Prediction of Collapse Using Patient-Specific Finite Element Analysis of Osteonecrosis of the Femoral Head

Relationship between lipid metabolism, coagulation and other blood indices and etiology and staging of non-traumatic femoral head necrosis: a multivariate logistic regression-based analysis

BACKGROUND

To analyze the relationship between lipid metabolism, coagulation function, and bone metabolism and the contributing factor and staging of non-traumatic femoral head necrosis, and to further investigate the factors influencing the blood indicators related to the staging of non-traumatic femoral head necrosis.

METHODS

The medical records of patients with femoral head necrosis were retrieved from the inpatient medical record management system, and the lipid metabolism, bone metabolism, and coagulation indices of non-traumatic femoral head necrosis (including alcoholic, hormonal, and idiopathic group) were obtained according to the inclusion and exclusion criteria, including Low-Density Lipoprotein Cholesterol, Triglycerides, Non-High-Density Lipoprotein Cholesterol, Apolipoprotein A1, Apolipoprotein (B), Apolipoprotein (E), Uric Acid, Alkaline Phosphatase, Bone-specific Alkaline Phosphatase, Activated Partial Thromboplastin Time, Prothrombin Time, D-dimer, Platelet count. The relationship between these blood indices and the different stages under different causative factors was compared, and the factors influencing the stages of non-traumatic femoral head necrosis were analyzed using multivariate logistic regression.

RESULTS

(i) Gender, Age and BMI stratification, Low-density Lipoprotein Cholesterol, Triglycerides, Non-High-density Lipoprotein Cholesterol, Apolipoprotein (B), Apolipoprotein (E), Uric Acid, Bone-specific Alkaline Phosphatase, Activated Partial Thromboplastin Time, Plasminogen Time, D-dimer, and Platelet count of the alcohol group were statistically different when compared among the different ARCO staging groups; (ii) The differences in Age and BMI stratification, Triglycerides, Non-High-density Lipoprotein Cholesterol, Apolipoprotein A1, Apolipoprotein B, Apolipoprotein E, Uric Acid, Bone-specific Alkaline Phosphatase, Activated Partial Thromboplastin Time, Plasminogen Time, D-dimer, and Platelet count were statistically significant when compared among the different phases in the hormone group (P < 0.05); (iii) The differences in Age and BMI stratification, Non-High-Density Lipoprotein Cholesterol, Apolipoprotein A1, Apolipoprotein (B), Apolipoprotein (E), Uric Acid, Activated Partial Thromboplastin Time, D-dimer, and Platelet count were statistically significant when compared among the different stages in the idiopathic group (P < 0.05); (v) Statistically significant indicators were included in the multivariate logistic regression analysis, excluding the highly correlated bone-specific alkaline phosphatase, and the results showed that Low-density lipoprotein was negatively correlated with changes in the course of ARCO, and Non-High-Density Lipoprotein cholesterol, Apo B, Activated Partial Thromboplastin Time, and Platelet count were significantly and positively correlated with disease progression.

CONCLUSION

An abnormal hypercoagulable state as well as an abnormal hyperlipidemic state are risk factors for the progression of non-traumatic femoral head necrosis under various exposure factors, as indicated by Non-High-Density Lipoprotein Cholesterol, Apolipoprotein B, Activated Fractional Thromboplastin Time, and Platelet Counts.

Subchondral Bone Plate Classification: A New and More Sensitive Approach for Predicting the Prognosis of Osteonecrosis of the Femoral Head

BACKGROUND

This study explores the impact of subchondral bone plate necrosis on the development of the osteonecrosis of femoral head (ONFH) and its joint collapse.

METHODS

This retrospective study included 76 ONFH patients (89 consecutive hips) with Association for Research on Osseous Circulation stage II who received conservative treatment without surgical intervention. The mean follow-up time was 15.60 ± 12.29 months. ONFH was divided into 2 types (I and II): Type I with a necrotic lesion involving subchondral bone plate and Type II with a necrotic lesion not involving subchondral bone plate. The radiological evaluations were based on plain x-rays. The data were analyzed using SPSS 26.0 statistical software.

RESULTS

The collapse rate in Type I ONFH was significantly higher than that in Type II ONFH (P < 0.001). The survival time of hips with Type I ONFH was significantly shorter than those with Type II ONFH and with the endpoint of the femoral head collapse (P < 0.001). The collapse rate of Type I in the new classification (80.95%) was higher compared with that of the China-Japan Friendship Hospital (CJFH) classification (63.64%), and the difference was statistically significant (χ2 = 1.776, P = 0.024).

CONCLUSION

Subchondral bone plate necrosis is an important factor that affects ONFH collapse and prognosis. Current classification using subchondral bone plate necrosis is more sensitive for predicting collapse compared with the CJFH classification. Effective treatments should be taken to prevent collapse if ONFH necrotic lesions involve the subchondral bone plate.

A new patient-specific overformed anatomical implant design method to reconstruct dysplastic femur trochlea

Patellar luxation with condylar defect is a challenging situation for reconstruction in humans. Patella reluxation, cartilage damage and pain are the most common complications. This study aims to present a new patient specific method of overformed implant design and clinical implantation that prevents luxation of patella without damaging the cartilage in a dog. Design processes are Computer Tomography, Computer Assisted Design, rapid prototyping of the bone replica, creation of the implant with surgeon's haptic knowledge on the bone replica, 3D printing of the implant and clinical application. The implant was fully seated on the bone. Patella reluxation or implant-related bone problem was not observed 80 days after the operation. However, before the implant application, there were soft tissue problems due to previous surgeries. Three-point bending test and finite element analysis were performed to determine the biomechanical safety of the implant. The stress acting on the implant was below the biomechanical limits of the implant. More cases with long-term follow-up are needed to confirm the success of this method in patellar luxation. Compared with trochlear sulcoplasty and total knee replacement, there was no cartilage damage done by surgeons with this method, and the implant keeps the patella functionally in sulcus. This is a promising multidisciplinary method that can be applied to any part of the bone and can solve some orthopaedic problems with surgeon's haptic knowledge.

Application of protective weight-bearing in osteonecrosis of the femoral head: A systematic review and meta-analysis of randomized controlled trials and observational studies

BACKGROUND

The aim of this systematic review and meta-analysis was to estimate the efficacy and prognostic value of protective weight-bearing for ONFH.

METHODS

The authors searched the PubMed, EMBASE and Cochrane Library databases, up to February 25, 2022. RCTs and observational studies on conservative treatment, including the use of crutches, for skeletally mature patients with ONFH and written in English were included. Outcomes were the total hip arthroplasty (THA) rate, collapse rate, Hip Harris score (HHS) and visual analog scale (VAS) score. Cochrane Review Manager Software 5.4 and Stata 15.1 were used to perform the statistical analyses.

RESULTS

A total of 14 studies involving 813 patients (1,025 hips) were included in this meta-analysis. The results showed that the THA rate, collapse rate, HHS and VAS scores in the protective weight-bearing group were not significantly different from those in the surgical group. In the protective weight-bearing group, the results showed that the THA rate was 40%, 8% in ARCO stage II, 37% in ARCO stage III, and the collapse rate was 46%. The mean HHS and VAS score was 80.86 and 1.00, respectively. The HHS score at the 3-, 6-, 12-, and 24-month follow-up was 79.93, 83.94, 85.94, and 96.09 points, respectively, whereas the VAS score at the 6- and 12-month follow-up was 2.20 and 1.29, respectively.

CONCLUSION

Protective weight bearing could achieve satisfactory results in terms of THA rate, collapse rate, HHS and VAS scores. Protective weight-bearing allows most precollapse patients to preserve the hip but also allows postcollapse patients to delay THA or hip-preserving surgery. The effects and prognosis of protective weight-bearing in the short or mid-term are noninferior to surgical hip preservation and are a viable alternative option for osteonecrosis of the femoral head.

Tongue Manifestation in Patients with Osteonecrosis of the Femoral Head: A Cross-sectional Study

OBJECTIVE

Although tongue manifestation is a vital component of Traditional Chinese Medicine (TCM), relevant research on patients with osteonecrosis of the femoral head (ONFH) is still lacking. This study will explore the characteristic tongue manifestation of ONFH patients to inform future research and clinical practice.

METHODS

This is a cross-sectional study. All ONFH patients meeting criteria and their clinical data were collected from the online China osteonecrosis of the femoral head database (CONFHD) since it was created. Organized tongue manifestations of eligible patients through the tongue manifestation acquisition instrument, including tongue shape, tongue color, tongue coating thickness, tongue coating color and tongue coating moisture. We used descriptive analysis for the general information while systematic clustering analysis for the better summary of tongue characteristics.

RESULTS

A total of 375 ONFH patients were included with an average age of 46.3 years. Most patients appeared with enlarged tongue body (54.4%), and the proportions of pale and red tongue (62.4%) were higher than others. Tongue coating were mainly showed as thick (64.5%), white (57.6%) and moist (79.7%). Comparison of tongue shape between different causes of ONFH had a significant statistically difference (P = 0.000). Tongue manifestations could be cluster analyzed into three categories which were matched into four TCM syndromes.

CONCLUSIONS

The tongue manifestation of ONFH patients has a significant change both in tongue body and coating, and different features may be related to the ONFH pathology. This study provides new and valuable tongue informations for a preliminary screening of ONFH patients.

The Role of Structural Deterioration and Biomechanical Changes of the Necrotic Lesion in Collapse Mechanism of Osteonecrosis of the Femoral Head

Osteonecrosis of the femoral head (ONFH) is a crippling disease which is due to a lack of effective therapeutic measures. Its natural progression is rapid, the internal bone structure of the femoral head changes dramatically, and the subsequent fractures and collapse cause severe hip pain and loss of hip function. Femoral head collapse is a critical turning point in the development of ONFH and is related to the prognosis of patients. Early prevention and intervention help to preserve the hip joint and delay femoral head collapse. However, the mechanism of collapse still needs to be further studied because it is affected by different complex factors. This review discusses the underlying causes of femoral head collapse from two aspects: structural degradation and regional changes of biomechanical properties in the necrotic femoral head.

Ultrasonic Intelligent Diagnosis of Papillary Thyroid Carcinoma Based on Machine Learning

Thyroid diseases are divided into papillary carcinoma and nodular diseases, which are very harmful to the human body. Ultrasound is a common diagnostic method for thyroid diseases. In the process of diagnosis, doctors need to observe the characteristics of ultrasound images, combined with professional knowledge and clinical experience, to give the disease situation of patients. However, different doctors have different clinical experience and professional backgrounds, and the diagnosis results lack objectivity and consistency, so an intelligent diagnosis technology for thyroid diseases based on the ultrasound image is needed in clinic, which can give objective and reliable diagnosis opinions on thyroid diseases by extracting the texture, shape, and other information of the image and assist doctors in clinical diagnosis. This paper mainly studies the intelligent ultrasonic diagnosis of papillary thyroid cancer based on machine learning, compares the ultrasonic characteristics of PTMC diagnosed by using the new ultrasound technology (CEUS and UE), and summarizes the differential diagnosis effect and clinical application value of the two technology methods for PTMC. In this paper, machine learning, diffuse thyroid image features, and RBM learning methods are used to study the ultrasonic intelligent diagnosis of papillary thyroid cancer based on machine learning. At the same time, the new contrast-enhanced ultrasound (CEUS) technology and ultrasound elastography (UE) technology are used to obtain the experimental phenomena in the experiment of ultrasonic intelligent diagnosis of papillary thyroid cancer. The results showed that 90% of the cases were diagnosed by contrast-enhanced ultrasound and confirmed by postoperative pathology. CEUS and UE have reliable practical value in the diagnosis of PTMC, and the combined application of CEUS and UE can improve the sensitivity and accuracy of PTMC diagnosis.

Evaluation System of Smart Logistics Comprehensive Management Based on Hospital Data Fusion Technology

With the acceleration of the informatization process, but because of the late start of the informatization construction of logistics management, the current digital system construction of logistics management has not been popularized, and the intelligent logistics integrated management evaluation system is also extremely lacking. In order to solve the lack of existing intelligent logistics comprehensive management evaluation system, this paper introduces the research of intelligent logistics comprehensive management evaluation system based on hospital data fusion technology. This paper analyzes and utilizes the Kalman filter and adaptive weighted data fusion technology in data fusion technology and then analyzes the evaluation index and system design principles of the intelligent logistics comprehensive management evaluation system and then designs the application layer from the application layer. Design the application layer from the application layer. Then design the framework of the intelligent logistics comprehensive management evaluation system at the network layer and the data layer. The system is finally tested, and the test results show that the evaluation accuracy of the system reaches 80%.

Prediction of the Collapse of Necrotic Femoral Head by CT and X-Ray Examinations before Hip Replacement Based on Intelligent Medical Big Data

It was to explore the effect of the CT and X-ray examinations before the hip replacement to predict the collapse of the necrotic femoral head under the classification of medical big data based on the decision tree algorithm of the difference grey wolf optimization (GWO) and provide a more effective examination basis for the treatment of patients with the osteonecrosis of the femoral head (ONFH). From January 2019 to January 2021, a total of 152,000 patients with ONFH and hip replacement in the tertiary hospitals were enrolled in this study. They were randomly divided into two groups, the study sample-X group (X-ray examination results) and based-CT group (CT examination results)-76,000 cases in each group. The actual measurement results of the femoral head form the gold standard to evaluate the effect of the two groups of detection methods. The measurement results of X-ray and CT before hip replacement are highly consistent with the detection results of the physical femoral head specimens, which can effectively predict the collapse of ONFH and carry out accurate staging. It is worthy of clinical promotion.

Lateral pillar is the key in supporting pre-collapse osteonecrosis of the femoral head: a finite element model analysis of propensity-score matched cohorts

Background

This study was designed as a cohort study using propensity-score matching to age, gender, and body mass index (BMI) for finite element model (FEM) analysis from pre-collapse CT images of collapsed and non-collapsed hips. Through FEM analysis, a global graphical output around the hip joint can provide simple impression of stress distribution: concentration or dispersion.

Methods

A total of 32 hips with ARCO stage 2 or 3 ONFH who were on follow up for over a one-year period were retrospectively reviewed. 16 hips with no interval progression of collapse were set as the study group, then 16 hips with progression of collapse which required arthroplasty were set as the control group using propensity-score matching. FEM was generated through Mechanical Finder for each patient, then 4500 N of load was applied to 1000 mm² area at the top of iliac crest to analyze the models in terms of equivalents for yield stress.

Results

Age, sex, and BMI had no significant differences between the two groups, while location (p = 0.015) was lateral, and size (p = 0.015) was significantly greater in the collapsed group. Non-collapsed hips mostly exhibited stress dispersion allocated to medial and lateral pillars, while collapsed hips exhibited stress concentration focused on the lateral pillar and the primary compression trabecula. (p = 0.001).

Conclusion

Through FEM analysis, stress concentration to the lateral pillar and the primary compression trabeculae can be used to predict future collapse in ONFH with high probability. Results provide a simple and intuitive, yet valuable information to aid surgeons. Therefore, especially for young patients, holding out the lateral pillar through joint preserving procedures might be the key in preventing further collapse.

Evaluation of the Effect of PDCA in Hospital Health Management

PDCA plays a very important role in the hygienic management of hospital operating rooms. Before the PDCA management from February 2018 to February 2019, routine hygiene management in the operating room was adopted; after the PDCA management from February 2018 to February 2019, PDCA cycle management was adopted. 500 surgical patients were randomly selected from both groups. We compare the quality control checklist scores of hand hygiene management, environmental hygiene management, medical waste management, and disinfection and isolation management in the routine group and the PDCA group. We also compared the detection rate of pathogenic bacteria in surgical incisions of the routine group and the PDCA group and the infection rate of various surgical incisions, air samples, surface samples, disinfectants, and sterilization rates of sterile items. The PDCA group's hand hygiene management score, environmental hygiene management score, medical waste management score, and disinfection and isolation management score were higher than those in the conventional group (P < 0.05). The detection rate of pathogenic bacteria in the PDCA group, the infection rate of type I, type II, and type III incisions, and the total infection rate of surgical incisions were lower than those in the conventional group, and the difference was statistically significant (P < 0.05). The qualified rate of air samples and surface samples in the PDCA group was higher than that in the conventional group (P < 0.05), and the difference in the qualified rate of disinfectants and sterile items between the two groups was not statistically significant (P > 0.05). The hygiene management of the operating room adopts PDCA sustainable improvement management measures to effectively increase the qualification rate of disinfection and sterilization, reduce the detection rate of pathogenic bacteria and infection rate of surgical incisions, and strengthen the management quality of hand hygiene, environmental hygiene, medical waste, and disinfection and isolation.

Diagnostic Value of SonoVue Contrast-Enhanced Ultrasonography in Nipple Discharge Based on Artificial Intelligence

This paper aims to explore the application value of SonoVue contrast-enhanced ultrasonography based on deep unsupervised learning (DNS) in the diagnosis of nipple discharge. In this paper, a new model (ODNS) is proposed based on the unsupervised learning model and stack self-coding network. The ultrasonic images of 1,725 patients with breast lesions in the shared database are used as the test data of the model. The differences in accuracy (Acc), recall (RE), sensitivity (Sen), and running time between the two models before and after optimization and other algorithms are compared. A total of 48 female patients with nipple discharge are enrolled. The differences in SE, specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of conventional ultrasound and contrast-enhanced ultrasonography are analyzed based on pathological examination results. The results showed that when the number of network layers is 5, the classification accuracies of DNS and ODNS model data reached the highest values, which were 91.45% and 98.64%, respectively.

Biomechanical effect of intertrochanteric curved varus osteotomy on stress reduction in femoral head osteonecrosis: a finite element analysis

Background

Intertrochanteric curved varus osteotomy (CVO) has been widely used to remove the necrotic bone away from the weight-bearing portion in the treatment of osteonecrosis of the femoral head (ONFH). However, whether all types of necrosis will benefit from CVO, in terms of the stress level, the effect of different center-edge (CE) angles of acetabulum on stress distribution of necrosis after CVO, and the relationship between the intact ratio and the stress of necrosis, has never been addressed. The purpose of the study was to evaluate the influence of CVO on the stress reduction in necrotic bone using a finite element analysis (FEA) with different CE angles.

Methods

CVO finite element models of the hip joint were simulated with a lesion of 60°. The osteotomy angles were divided into four configurations (15°, 20°, 25°, and 30°), and three types (A, B, and C1) of lesions were established based on the Japanese Investigation Committee (JIC) classification. In addition, two CE angles (18° and 33°) of acetabulum were considered. The maximum and mean von Mises stress were analyzed in terms of the necrotic bone by a physiological loading condition. Moreover, the correlation of the intact ratio measured in 3D and the stress distribution after CVO was analyzed.

Results

Stress reduction was obtained after CVO. For type B, the CVO angle was 20° (0.61 MPa), and for type C1, the CVO angle was 30° (0.77 MPa), if the mean stress level was close to type A (0.61 MPa), as a standard. The maximum and mean von Mises stress were higher in the CE angle of 18°models, respectively. The intact ratio measured in 3D had a good negative correlation with stress after CVO and had more influence on stress distribution in comparison to other geometric parameters.

Conclusions

For making decisions about the biomechanics of CVO, a CVO angle of > 20° was recommended for type B and > 30° was safe for type C1. The risk of progressive collapse was increased in the insufficient situation of the weight-bearing portion after CVO. The intact ratio could provide information about clinical outcomes and stress distribution after CVO.