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Akhtar Ali K, He L, Li J, Zhang W, Tasiken B, Huang H. MRI spectrum of avascular necrosis of femoral head in patients treated for COVID-19. Hip Int 2024; 34:510-515. [PMID: 38456448 DOI: 10.1177/11207000241233906] [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: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE This prospective observational study aimed to investigate the occurrence of avascular necrosis (AVN) of the femoral head in COVID-19 patients through MRI scans. The study examined the patterns of AVN in 110 individuals who had undergone conventional COVID-19 therapy and reported hip discomfort. This study highlights the importance of considering AVN as a potential complication of COVID-19 therapy, particularly in younger patients who experience hip discomfort. METHODS Individuals who had corticosteroid treatment for COVID-19 and experienced hip discomfort during 6 months between January 2022 and August 2022 were included in this study, and an MRI scan was done to observe changes in the hip joint. RESULTS The results were classified using the Ficat and Arlet classification system. The analysis revealed that AVN was not present in 91.81% of cases. However, Stage I AVN was detected in 4.54% of cases, Stage II AVN in 2.72% of cases, and Stage III AVN in 1.1% of cases. No cases of Stage IV AVN were observed. CONCLUSIONS The study concludes that AVN occurred in 6% of individuals who underwent conventional therapy for COVID-19 and experienced hip discomfort. In these settings (post COVID-19), normal MRI results were more typical, and mild AVN (Stage I) was a frequent finding in MRI scans that were positive.
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Affiliation(s)
- Khan Akhtar Ali
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lingxiao He
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianwen Li
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weikai Zhang
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Hui Huang
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Singh M, Singh B, Sharma K, Kumar N, Mastana S, Singh P. A Molecular Troika of Angiogenesis, Coagulopathy and Endothelial Dysfunction in the Pathology of Avascular Necrosis of Femoral Head: A Comprehensive Review. Cells 2023; 12:2278. [PMID: 37759498 PMCID: PMC10528276 DOI: 10.3390/cells12182278] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Avascular necrosis of the femoral head (ANFH) is a painful disorder characterized by the cessation of blood supply to the femoral head, leading to its death and subsequent joint collapse. Influenced by several risk factors, including corticosteroid use, excessive alcohol intake, hypercholesterolemia, smoking and some inflammatory disorders, along with cancer, its clinical consequences are thrombus formation due to underlying inflammation and endothelial dysfunction, which collaborates with coagulopathy and impaired angiogenesis. Nonetheless, angiogenesis resolves the obstructed free flow of the blood by providing alternative routes. Clinical manifestations of early stage of ANFH mimic cysts or lesions in subchondral bone, vasculitis and transient osteoporosis of the hip, rendering it difficult to diagnose, complex to understand and complicated to cure. To date, the treatment methods for ANFH are controversial as no foolproof curative strategy is available, and these depend upon different severity levels of the ANFH. From an in-depth understanding of the pathological determinants of ANFH, it is clear that impaired angiogenesis, coagulopathy and endothelial dysfunction contribute significantly. The present review has set two aims, firstly to examine the role and relevance of this molecular triad (impaired angiogenesis, coagulopathy and endothelial dysfunction) in ANFH pathology and secondly to propose some putative therapeutic strategies, delineating the fact that, for the better management of ANFH, a combined strategy to curtail this molecular triangle must be composed rather than focusing on individual contributions.
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Affiliation(s)
- Monica Singh
- Division of Molecular Genetics, Department of Human Genetics, Punjabi University, Patiala 147002, India; (M.S.)
| | - Baani Singh
- Division of Molecular Genetics, Department of Human Genetics, Punjabi University, Patiala 147002, India; (M.S.)
| | - Kirti Sharma
- Division of Molecular Genetics, Department of Human Genetics, Punjabi University, Patiala 147002, India; (M.S.)
| | - Nitin Kumar
- Division of Molecular Genetics, Department of Human Genetics, Punjabi University, Patiala 147002, India; (M.S.)
| | - Sarabjit Mastana
- Human Genomics Laboratory, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Puneetpal Singh
- Division of Molecular Genetics, Department of Human Genetics, Punjabi University, Patiala 147002, India; (M.S.)
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Fan Y, Liu X, Zhong Y, Zhang J, Liu Y, Fang H, He W, Zhou C, Chen Z. Evaluation of the predictive values of collapse and necrotic lesion boundary for osteonecrosis of the femoral head prognosis. Front Endocrinol (Lausanne) 2023; 14:1137786. [PMID: 36992802 PMCID: PMC10040974 DOI: 10.3389/fendo.2023.1137786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE Osteonecrosis of the femoral head (ONFH) is a disabling and intractable orthopedic disease largely affecting young and middle-aged groups. Current standard of treatment relies on the collapse of femoral head as a predictor for prognosis. However, a wide range of variability in repair potentials is observed in patients with femoral head collapse. Therefore, the present study aimed to evaluate the accuracy of femoral head collapse as a predictor and to propose the necrotic lesion boundary as a novel yet reliable measure for ONFH prognosis. METHODS A retrospective cross-sectional study was conducted at the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 203 hips with ONFH from 134 patients were included. The occurrences and progression of femoral head collapse were recorded. Necrosis lesion boundary was quantified and classified for each case based on anteroposterior view intact ratio (APIR) and the frog-leg view intact ratio (FLIR) as independent variables. Dependent variables were defined as progressive collapse or terminal collapse for Association Research Circulation Osseous (ARCO) stage II and III respectively. Logistic regression analysis, Receiver Operating Characteristic (ROC) curve and Kaplan-Meier (K-M) survival analysis was performed and results were interpreted. RESULTS Out of the 106 hips in ARCO stage II, 31 hips collapsed with further progression, while 75 hips had no collapse or collapse with repair of the necrotic areas. Out of the 97 hips in ARCO stage IIIA, the collapse continued to progress in 58 hips while the necrotic areas were repaired in 39 hips. Logistic regression analysis demonstrated that both APIR and FLIR, were independent risk factors. Further ROC curve analysis indicated that the cutoff values of APIR and FLIR could be considered as indications for evaluating the prognosis of ONFH. Contrary to the traditional view of poor prognosis after femoral head collapse, K-M survival analysis demonstrated a high value of APIR and FLIR for ONFH prognosis. CONCLUSION The present study found that the occurrence of collapse is an oversimplified predictor for ONFH prognosis. The collapse of the femoral head in ONFH does not predict a poor prognosis. The necrosis lesion boundary has a high value in predicting ONFH prognosis and informing clinical treatment strategies.
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Affiliation(s)
- Yinuo Fan
- The Third Clinical of Medical School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xuejie Liu
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yuan Zhong
- The Third Clinical of Medical School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jiahao Zhang
- The First Clinical of Medical School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yuhao Liu
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hanjun Fang
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wei He
- The Department of Orthopedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- *Correspondence: Wei He, ; Zhenqiu Chen,
| | - Chi Zhou
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhenqiu Chen
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- *Correspondence: Wei He, ; Zhenqiu Chen,
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Karimi M, Moharrami A, Vahedian Aedakani M, Mirghaderi SP, Ghadimi E, Mortazavi SJ. Predictors of Core Decompression Success in Patients with Femoral Head Avascular Necrosis. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:517-523. [PMID: 37674700 PMCID: PMC10479819 DOI: 10.22038/abjs.2022.61327.3011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 09/02/2022] [Indexed: 09/08/2023]
Abstract
Background Avascular necrosis of the femoral head typically occurs in the young population. Core decompression in the precollapse stage provides pain relief and preservation of the femoral head. The results of core decompression vary considerably despite the early diagnosis. Clinicians concur that primary treatment should focus on preserving the natural surface of the joint. This study investigated the predictive risk factors of failure in femoral head decompression. Methods We retrospectively reviewed 135 patients and 207 hips (77 male (127 hips) and 58 female (80 hips)) who underwent core decompression (mean age: 34.7 years [age range: 21-71]) from April 2010 to December 2017. All patients were followed by a mean of 57 months. All hips were in the precollapse stage (Ficat I, II). Results A total of 207 hips were treated with core decompression surgery, and the overall success rate was 58%. The higher grade of Kerboul, Ficat, ARCO classifications, multifocal avascular necrosis of the femoral head, smoking, opium, and corticosteroids were significantly associated with a higher failure rate after core decompression in univariate analysis. In multivariate logistic regression analysis, the Kerboul and Ficat classifications, alcohol consumption, and multifocal avascular necrosis of the femoral head were significantly correlated with core decompression failure. The most common predictive factors in core decompression failure were Ficat II, Kerboul stage 3, multifocal avascular necrosis of the femoral head, and alcohol consumption. Conclusion In conclusion, we had an overall 58 % success rate in core decompression of femoral head avascular necrosis. Based on the results of this study, imaging evaluation and imaging-based classifications are the most valuable predictor factors for the success of core decompression. Consistent with previous reports, corticosteroid was not a significant predictor of core decompression failure.
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Affiliation(s)
- Mehdi Karimi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Moharrami
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Ehsan Ghadimi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sm Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Liu B, Gao F, Xiu X, Wu T, Liu Z, Zhang B, Liu S, Han Y. Denosumab Can Prevent Collapse in Patients with Early-Stage Steroid-Induced Osteonecrosis of the Femoral Head by Inhibiting Osteoclasts and Autophagy. Orthop Surg 2022; 15:256-265. [PMID: 36398455 PMCID: PMC9837242 DOI: 10.1111/os.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/10/2022] [Accepted: 10/16/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The osteoclastic bone resorption inhibitors might have positive effect in preventing femoral head collapse in patients with osteonecrosis of the femoral head (ONFH). However, as a novel osteoclastic inhibitor, whether denosumab can prevent collapse in steroid-induced ONFH remains unknown. This study aims to evaluate the treatment effect of denosumab and the potential protective mechanism. METHODS This was a retrospective study. A total of 161 patients with steroid-induced ONFH who underwent denosumab treatment were reviewed, and 209 untreated patients were selected as controls. Their clinical characteristics and radiological exam results were obtained. Patients were treated with 60 mg denosumab every 6 months for 2 years. The primary outcome was the incidence of femoral head collapse at 2 years after the initial diagnosis of ONFH. Secondary outcomes included the Harris hip score, progression of osteosclerosis, increase in necrotic area, bone marrow oedema relief, and bone mineral density increase in the femoral head. The Mann-Whitney U test and chi-square tests were performed to identify the differences between the continuous and categorical variables, respectively. A multivariate logistic regression model was built to identify the factors associated with the treatment effect of denosumab. RESULTS The incidence of femoral head collapse was 42.24% (68/161) in the denosumab group and 54.07% (113/209) in the control group (χ2 = 5.094, p = 0.024; relative risk = 0.787, 95% CI = 0.627-0.973). The excellent-good rates of the Harris hip score were 63.98% (103/161) in the denosumab group and 44.98% (94/209) in the control group (χ2 = 13.186, p < 0.001). The incidence of osteosclerosis progression in the denosumab group was 55.28% (89/161), which was significantly higher than that in the control group (43.54%, 91/209, χ2 = 5.016, p = 0.025). Meanwhile, a significant increase in bone mineral density was identified in 29.19% (47/161) and 7.18% (15/209) of patients in the denosumab and control groups, respectively (χ2 = 31.600, p < 0.001). The osteoclastic cytoplasm expression of LC3-II was more positive in the control group than in the denosumab group (immunohistochemistry scoring: 3.58 ± 2.27 vs 6.33 ± 2.64, Z = -2.684, p = 0.007). A total of three independent factors were considered to be associated with the positive treatment effect of denosumab, the time of first denosumab administration (OR = 2.010, 95% CI = 1.272-3.177), osteosclerosis (OR = 1.583, 95% CI = 1.024-2.445), and the necrotic area before denosumab administration (medium necrotic area: OR = 2.084, 95% CI = 1.245-3.487; large necrotic area: OR = 2.211, 95% CI = 1.255-3.893). CONCLUSIONS The current study demonstrated that denosumab had a positive effect on preventing femoral head collapse in patients with steroid ONFH. This effect might be closely associated with the inhibition of osteoclasts and their autophagy.
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Affiliation(s)
- Bo Liu
- Department of Osteonecrosis and Hip Surgerythe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Feng Gao
- Department of Pathologythe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Xiaofei Xiu
- Department of Pathologythe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Tao Wu
- Department of Osteonecrosis and Hip Surgerythe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Zeming Liu
- Department of Osteonecrosis and Hip Surgerythe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Bingshi Zhang
- Department of Osteonecrosis and Hip Surgerythe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Sikai Liu
- Department of Osteonecrosis and Hip Surgerythe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Yongtai Han
- Department of Osteonecrosis and Hip Surgerythe Third Hospital of Hebei Medical UniversityShijiazhuangChina
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Osteonecrosis of the Femoral Head. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202205000-00002. [PMID: 35511598 PMCID: PMC9076447 DOI: 10.5435/jaaosglobal-d-21-00176] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/23/2022] [Indexed: 11/18/2022]
Abstract
Osteonecrosis of the femoral head is a progressive and debilitating condition with a wide variety of etiologies including trauma, steroid use, and alcohol intake. Diagnosis and staging are based on imaging including MRI at any stage and plain radiography in more advanced lesions. The only definitive treatment is total hip arthroplasty, although numerous treatments including disphosphonates and core decompression are used to delay the progression. Lack of satisfactory conservative measures suggests the need for additional research of osteonecrosis including large patient registries to further understand this condition.
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Ansari MJ, Bokov D, Markov A, Jalil AT, Shalaby MN, Suksatan W, Chupradit S, AL-Ghamdi HS, Shomali N, Zamani A, Mohammadi A, Dadashpour M. Cancer combination therapies by angiogenesis inhibitors; a comprehensive review. Cell Commun Signal 2022; 20:49. [PMID: 35392964 PMCID: PMC8991477 DOI: 10.1186/s12964-022-00838-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/03/2022] [Indexed: 02/06/2023] Open
Abstract
Abnormal vasculature is one of the most conspicuous traits of tumor tissue, largely contributing to tumor immune evasion. The deregulation mainly arises from the potentiated pro-angiogenic factors secretion and can also target immune cells' biological events, such as migration and activation. Owing to this fact, angiogenesis blockade therapy was established to fight cancer by eliminating the nutrient and oxygen supply to the malignant cells by impairing the vascular network. Given the dominant role of vascular-endothelium growth factor (VEGF) in the angiogenesis process, the well-known anti-angiogenic agents mainly depend on the targeting of its actions. However, cancer cells mainly show resistance to anti-angiogenic agents by several mechanisms, and also potentiated local invasiveness and also distant metastasis have been observed following their administration. Herein, we will focus on clinical developments of angiogenesis blockade therapy, more particular, in combination with other conventional treatments, such as immunotherapy, chemoradiotherapy, targeted therapy, and also cancer vaccines. Video abstract.
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Affiliation(s)
- Mohammad Javed Ansari
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Dmitry Bokov
- Institute of Pharmacy, Sechenov First Moscow State Medical University, 8 Trubetskaya St., bldg. 2, Moscow, 119991 Russian Federation
- Laboratory of Food Chemistry, Federal Research Center of Nutrition, Biotechnology and Food Safety, 2/14 Ustyinsky pr., Moscow, 109240 Russian Federation
| | - Alexander Markov
- Tyumen State Medical University, Tyumen, Russian Federation
- Industrial University, Tyumen, Russian Federation
| | - Abduladheem Turki Jalil
- Faculty of Biology and Ecology, Yanka Kupala State University of Grodno, 230023 Grodno, Belarus
- College of Technical Engineering, The Islamic University, Najaf, Iraq
- Department of Dentistry, Kut University College, Kut, Wasit 52001 Iraq
| | - Mohammed Nader Shalaby
- Biological Sciences and Sports Health Department, Faculty of Physical Education, Suez Canal University, Ismailia, Egypt
| | - Wanich Suksatan
- Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Supat Chupradit
- Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200 Thailand
| | - Hasan S. AL-Ghamdi
- Internal Medicine Department, Division of Dermatology, Albaha University, Al Bahah, Kingdom of Saudi Arabia
| | - Navid Shomali
- Immunology Research Center (IRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Zamani
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mohammadi
- Department of Neurology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Mehdi Dadashpour
- Department of Medical Biotechnology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Zheng Y, Zheng Z, Zhang K, Zhu P. Osteonecrosis in systemic lupus erythematosus: Systematic insight from the epidemiology, pathogenesis, diagnosis and management. Autoimmun Rev 2021; 21:102992. [PMID: 34793961 DOI: 10.1016/j.autrev.2021.102992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/14/2021] [Indexed: 02/08/2023]
Abstract
Osteonecrosis (ON) is one of the serious and well recognized complicationscausing severe pain and disability in patients with systemic lupus erythematosus (SLE), and its manifestation and pathogenesis are only partially understood. This review provide an update of the recent progress in etiology, pathogenesis, diagnosis, and treatment of systemic lupus erythematosus related osteonecrosis (SLE-ON). Despite the concomitant use of corticosteroids, alcohol and obesity, the dysregulated immune micro-environment and the complex pathogenesis of SLE synergistically play important roles in the development of ON. Osteonecrosis of femoral head (ONFH) is the most often involved joint in SLE. The current classification and staging system of ONFH is based on imaging techniques, particularly relating to MRI and CT, for the identification and quantification of necrotic lesions. For SLE-ONFH patients, both SLE specific clinical symptoms and ONFH imaging findings should be comprehensively evaluated. Even though advances concerning bone grafting and arthroplasty procedures have resulted in improved clinical outcomes, early pharmacological treatment at the pre-collapse stage may prevent joint collapse and reduce the joint arthroplasty rate, and this needs to be accounted. Although some progress has been made, considerably more research is needed before we fully understand SLE-ONFH. Future treatments of SLE-ONFH may involve genetic or cell-based therapies that target potential biomarkers, and this will lead to effective measures for saving thefunction of hip joint and preventing osteonecrosis.
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Affiliation(s)
- Yan Zheng
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Shaanxi Province, PR China; National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi Province, PR China
| | - Zhaohui Zheng
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Shaanxi Province, PR China
| | - Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Shaanxi Province, PR China
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Shaanxi Province, PR China; National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi Province, PR China.
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Zhang S, Wang C, Shi L, Xue Q. Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19-Experience and Lessons from the SARS Epidemic. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:983-995. [PMID: 33692615 PMCID: PMC7939498 DOI: 10.2147/dddt.s298691] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/19/2021] [Indexed: 01/08/2023]
Abstract
Summary The recent outbreak of coronavirus disease 2019 (COVID-19) has become a global epidemic. Corticosteroids have been widely used in the treatment of severe acute respiratory syndrome (SARS), and the pathological findings seen in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are very similar to those observed in severe acute respiratory syndrome-related coronavirus (SARS-CoV) infection. However, the long-term use of corticosteroids (especially at high doses) is associated with potentially serious adverse events, particularly steroid-induced avascular necrosis of the femoral head (SANFH). In today’s global outbreak, whether corticosteroid therapy should be used, the dosage and duration of treatment, and ways for the prevention, early detection, and timely intervention of SANFH are some important issues that need to be addressed. This review aims to provide a reference for health care providers in COVID-19 endemic countries and regions. Article Focus Hormones are a double-edged sword. This review aims to provide a reference for health care providers in coronavirus disease 2019 (COVID-19) endemic countries and regions, especially with respect to the pros and cons of corticosteroid use in the treatment of patients with COVID-19. Key Messages In today’s global outbreak, whether corticosteroid therapy should be used, the dosage and duration of treatment, and ways for the prevention, early detection, and timely intervention of SANFH are some important issues that need to be addressed. Strengths and Limitations Since SARS was mainly prevalent in China at that time, many evidences in this paper came from the reports of Chinese scholars. There is a bias in the selection of data, which may ignore the differences in environment, race, living habits, medical level and so on. SANFH may be the result of multiple factors. Whether the virus itself is an independent risk factor for SANFH has not been confirmed. In this paper, through literature retrieval, some reference opinions on glucocorticoid usage, diagnosis and treatment of SANFH are given. However, due to the lack of large-scale research data support, it can not be used as the gold standard for the above problems.
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Affiliation(s)
- Shenqi Zhang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China.,Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Department of Joint and Sports Medicine, Zaozhuang Municipal Hospital Affiliated to Jining Medical University, Shandong, People's Republic of China
| | - Chengbin Wang
- Department of Joint and Sports Medicine, Zaozhuang Municipal Hospital Affiliated to Jining Medical University, Shandong, People's Republic of China
| | - Lei Shi
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Qingyun Xue
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China.,Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Jiang M, Liu L, Xiang X, Liang R, Qin X, Zhao J, Wei Q. An MSC bone-homing compound, Rab001, increases bone mass and reduces the incidence of osteonecrosis in a glucocorticoid-induced osteonecrosis mouse model. Clin Exp Pharmacol Physiol 2020; 48:770-781. [PMID: 33319413 DOI: 10.1111/1440-1681.13441] [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: 08/21/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
Currently, there are no effective medications to either prevent or slow the progression of atraumatic osteonecrosis (ON). The objective of this study is to determine the effects of bone-targeted delivery of mesenchymal stem cells on the prevalence of ON in a glucocorticoid (GC)-induced mouse model. Eight-week-old male BALB/c mice were randomized into groups that received placebo (PL), prednisolone (GC), or concurrent treatments with GC + mesenchymal stromal cells (MSCs), Rab001 or GC + Rab001 + MSCs. Human parathyroid hormone (hPTH) was used as a positive control for bone anabolism. Mice were killed after 30 days, and quantitative measurements of bone mass, bone strength, prevalent ON at the distal femoral epiphysis (DFE) were performed. Angiogenesis was accessed by RNA-Seq, the circulating angiogenic markers, as well as by immunohistochemical staining. We have showed that a novel agent, Rab001 that can noncovalently bind to mesenchymal stem cells (MSC) and direct them to the bone, prevents the incidence of glucocorticoid-induced osteonecrosis in the mouse. In contrast, PTH, a bone anabolic treatment, preserves bone mass but sustains higher ON incidence than Rab001+/- MSC-treated mice. The results of these experiments reveal that glucocorticoids increase the prevalence of ON, and agents that prevent loss of bone vascularity appear to prevent the development of ON. This intervention might be useful in patients with early stages of atraumatic ON.
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Affiliation(s)
- Min Jiang
- Guangxi Laide Kangshun Bio-pharmaceutical Technology Co., Ltd., Nanning, China.,Shanghai Key Laboratory for Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lixian Liu
- Yunnan Vocational and Technical College of Agriculture, Kunming, China
| | - Xuexiang Xiang
- Guangxi Laide Kangshun Bio-pharmaceutical Technology Co., Ltd., Nanning, China
| | - Runmin Liang
- Guangxi Laide Kangshun Bio-pharmaceutical Technology Co., Ltd., Nanning, China
| | - Xuelian Qin
- Guangxi Laide Kangshun Bio-pharmaceutical Technology Co., Ltd., Nanning, China
| | - Jinmin Zhao
- Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China.,Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Qingjun Wei
- Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
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Chinese herbal Huo-Gu formula for the treatment of steroid-associated osteonecrosis of femoral head: A 14-year follow-up of convalescent SARS patients. J Orthop Translat 2020; 23:122-131. [PMID: 32292697 PMCID: PMC7129775 DOI: 10.1016/j.jot.2020.03.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose The coronavirus disease 2019 (COVID-19) reminds us of the severe acute respiratory syndrome (SARS) outbreak in 2003, and up to date, corticosteroid is commonly administrated to severe patients with COVID-19. Osteonecrosis of the femoral head (ONFH) is a common disabling complication among convalescent SARS patients who received corticosteroid therapy. In China, a considerable number of convalescent SARS patients with steroid-associated ONFH had undergone conservative treatment by traditional Chinese medicine, and this study aims to evaluate the long-term results of a spleen-invigorating Huo-Gu formula (HGF) therapy in these patients. Participants and methods A total of 33 convalescent SARS patients (9 males and 24 females) with bilateral steroid-associated ONFH (66 hips) were enrolled in this study. All patients received oral HGF therapy for 6 months when they were confirmed the diagnosis of steroid-associated ONFH. They had been regularly followed up at an interval of 1 year. Harris hip score and medical imaging modalities, including plain radiography, computed tomography and magnetic resonance imaging, were performed to evaluate the outcomes. Results Based on average 14 years of follow-up of HGF therapy (ranging from 6 to 16 years), 38 hips (57%) among the 66 hips developed definite osteoarthritis, and 14 hips (26%) in 53 precollapse hips (Association Research Circulation Osseous [ARCO] Stage I or II) progressed to femoral head collapse (ARCO Stage III or IV). Only five patients (also 5 hips) underwent total hip arthroplasty, and the mean hip survival time was over 15 years by the Kaplan-Meier analysis. We observed a mean Harris hip score of 63 points, which represented the reserve of 55% in pain score and 70% in physical function score. The severity of groin pain was not correlated to the severity of osteoarthritis. Conclusion Chinese herbal HGF therapy demonstrates beneficial effects on preventing femoral head collapse, delaying total hip arthroplasty, and maintaining physical function in the treatment of steroid-associated ONFH. HGF therapy might be therefore a good alternative for the treatment of steroid-associated ONFH secondary to rheumatologic and infection diseases. Translational potential of the article HGF therapy might be a good alternative for the treatment of steroid-associated ONFH secondary to rheumatologic and infectious diseases.
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Messer JG, Jiron JM, Mendieta Calle JL, Castillo EJ, Israel R, Phillips EG, Yarrow JF, Van Poznak C, Kesavalu L, Kimmel DB, Aguirre JI. Zoledronate treatment duration is linked to bisphosphonate-related osteonecrosis of the jaw prevalence in rice rats with generalized periodontitis. Oral Dis 2019; 25:1116-1135. [PMID: 30712276 PMCID: PMC6487955 DOI: 10.1111/odi.13052] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/23/2019] [Accepted: 01/27/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine the extent that zoledronate (ZOL) dose and duration is associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ) prevalence in rice rats with generalized periodontitis (PD), characterize structural and tissue-level features of BRONJ-like lesions in this model, and examine the specific anti-resorptive role of ZOL in BRONJ. MATERIALS AND METHODS Rice rats (n = 228) consumed high sucrose-casein diet to enhance generalized PD. Groups of rats received 0, 8, 20, 50 or 125 µg/kg IV ZOL/4 weeks encompassing osteoporosis and oncology ZOL doses. Rats from each dose group (n = 9-16) were necropsied after 12, 18, 24 and 30 weeks of treatment. BRONJ-like lesion prevalence and tissue-level features were assessed grossly, histopathologically and by MicroCT. ZOL bone turnover effects were assessed by femoral peripheral quantitative computed tomography, serum bone turnover marker ELISAs and osteoclast immunolabelling. RESULTS Prevalence of BRONJ-like lesions was significantly associated with (a) ZOL treatment duration, but plateaued at the lowest oncologic dose, and (b) there was a similar dose-related plateau in the systemic anti-resorptive effect of ZOL. ZOL and BRONJ-like lesions also altered the structural and tissue-level features of the jaw. CONCLUSION The relationship between BRONJ-like lesion prevalence and ZOL dose and duration varies depending on the co- or pre-existing oral risk factor. At clinically relevant doses of ZOL, BRONJ-like lesions are associated with anti-resorptive activity.
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Affiliation(s)
- Jonathan G Messer
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | - Jessica M Jiron
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | | | - Evelyn J Castillo
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | - Ronnie Israel
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | - Ean G Phillips
- Research Service, VA Medical Center, Gainesville, Florida
| | | | | | - Lakshmyya Kesavalu
- Department of Periodontology and Oral Biology, College of Dentistry, Gainesville, Florida
| | - Donald B Kimmel
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | - J Ignacio Aguirre
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
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Wei QS, Hong GJ, Yuan YJ, Chen ZQ, Zhang QW, He W. Huo Xue Tong Luo capsule, a vasoactive herbal formula prevents progression of asymptomatic osteonecrosis of femoral head: A prospective study. J Orthop Translat 2018; 18:65-73. [PMID: 31508309 PMCID: PMC6718872 DOI: 10.1016/j.jot.2018.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/21/2018] [Accepted: 11/28/2018] [Indexed: 12/14/2022] Open
Abstract
Background/objective A prospective cohort study aimed to evaluate the clinical efficacy of a specific vasoactive herbal formula, Huo Xue Tong Luo capsule (HXTL capsule), for the treatment of patients with asymptomatic osteonecrosis of femoral head (ONFH). Methods We evaluated a clinical trial of 55 patients (59 hips) with asymptomatic ONFH (no joint collapse) evaluated by Steinberg staging system and necrosis range classification criteria. Then, they were given HXTL capsule under specific protocol. Among them, 39 males and 16 females with an average age of 36.4 ± 10.1 years were followed up for an average of 4.38 years during treatment. The aggravation of clinical and imaging results was assessed by initial pain and joint collapse. The clinical and imaging outcomes of these patients were compared with those of a historical control group from the literature under critical inclusion criteria. Results At the latest follow-up, initial pain occurred in five of 59 (8.5%) hips of patients taking HXTL capsule compared with 31 of 81 (38.3%) controls (p < 0.001), and joint collapse occurred in 13 of 59 (22.0%) hips of patients taking HXTL capsule compared with 26 of 81 (32.1%) controls (p < 0.001). There was no association between joint collapse and multiple key factors of ONFH. Only the location of type C2 necrotic lesions (hazard ratio, 4.12; 95% confidence interval, 2.64–18.91) and the extent of large necrotic lesions (hazard ratio, 3.39; 95% confidence interval, 1.43–16.21) predicted joint collapse. Conclusion As an agent formulated by vasoactive herbals, HXTL capsule with specific protocol is an effective medicine for relieving hip pain and preventing joint collapse in patients with asymptomatic ONFH. The translational potential of this article The translation potential of this prospective cohort study is that the initially officially approved clinical indication for HXTL capsule for treatment of ONFH is due to its possible effect of revascularization on angiogenesis of necrosis. It is has been now proven to be effective for a new clinical application.
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Affiliation(s)
- Qiu-Shi Wei
- Hip Preserving Ward, No. 3 Orthopaedic Region, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,Institute of Hip Diseases, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Guo-Ju Hong
- Department of Surgery, University of Alberta, Edmonton, Alberta, T6G 2R3, Canada
| | - Ying-Jia Yuan
- Hip Preserving Ward, No. 3 Orthopaedic Region, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Zhen-Qiu Chen
- Hip Preserving Ward, No. 3 Orthopaedic Region, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,Institute of Hip Diseases, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Qing-Wen Zhang
- Hip Preserving Ward, No. 3 Orthopaedic Region, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,Institute of Hip Diseases, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Wei He
- Hip Preserving Ward, No. 3 Orthopaedic Region, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,Institute of Hip Diseases, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
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Lo Gullo A, Talotta R, Atteritano M. Pamidronate Treatment of Osteonecrosis of the Hip in Young Male. Open Rheumatol J 2018; 12:125-128. [PMID: 30197706 PMCID: PMC6118033 DOI: 10.2174/1874312901812010125] [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: 05/17/2018] [Revised: 06/28/2018] [Accepted: 07/04/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Aseptic osteonecrosis of the hip is a clinical entity in which the necrotic process of the bone leads to pain and progressive disability. Objective: Pamidronate seems to reduce drastically the activation of the osteoclasts so that it can be useful only in the early stage of the disease, delaying the time of bone collapsing. Method: A 27-years-old male was treated with pamidronate for three consecutive days every four weeks. Results: After three months the patient came back at control showing a marked improvement in clinical condition, referred full recover from pain and dysmotility with improvement of the quality of life, which was confirmed by the result of MRI he had for control. Conclusion: We reported a case of aseptic osteonecrosis of the hip which was successfully treated pamidronate at dosage of 45 mg.
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Affiliation(s)
- A Lo Gullo
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - R Talotta
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - M Atteritano
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
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Clinical and Radiological Outcomes of Extracorporeal Shock Wave Therapy in Early-Stage Femoral Head Osteonecrosis. Adv Orthop 2018; 2018:7410246. [PMID: 30210874 PMCID: PMC6120295 DOI: 10.1155/2018/7410246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022] Open
Abstract
Objective Femoral head osteonecrosis is a progressive clinical condition with significant morbidity and long-term disability. Several treatment modalities including both surgical and nonsurgical options have been used with variable levels of success. High-energy extracorporeal shock wave therapy is a nonoperative treatment option that has been described for early-stage disease. We aimed to assess the functional and radiological outcomes of extracorporeal shockwave therapy (ESWT) in the treatment of osteonecrosis of the femoral head (ONFH). Methods Thirty-three hips of 21 patients were included in this study. Adult patients with ONFH of any etiology and in the precollapse stage were included. Clinical (visual analogue scale [VAS] and Harris hip score [HHS]) and radiological (plain radiographs and magnetic resonance imaging [MRI]) evaluations were performed before and after intervention. We used 3000–4500 pulses in a single session performed under general anesthesia. Results At an average of 8 months after ESWT, pain scores and HHS were significantly improved compared with the preintervention scores (p<0.001). The overall clinical outcomes were improved in 21 hips (63.3%), unchanged in 5 hips (15.15%), and worsened in 7 hips (21.2%). A trend toward a decrease in the size of the ONFH was observed although not of clinical significance (p=0.235). MRI revealed significant resolution of bone marrow edema (p<0.003). Regression was observed in 9 lesions (42.9%) and progression in 1 lesion (4.7%); no change was observed in the remaining 23 lesions (52.4%). Conclusion ESWT is a viable noninvasive treatment option for early-stage ONFH. It significantly improves clinical outcomes and may halt or delay the radiographic progression of the disease in the precollapse stage.
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Xie K, Mao Y, Qu X, Dai K, Jia Q, Zhu Z, Yan M. High-energy extracorporeal shock wave therapy for nontraumatic osteonecrosis of the femoral head. J Orthop Surg Res 2018; 13:25. [PMID: 29394948 PMCID: PMC5797389 DOI: 10.1186/s13018-017-0705-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/26/2017] [Indexed: 12/25/2022] Open
Abstract
Background Nontraumatic osteonecrosis of the femoral head (ONFH) is treated with a series of methods. High-energy extracorporeal shock wave therapy (ESWT) is an option with promising mid-term outcomes. The objective of this study was to determine the long-term outcomes of ESWT for ONFH. Methods Fifty-three hips in 39 consecutive patients were treated with ESWT in our hospital between January 2005 and July 2006. Forty-four hips in 31 patients with stage I–III nontraumatic ONFH, according to the Association Research Circulation Osseous (ARCO) system, were reviewed in the current retrospective study. The visual analog pain scale (VAS), Harris hip score, radiography, and magnetic resonance imaging were used to estimate treatment results. The progression of ONFH was evaluated by imaging examination and clinical outcomes. The results were classified as clinical success (no progression of hip symptoms) and imaging success (no progression of stage or substage on radiography and MRI). Results The mean follow-up duration was 130.6 months (range, 121 to 138 months). The mean VAS decreased from 3.8 before ESWT to 2.2 points at the 10-year follow-up (p < 0.001). The mean Harris hip score improved from 77.4 before ESWT to 86.9 points at the 10-year follow-up. The clinical success rates were 87.5% in ARCO stage I patients, 71.4% in ARCO stage II patients, and 75.0% in ARCO stage III patients. Imaging success was observed in all stage I hips, 64.3% of stage II hips, and 12.5% of stage III hips. Seventeen hips showed progression of the ARCO stage/substage on imaging examination. Eight hips showed femoral head collapse at the 10-year follow-up. Four hips in ARCO stage III and one hip in ARCO stage II were treated with total hip arthroplasty during the follow-up. Three were performed 1 year after ESWT, one at 2 years, and one at 5 years. Conclusions The results of the current study indicated that ESWT is an effective treatment method for nontraumatic ONFH, resulting in pain relief and function restoration, especially for patients with ARCO stage I–II ONFH.
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Affiliation(s)
- Kai Xie
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanqing Mao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinhua Qu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kerong Dai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingwei Jia
- Affiliated Hospital of Taishan Medical University, Taian, China
| | - Zhenan Zhu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Mengning Yan
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Tao J, Dong B, Yang LX, Xu KQ, Ma S, Lu J. TGF‑β1 expression in adults with non‑traumatic osteonecrosis of the femoral head. Mol Med Rep 2017; 16:9539-9544. [PMID: 29152655 DOI: 10.3892/mmr.2017.7817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/01/2017] [Indexed: 11/05/2022] Open
Abstract
Non-traumatic osteonecrosis of the femoral head (NONFH) is a common clinical osteoarthropathy. The present study aimed to investigate the association between transforming growth factor β1 (TGF‑β1) and NONFH. Femoral head specimens were collected from patients with NONFH. Patients with traumatic osteonecrosis served as the control. Hematoxylin and eosin (H&E) staining was used to visualize the bone tissue architecture. Immunohistochemistry and densitometry were performed to quantify TGF‑β1 expression in tissues. Flow cytometry was used to detect cluster of differentiation (CD)3+, CD4+ and CD8+ cells, and the ratio of CD4+ to CD8+ T cells in the peripheral blood. H&E staining revealed osteonecrosis, disintegration of osteocytes with karyopyknosis and karyorrhexis, loss of osteocyte lacunae, aberrantly arranged circumferential lamellae, as well as dissolution of the lamellae and subtle osteogenesis in the experimental group, as opposed to the control group. Immunohistochemistry revealed that the expression of TGF‑β1 was significantly reduced in the experimental group (P<0.01). Further, the NONFH group had a decrease in the CD3+ and CD4+ cell populations (P<0.05 and P<0.01, respectively), an increase in the CD8+ cell population (P<0.05), as well as a reduction in the ratio of CD4+ to CD8+ cells (P<0.01). The present study indicated that TGF‑β1 expression was reduced in NONFH. This was associated with impaired repairing capacity of the femoral head and dysregulated subsets of T‑lymphocytes and possible immune functions.
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Affiliation(s)
- Jun Tao
- Department of Orthopaedics, Huainan No. 1 People's Hospital, Huainan, Anhui 232007, P.R. China
| | - Bin Dong
- Department of Orthopaedics, Huainan No. 1 People's Hospital, Huainan, Anhui 232007, P.R. China
| | - Li-Xin Yang
- Department of Orthopaedics, Huainan No. 1 People's Hospital, Huainan, Anhui 232007, P.R. China
| | - Ke-Qing Xu
- Department of Orthopaedics, Huainan No. 1 People's Hospital, Huainan, Anhui 232007, P.R. China
| | - Shuai Ma
- Department of Orthopaedics, Huainan No. 1 People's Hospital, Huainan, Anhui 232007, P.R. China
| | - Jun Lu
- Department of Pathogen Biology and Immunology, School of Medicine, Anhui University of Science and Technology, Huainan, Anhui 232001, P.R. China
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Liu T, Ma J, Su B, Wang H, Wang Q, Ma X. A 12-year follow-up study of combined treatment of post-severe acute respiratory syndrome patients with femoral head necrosis. Ther Clin Risk Manag 2017; 13:1449-1454. [PMID: 29089773 PMCID: PMC5656358 DOI: 10.2147/tcrm.s140694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To investigate the long-term efficacy of a combination treatment of alendronate, extracorporeal shock and hyperbaric oxygen for osteonecrosis of the femoral head (ONFH) of post-severe acute respiratory syndrome (SARS) patients. PATIENTS AND METHODS The retrospective study was performed including a total of 37 post-SARS ONFH patients (66 hip joints) in the Department of Orthopedics of the General Hospital of Tianjin Medical University between November 2003 and November 2015, consisting of 6 males (11 hip joints) and 31 females (55 hip joints), with age between 19 and 47 years (average 29.9 years). Visual analog scale (VAS) score, Harris score and Association Research Circulation Osseous (ARCO) stage of imaging examination were compared among those before treatment, and at 1, 3, 6, 9 and 12 years after treatment. Paired t-test was used for statistical analysis of VAS and Harris score before and after treatment. Difference of effective rate on all stages was analyzed with Chi-square test. RESULTS With 12-year follow-up, significant improvements on VAS (6.81 of pre-treatment vs 3.94 of 12-year post-treatment) and Harris score (74.54 of pre-treatment vs 80.14 of 12-year post-treatment) were observed (all p<0.05). Effective rate showed statistical significance among three stages of ARCO (p<0.05). The combined treatment showed different efficacies on different ARCO stages; the best was on ARCO Phase I. CONCLUSION The combined treatment may delay or discontinue the development of ONFH in post-SARS patients.
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Affiliation(s)
- Tiansheng Liu
- Department of Orthopaedic Surgery, The General Hospital of Tianjin Medical University.,Department of Orthopaedic Surgery, Tianjin Hospital
| | | | - Bin Su
- Department of Pneumology, the Affiliated Hospital of Logistics University of PAP, Tianjin, People's Republic of China
| | - Hao Wang
- Department of Orthopaedic Surgery
| | - Qi Wang
- Department of Orthopaedic Surgery
| | - Xinlong Ma
- Department of Orthopaedic Surgery, The General Hospital of Tianjin Medical University.,Department of Orthopaedic Surgery, Tianjin Hospital
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Zhang Q, Liu L, Sun W, Gao F, Cheng L, Li Z. Extracorporeal shockwave therapy in osteonecrosis of femoral head: A systematic review of now available clinical evidences. Medicine (Baltimore) 2017; 96:e5897. [PMID: 28121934 PMCID: PMC5287958 DOI: 10.1097/md.0000000000005897] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Osteonecrosis is an incapacitating disorder with high morbidity. Though extracorporeal shockwave therapy (ESWT) provides a noninvasive treatment option, controversial subjects still exist about its effectiveness, indications, and mechanism of action. METHODS An electronic databases search was performed using PubMed, Embase, and the Cochrane library to collect clinical trials, case reports, and cases series on this topic and then useful data were extracted and appraised by experienced clinicians. We evaluated the quality of included evidences by using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence. RESULTS A total of 17 articles including 2 case reports, 9 open label trials, 2 cohorts, and 6 randomized controlled trials were considered to be eligible for this systematic review. Visual analog scale (VAS), Harris hip scores, and the imaging results were the frequently-used outcome estimates of included studies. CONCLUSION By systematically analyzing these evidences, we could conclude that ESWT could act as a safe and effective method to improve the motor function and relieve the pain of patients with osteonecrosis of femoral hip, especially those at early stage. Imaging revealed that bone marrow edema was significantly relieved, but the necrotic bone could not be reversed after ESWT. This technique could slow or even block the progression of ONFH and therefore reduce the demand for surgery. Collaboration with other conservative modalities would not improve the curative benefits of ESWT. Meanwhile, ONFH with various risk factors showed similar reaction to this noninvasive treatment method. However, these conclusions should be interpreted carefully for the low-quality of included publications and further studies are requisite to validate the effect of ESWT in ONFH.
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Affiliation(s)
- Qingyu Zhang
- Peking Union Medical College, China–Japan Friendship Institute of Clinical Medicine
| | - Lihua Liu
- Peking Union Medical College, China–Japan Friendship Institute of Clinical Medicine
| | - Wei Sun
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China–Japan Friendship Hospital, Chaoyang District, Beijing, China
| | - Fuqiang Gao
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China–Japan Friendship Hospital, Chaoyang District, Beijing, China
| | - Liming Cheng
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China–Japan Friendship Hospital, Chaoyang District, Beijing, China
| | - Zirong Li
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China–Japan Friendship Hospital, Chaoyang District, Beijing, China
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Lespasio MJ, Mont MA, Pierce TP, Guarino A. Osteonecrosis: A Primer. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wu B, Dong Z, Li S, Song H. Steroid-induced ischemic bone necrosis of femoral head: Treatment strategies. Pak J Med Sci 2015; 31:471-6. [PMID: 26101514 PMCID: PMC4476365 DOI: 10.12669/pjms.312.6592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 01/16/2023] Open
Abstract
UNLABELLED Fat hypertrophy, intravascular coagulation, and fat emboli are important risk factors of steroid-induced ischemic bone necrosis (SI-IBN) which may develop during the initial one year after commencing the use of steroids. This pathology is best studied by MRI, particularly for its staging. The cautious strategies such as low dose, oral route, short duration of steroid usage, use of steroid sparing agent, and alcohol avoidance should be followed as a traditional therapy. The objective of this review article was to recognize and evaluate various Treatment strategies for steroid-induced ischemic bone necrosis of femoral head. LITERATURE SEARCH Various electronic databases including PubMed, Google and Cochrane library were comprehensively searched for articles on steroid-induced ischemic bone necrosis of femoral head and its treatment strategies. Ninety four articles were reviewed, examined and importantly appraised and the most appropriate 32 papers were used to write this review article. CONCLUSION Bisphosphonates, alendronate, and hyperbaric oxygen (HBO) treatments have been reported to be effective against IBN. To recommend the regular use of bisphosphonate in IBN patients, more evidences with a larger number of patients are required to verify its therapeutic effectiveness. Core decompression, osteotomy, bone graft and tantalum rod are the surgical approaches for the management of IBN. Advance form of IBN (bone tissue collapse) is advised to be treated with arthroplasty which should be durable, particularly in young patients.
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Affiliation(s)
- Bin Wu
- Bin Wu, FCPS. Second People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou 350003, Fujian Province, China
| | - Zhong Dong
- Zhong Dong, MD. Second People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou 350003, Fujian Province, China
| | - Shuyuan Li
- Shuyuan Li, PhD. Second People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou 350003, Fujian Province, China
| | - Hongmei Song
- Hongmei Song, FCPS. Second People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou 350003, Fujian Province, China
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Comment on “Efficacy of Alendronate for Preventing Collapse of Femoral Head in Adult Patients with Nontraumatic Osteonecrosis”. BIOMED RESEARCH INTERNATIONAL 2015; 2015:354109. [PMID: 26064902 PMCID: PMC4443637 DOI: 10.1155/2015/354109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022]
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