosthetic loosening were found in the AVN group. CONCLUSION The increase of width and extent of radiolucent lines over time in patients with AVN could be a sign of lack of osteointegration. However, prosthetic loosening in absence of clinical symptoms cannot be deduced from radiological findings after medium-term postoperative follow-up. Further long-term studies are required to monitor how radiolucent lines develop in respect to long-term implant loosening. Dependent on bone quality, individually adapted reaming and broaching of the implant site are recommended.
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Affiliation(s)
- Michael Woerner
- Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
| | - Anna Koehn
- Department of Orthopedics, Regensburg University Medical Center, Bad Abbach, Germany
| | - Patrick Morris
- Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
| | - Markus Weber
- Department of Orthopedics, Regensburg University Medical Center, Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopedics, Heidelberg University, Heidelberg, Germany
| | - Joachim Grifka
- Department of Orthopedics, Regensburg University Medical Center, Bad Abbach, Germany
| | - Benjamin Craiovan
- Endoprothetik im Zentrum Orthopädie und Unfallchirurgie, Philipps-Universität Marburg Fachbereich Medizin, Marburg, Germany
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Yue J, Guo X, Wang R, Li B, Sun Q, Liu W, Chen J, Zhao F. Reliability and repeatability of 2021 ARCO classification and its guiding significance in treatment of nontraumatic osteonecrosis of the femoral head. BMC Musculoskelet Disord 2023; 24:469. [PMID: 37291529 DOI: 10.1186/s12891-023-06587-4] [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: 03/26/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The study was designed to evaluate the interobserver reliability and intraobserver repeatability of the 2021 Association Research Circulation Osseous (ARCO) classification and explore its guiding significance in the treatment of nontraumatic osteonecrosis of the femoral head (ONFH). METHODS In this retrospective study, we randomly selected and investigated 50 sets of preoperative computed tomography or magnetic resonance imaging scans from 96 patients (139 hips) to validate the reliability and repeatability of the 2021 ARCO classification. Patients with a nano-hydroxyapatite/polyamide-66 support rod were included in the clinical efficacy study. The Harris hip score (HHS) was used to assess hip function. Femoral head collapse of > 2 mm was considered radiological failure. Total hip arthroplasty (THA) was performed for clinical failure, and follow-up was discontinued. RESULTS The average kappa value of interobserver consistency was 0.652. The average rate of consistency was 90.25%, and the average kappa value of intraobserver consistency was 0.836. Eighty-two patients (122 hips) were enrolled and followed up for a mean of 43.57 ± 9.64 months. There was no significant difference in the HHS among the three groups before surgery, but the difference was statistically significant at the last follow-up. Among them, types 1 and 2 had significantly higher scores at the last follow-up than preoperatively (P < 0.05), whereas type 3 had a lower score at the last follow-up than preoperatively, although the difference was not statistically significant (P > 0.05).According to the imaging evaluation, the failure rate of type 1, 2, and 3 at the last follow-up was 0%, 19%, and 87%, respectively. Univariate analysis showed that the femoral head survival rate of radiography was significantly affected by the new classification system (P = 0.00). At the last follow-up, the incidence rate of THA in type 1, 2, and 3 was 5%, 7%, and 31%, respectively. Univariate analysis showed that the femoral head survival rate was significantly affected by the new classification system (P = 0.001). CONCLUSIONS The 2021 ARCO classification for early-stage ONFH shows substantial consistency and repeatability. We do not recommend femoral head-preserving surgery for patients with type 3 ONFH.
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Affiliation(s)
- Ju'an Yue
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China
| | - Xiaozhong Guo
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China.
| | - Randong Wang
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China
| | - Bing Li
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China
| | - Qiang Sun
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China
| | - Wangyan Liu
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China
| | - Jiao Chen
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China
| | - Fengnian Zhao
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, Anwai Beiyuan, Chaoyang District, Beijing, China
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Winter P, Landgraeber S. [The importance of removing osteonecrosis during treatment of femoral head osteonecrosis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:800-807. [PMID: 36136134 DOI: 10.1007/s00132-022-04302-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
Atraumatic femoral head necrosis (aFHN) in adults is estimated to be the leading cause of approximately 10% of all hip prosthesis implantations. Due to the relatively frequent occurrence of aFHN at a young age, the possibility of a joint-preserving intervention should be examined. This includes the classic "core decompression" and modifications based on it. There are different data on the success rates of this method. Reasons for treatment failure could include a lack of clearance of the necrosis zone. The clearance of the necrosis zone is taken into account by alternative surgical procedures for the treatment of aFHN. These are the "trap-door procedure", the "light-bulb procedure" and "advanced core decompression". The current state of knowledge on these procedures is reviewed in this keynote article. It is shown that the extensive excision of femoral head necrosis is of particular importance. None of the procedures mentioned can currently be recommended in preference over the others.
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Affiliation(s)
- Philipp Winter
- Klinik für Orthopädie und Orthopädische Chirurgie, Universität des Saarlandes, Kirrberger Str. 100, 66421, Homburg, Deutschland.
| | - Stefan Landgraeber
- Klinik für Orthopädie und Orthopädische Chirurgie, Universität des Saarlandes, Kirrberger Str. 100, 66421, Homburg, Deutschland
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Zippelius T, Strube P, Matziolis G, Röhner E, Böhle S, Brodt S. Cone beam-navigated core decompression of bone marrow edema syndrome. Arch Orthop Trauma Surg 2020; 140:1603-1609. [PMID: 31960167 DOI: 10.1007/s00402-020-03339-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The aim of the study was to compare decompression of bone-marrow edema or osteonecrosis of the proximal femur by means of a cone beam-based imaging and navigation system (cone beam-navigated decompression, CBND) with decompression by the conventional technique of drilling using fluoroscopy (FD). MATERIALS AND METHODS The data of patients with bone-marrow edema syndrome treated between 2016 and 2018 by drilling of the proximal femur in CBND or FD technique were compared retrospectively. RESULTS Each treatment group included 20 patients. The mean operating time for CBND was 16.4 ± 5.8 min, compared with 29.1 ± 20.8 min for FD (p = 0.018). The lesion was definitely reached by CBND in 19/20 patients. Eighteen of the 20 patients in the CBND group reported that their pain decreased after the treatment, compared with 12/20 patients in the FD group (p = 0.065). The radiation dosage was significantly higher (p < 0.001) for CBND than for FD. CONCLUSION Decompression by CBND can be carried out safely and without complications. The advantages of CBND over FD are the minimally invasive access and the ability to address the affected area precisely with only one drilling maneuver. The high radiation dose of CBND can be reduced using low-dose protocols.
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Affiliation(s)
- Timo Zippelius
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Patrick Strube
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Sabrina Böhle
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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Zippelius T, Matziolis G, Röhner E, Windisch C, Lindemann C, Strube P. Psychological distress and health-related quality of life in patients with bone marrow edema syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:552. [PMID: 31807533 DOI: 10.21037/atm.2019.09.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The aim of the study was to investigate psychological distress and health-related quality of life (HrQoL) in patients with bone marrow edema syndrome (BMES) of the hip or knee joint. METHODS This retrospective study included patients with the diagnosis BMES treated in the period 2016-2017. As well as analyzing the epidemiological data (age, sex, vascular disease, hypertension, etc.), we used the Hospital Anxiety and Depression Scale (HADS) to document anxiety and depression and the five-level version of the EuroQol Group's EQ-5D instrument (EQ-5D-5L) to assess HrQoL and compared it to historical controls of the healthy population. RESULTS The study group comprised 56 patients (26 females, 30 males) with a mean age of 55.8 (range, 15-84) years. HADS: there was no difference between the study and control cohorts in the rates of anxiety (P=0.595) or depression (P=0.241). EQ-5D-5L: the HrQoL was significantly lower in the patients with BMES than in the healthy controls both for parameters of the EQ-5D-5L index and in the various age groups. No difference in HrQoL was seen between BMES of the hip and the knee or among the different radiological stages of BMES. CONCLUSIONS The patients with BMES displayed a clear reduction in HrQoL, but this was not associated with psychological distress with regard to significant anxiety and depression. Patients with BMES and a high score for anxiety and depression are at great risk of chronic pain, and we recommend they should receive psychological counseling.
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Affiliation(s)
- Timo Zippelius
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Christoph Windisch
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany.,Orthopaedic Department, Helios Klinik Blankenhain, Blankenhain, Germany
| | - Chris Lindemann
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Patrick Strube
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
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[Core decompression ("conventional method") in atraumatic osteonecrosis of the hip]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 32:89-95. [PMID: 31754745 DOI: 10.1007/s00064-019-00640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/28/2019] [Accepted: 05/08/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Retrograde drilling of a necrotic zone within the femoral head to reduce intraosseous pressure and stimulate revascularization. INDICATIONS Atraumatic osteonecrosis of the hip ARCO stage I (reversible) and ARCO stage II (potentially reversible) with a medial or central necrotic zone <30% or ARCO stage III with a subchondral fracture for reduction of pain. CONTRAINDICATIONS ARCO stage III C, ARCO stage IV (secondary osteoarthritis), stage-independent necrotic zone > 30%, infections. SURGICAL TECHNIQUE Supine position. Visualization of the necrotic zone via an image intensifier, approach is determined by using a Kirschner wire, laterodorsal skin incision on a level with the wire, longitudinal incision of iliotibial band and vastus lateralis muscle, drilling the necrotic zone with a 2-3 mm Kirschner wire, optionally placing more wires or a hollow drill, wound closure. POSTOPERATIVE MANAGEMENT Partial weightbearing with 20 kg for 6 weeks due to risk of fracture, followed by avoidance of jumping or sprinting for another 6 weeks; physiotherapy from day 1 after surgery, thromboembolic prophylaxis until full weightbearing is possible. RESULTS Results are dependent on ARCO stages and are promising in early stages.
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[Total hip arthroplasty in young patients : Bearings and custom-made prostheses]. DER ORTHOPADE 2019; 48:292-299. [PMID: 30737518 DOI: 10.1007/s00132-019-03692-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Carefully and correctly implanted components are the prerequisite for the lifespan of a prosthesis. Whether higher levels of activity lead to prior failure of total hip arthroplasty in young patients is controversially discussed. The right choice of bearings is still of great relevance. BEARINGS Ceramic-on-ceramic as well as polyethylene-on-ceramic bearings achieve comparable results, although ceramic-on-ceramic bearings should be avoided in patients with high demands on their range of motion. Polyethylene-on-metal bearings also show good clinical results, if corrosion between head and stem is absent. Metal-on-metal bearings lead to adverse systemic effects due to metal wear and should be implanted in individual cases only, e. g. as hip resurfacing. Alternative bearings have to give proof of effectivity first. Custom-made prostheses constitute an option for young patients with special conditions of hip anatomy. Planning and study results of these prostheses are elucidated in this review article.
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Roth A, Beckmann J, Bohndorf K, Heiß C, Jäger M, Landgraeber S, Maus U, Nöth U, Peters KM, Rader C, Reppenhagen S, Smolenski U, Kopp I, Tingart M. [Update of the German S3 guideline on atraumatic femoral head necrosis in adults]. DER ORTHOPADE 2019; 47:757-769. [PMID: 30116852 DOI: 10.1007/s00132-018-3620-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The update of the German S3 guideline on atraumatic femoral head necrosis in adults aims to provide an overview of diagnosis and treatment. All clinical studies, systematic reviews, and meta-analyses published in German or English between 01.05.2013 and 30.04.2017 were included. Of 427 studies, 28 were suitable for analysis. Risk factors are corticosteroids, chemotherapy, kidney transplants, hemoglobinopathies, and alcoholism. Differential diagnoses are for example bone marrow edema, insufficiency fracture, and destructive arthropathy. Radiography should be performed upon clinical suspicion. In patients with normal radiography findings but persistent complaints, magnetic resonance imaging (ARCO classification) is the method of choice. Computed tomography (CT) can be used to confirm/exclude articular surface collapse. A subchondral sclerosis zone >30% in CT indicates a better prognosis. Left untreated, a subchondral fracture will develop within 2 years. The risk of disease development in the opposite side is high during the first 2 years, but unlikely thereafter. In conservative therapy, iloprost and alendronate can be used in a curative approach, the latter for small, primarily medial necrosis. Conservative therapy alone as well as other drug-based and physical approaches are not suitable for treatment. No particular joint-preserving surgery can currently be recommended. Core decompression should be performed in early stages with <30% necrosis. From ARCO stage IIIc or in stage IV, the indication for total hip arthroplasty should be checked. Results after total hip arthroplasty are comparable with those after coxarthrosis, although the revision rate is higher due to the relatively young age of patients. Statements on the effectiveness of cell-based therapies such as expanded stem cells or bone marrow aspirates cannot currently be made.
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Affiliation(s)
- Andreas Roth
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie, und Plastische Chirurgie, Bereich Endoprothetik/Orthopädie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, Haus 4, 04103, Leipzig, Deutschland.
| | - Johannes Beckmann
- Sektion Endoprothetik, Sportklinik Stuttgart, Stuttgart, Deutschland
| | - Klaus Bohndorf
- Universitätsklinik und Poliklinik für Diagnostische Radiologie, Martin-Luther Universität Halle-Wittenberg, Halle/Saale, Deutschland
| | - Christian Heiß
- Klinik für Unfallchirurgie, Universitätsklinikum Gießen-Marburg, Standort Gießen, Gießen, Deutschland
| | - Marcus Jäger
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Stefan Landgraeber
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Uwe Maus
- Klinik für Orthopädie und orthopädische Chirurgie, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital, Oldenburg, Deutschland
| | - Ulrich Nöth
- Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Berlin/Spandau, Berlin, Deutschland
| | - Klaus M Peters
- Orthopädie und Osteologie, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht, Deutschland
| | - Christof Rader
- Franziskushospital Aachen, Praxisklinik Orthopädie Aachen, Aachen, Deutschland
| | - Stephan Reppenhagen
- Orthopädische Klinik König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Ulrich Smolenski
- Institut für Physiotherapie, Friedrich-Schiller Universität Jena, Jena, Deutschland
| | - Ina Kopp
- AWMF-Institut, Philipps-Universität Marburg, Marburg, Deutschland
| | - Markus Tingart
- Klinik für Orthopädie, Universitätsklinikum Aachen, Aachen, Deutschland
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Zhang QY, Li ZR, Gao FQ, Sun W. Pericollapse Stage of Osteonecrosis of the Femoral Head: A Last Chance for Joint Preservation. Chin Med J (Engl) 2019; 131:2589-2598. [PMID: 30381593 PMCID: PMC6213842 DOI: 10.4103/0366-6999.244111] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective: To propose a new definition of the pericollapse stage of osteonecrosis of the femoral head (ONFH) and review its significance in disease diagnosis and treatment selection. Data Sources: A search for eligible studies was conducted in three electronic databases including PubMed, Cochrane Library, and Embase up to August 10, 2018, using the following keywords: “osteonecrosis”, “prognosis”, and “treatment”. Study Selection: Investigations appraising the clinical signs, symptoms, and imaging manifestations in different stages of ONFH were included. Articles evaluating the prognosis of various joint-preserving procedures were also reviewed. Results: The pericollapse stage refers to a continuous period in the development of ONFH from the occurrence of subchondral fracture to early collapse (<2 mm), possessing specific imaging features that mainly consist of bone marrow edema and joint effusion on magnetic resonance imaging (MRI), crescent signs on X-ray films, and clinical manifestations such as the sudden worsening of hip pain. Accumulating evidence has indicated that these findings may be secondary to the changes after subchondral fractures. Of note, computed tomography provides more information for identifying possible subchondral fractures than does MRI and serves as the most sensitive tool for grading the pericollapse lesion stage. The pericollapse stage may indicate a high possibility of progressive disease but also demonstrates satisfactory long- and medium-term outcomes for joint-preserving techniques. In fact, if the articular surface subsides more than 2 mm, total hip arthroplasty is preferable. Conclusions: The pericollapse stage with distinct clinical and imaging characteristics provides a last good opportunity for the use of joint-preserving techniques. It is necessary to separate the pericollapse stage as an independent state in evaluating the natural progression of ONFH and selecting an appropriate treatment regimen.
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Affiliation(s)
- Qing-Yu Zhang
- Department of Orthopaedic, Graduate School of Peking Union Medical College, China-Japan Friendship Hospital Institute of Clinical Medicine, Beijing 100029, China
| | - Zi-Rong Li
- Department of Orthopaedic, Centre for Osteonecrosis and Joint-Preserving and Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fu-Qiang Gao
- Department of Orthopaedic, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Wei Sun
- Department of Orthopaedic, Graduate School of Peking Union Medical College, China-Japan Friendship Hospital Institute of Clinical Medicine, Beijing 100029, China
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Lüring C, Benignus C, Beckmann J. [Joint-preserving operative treatment of avascular necrosis of the femoral head]. DER ORTHOPADE 2018; 47:745-750. [PMID: 30046854 DOI: 10.1007/s00132-018-3607-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The cause of avascular necrosis of the femoral head is multifactorial. Conservative treatment is only an option in the early stages. It is only symptomatic and not causative treatment. The implantation of an artificial hip joint should be postponed as the typically affected middle-aged males are right in the middle of their working life. Therefore, some joint-preserving operative therapies might be considered in stages ARCO I-III. Those range from core decompression to osteotomies and grafts, the advantages and disadvantages of which have to be weighted in each case. More recent therapies such as additive stem cells or platelet rich plasma (PRP) combined with core decompression have yet to prove their efficacy.
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Affiliation(s)
- C Lüring
- Orthopädische Klinik, Klinikum Dortmund gGmbH, Beurhausstraße 40, 44137, Dortmund, Deutschland.
| | - C Benignus
- Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Deutschland
| | - J Beckmann
- Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Deutschland
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Liu LH, Zhang QY, Sun W, Li ZR, Gao FQ. Corticosteroid-induced Osteonecrosis of the Femoral Head: Detection, Diagnosis, and Treatment in Earlier Stages. Chin Med J (Engl) 2018; 130:2601-2607. [PMID: 29067959 PMCID: PMC5678261 DOI: 10.4103/0366-6999.217094] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: This review aimed to provide a current recommendation to multidisciplinary physicians for early detection, diagnosis, and treatment of corticosteroid-induced osteonecrosis of the femoral head (ONFH) based on a comprehensive analysis of the clinical literature. Data Sources: For the purpose of collecting potentially eligible articles, we searched for articles in the PubMed, Cochrane Library, Embase, and CNKI databases up to February 2017, using the following key words: “corticosteroid”, “osteonecrosis of the femoral head”, “risk factors”, “diagnosis”, “prognosis”, and “treatment”. Study Selection: Articles on relationships between corticosteroid and ONFH were selected for this review. Articles on the diagnosis, prognosis, and intervention of earlier-stage ONFH were also reviewed. Results: The incidence of corticosteroid-induced ONFH was associated with high doses of corticosteroids, and underlying diseases in certain predisposed individuals mainly occurred in the first 3 months of corticosteroid prescription. The enhanced awareness and minimized exposure to the established risk factors and earlier definitive diagnosis are essential for the success of joint preservation. When following up patients with ONFH, treatment should be started if necessary. Surgical treatment yielded better results than conservative therapy in earlier-stage ONFH. The ideal purpose of earlier intervention and treatment is permanent preservation of the femoral head without physical restrictions in daily living. Conclusions: Clinicians should enhance their precaution awareness of corticosteroid-induced ONFH. For high-risk patients, regular follow-up is very important in the 1st year after high-dose prescription of corticosteroids. Patients with suspected ONFH should be referred to orthopedists for diagnosis and treatment in its earlier stage to preserve the joint.
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Affiliation(s)
- Li-Hua Liu
- Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Beijing 100029, China
| | - Qing-Yu Zhang
- Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Beijing 100029, China
| | - Wei Sun
- Department of Orthopaedic Surgery, Centre for Osteonecrosis and Joint Preserving and Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zi-Rong Li
- Department of Orthopaedic Surgery, Centre for Osteonecrosis and Joint Preserving and Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fu-Qiang Gao
- Department of Orthopaedic Surgery, Centre for Osteonecrosis and Joint Preserving and Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
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Liu L, Gao F, Sun W, Wang Y, Zhang Q, Wang B, Cheng L, Li ZR. Investigating clinical failure of core decompression with autologous bone marrow mononuclear cells grafting for the treatment of non-traumatic osteonecrosis of the femoral head. INTERNATIONAL ORTHOPAEDICS 2018; 42:1575-1583. [PMID: 29654394 DOI: 10.1007/s00264-018-3918-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/22/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to analyze the clinical factors related to the failure of autologous bone marrow mononuclear cells grafting (BMMCG) following core decompression (CD) in early stage osteonecrosis of the femoral head (ONFH). METHODS In total, 148 patients (192 hips) underwent CD with autologous BMMCG for treatment of non-traumatic ONFH. The patients were classified by their ARCO staging and China-Japan Friendship Hospital (CJFH) typing system. All patients were clinically and radiographically followed up every three months during the first year and every six months in the following years. The clinical evaluation was conducted by pre- and post-operative Harris hip scores (HHS), while serial anteroposterior (AP) and frog lateral radiographs were used for post-operative radiographic evaluation. RESULTS There were 56 hips as clinical failure cases, and 50 hips (89.29%) of failure cases developed between three and ten months after operation. Based on CJFH classification system, type L2 showed more failure rate with 60.0% (9 of15). The Cox risk model showed that disease type was an independent risk factor for post-operative clinical failure (P = 0.042). Multivariate analysis of the Cox proportional-hazards model showed that type L1 had a hazard ratio (HR) of 0.286 (95% CI 0.100-0.816), type L3 with HR of 0.245 (95% CI 0.079-0.759), respectively. CONCLUSION Disease type is an important risk factor for autologous BMMCG combined with CD, and the degree of lateral pillar necrosis is a significant reference index for prognosis evaluation in early stage of ONFH.
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Affiliation(s)
- Lihua Liu
- Graduate School of Peking Union Medical College, China-Japan Friendship institute of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Fuqiang Gao
- Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wei Sun
- Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Graduate School of Peking Union Medical College, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Yunting Wang
- Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Graduate School of Peking Union Medical College, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Qingyu Zhang
- Graduate School of Peking Union Medical College, China-Japan Friendship institute of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Bailiang Wang
- Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Liming Cheng
- Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Zi-Rong Li
- Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
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13
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Ko YM, Kwon H, Chun SJ, Kim YH, Choi JY, Shin S, Jung JH, Park SK, Han DJ. Predictors of Avascular Necrosis after Kidney Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2017. [DOI: 10.4285/jkstn.2017.31.4.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Young Min Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunwook Kwon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Jin Chun
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yoon Choi
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Shin
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hee Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su-Kil Park
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duck Jong Han
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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14
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Scaglione M, Fabbri L, Celli F, Casella F, Guido G. Hip replacement in femoral head osteonecrosis: current concepts. ACTA ACUST UNITED AC 2016; 12:51-4. [PMID: 27134633 DOI: 10.11138/ccmbm/2015.12.3s.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Osteonecrosis of the femoral head is a destructive disease that usually affects young adults with high functional demands and can have devastating effects on hip joint. The treatment depends on extent and location of the necrosis lesion and on patient's factors, that suggest disease progression, collapse probability and also implants survival. Non-idiopathic osteonecrosis patients had the worst outcome. There is not a gold standard treatment and frequently it is necessary a multidisciplinary approach. Preservation procedures of the femoral head are the first choice and can be attempted in younger patients without head collapse. Replacement procedure remains the main treatment after failure of preserving procedures and in the late-stage ONFH, involving collapse of the femoral head and degenerative changes to the acetabulum. Resurfacing procedure still has good results but the patient selection is a critical factor. Total hip arthroplasties had historically poor results in patients with osteonecrosis. More recently, reports have shown excellent results, but implant longevity and following revisions are still outstanding problems.
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Affiliation(s)
| | - Luca Fabbri
- Orthopedic Clinic, University of Pisa, Pisa, Italy
| | - Fabio Celli
- Orthopedic Clinic, University of Pisa, Pisa, Italy
| | | | - Giulio Guido
- Orthopedic Clinic, University of Pisa, Pisa, Italy
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15
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Roth A, Beckmann J, Bohndorf K, Fischer A, Heiß C, Kenn W, Jäger M, Maus U, Nöth U, Peters KM, Rader C, Reppenhagen S, Smolenski U, Tingart M, Kopp I, Sirotin I, Breusch SJ. S3-Guideline non-traumatic adult femoral head necrosis. Arch Orthop Trauma Surg 2016; 136:165-74. [PMID: 26667621 DOI: 10.1007/s00402-015-2375-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The treatment of adult non-traumatic avascular necrosis of the femoral head (AVN; N-ANFH) within an estimated incidence of 5000-7000 cases per annum in Germany remains a challenge. Risk factors include steroids, alcohol abuse, chemotherapy and immunosuppressive medication, but a genetic predisposition has been suggested. Early diagnosis of this often bilateral disease process is essential for successful conservative or joint preserving surgical management. In this review, we present the update German consensus S3 guideline "diagnosis and management for N-ANFH" as a concise summary. MATERIALS AND METHODS This systematic review is based on the published literature from January 1, 1970 to April 31, 2013 (German and English language). Inclusion criteria were systematic reviews, meta-analyses and relevant peer review publications. We identified a total of 3715 related publications, of which 422 were suitable according to the SIGN criteria, but only 159 fulfilled our inclusion criteria. RESULTS AND CONCLUSIONS Clinical suspicion of N-ANFH mandates radiographic evaluation. If radiographs are normal MRI scans are recommended, which should be evaluated according to the ARCO-classification. Differential diagnoses include transient osteoporosis, bone bruise, insufficiency fracture and destructive arthropathy. Untreated, subchondral fractures commonly occur within 2 years, during which the risk for contralateral involvement is high-thereafter unlikely. Conservative management with Ilomedin and Alendronat can be tried, but other pharmacological or physical treatments are inappropriate. No specific joint preserving procedure can be recommended, but core decompression should be considered in early stages if necrosis is <30 %. In ARCO stages IIIc or IV total hip arthroplasty (THA) should be contemplated, which offers similar outcome compared to osteoarthritis. Young age is the main risk factor for higher revision rates after THA for N-ANFH.
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Affiliation(s)
- A Roth
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie; Bereich Endoprothetik/Orthopädie, Universitätsklinik Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Germany.
| | - J Beckmann
- Sektion Endoprothetik, Sportklinik Stuttgart, Stuttgart, Germany
| | - K Bohndorf
- Universitätsklinik für Radiologie und Nuklearmedizin, Exzellenzzentrum für Hochfeld MR, Medizinische Universität Wien, Vienna, Austria.,Christian Doppler Laboratory for Molecular Imaging, Medizinische Universität Wien, Vienna, Austria
| | - A Fischer
- Abteilung für Physikalische und Rehabilitative Medizin, Klinikum Burgenlandkreis GmbH, Naumburg, Germany
| | - C Heiß
- Klinik für Unfallchirurgie, Universitätsklinikum Gießen-Marburg, Marburg, Germany
| | - W Kenn
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - M Jäger
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen-Duisburg, Essen, Germany
| | - U Maus
- Klinik für Orthopädie und orthopädische Chirurgie, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital, Oldenburg, Germany
| | - U Nöth
- Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
| | - K M Peters
- Orthopädie und Osteologie, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht, Germany
| | - C Rader
- Praxisklinik Orthopädie Aachen, Franziskushospital Aachen, Aachen, Germany
| | - S Reppenhagen
- Orthopädische Klinik König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - U Smolenski
- Institut für Physiotherapie, Friedrich-Schiller Universität Jena, Jena, Germany
| | - M Tingart
- Klinik für Orthopädie, Universitätsklinikum Aachen, Aachen, Germany
| | - I Kopp
- AWMF-Institut, Philipps-Universität Marburg, Marburg, Germany
| | - I Sirotin
- Pirogov-Universität Moskau, 64. Städtisches Krankenhaus, Moscow, Russia
| | - S J Breusch
- FRCS Ed, Orthopaedic Department, Edinburgh Royal Infirmary, Edinburgh, UK
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