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Treu EA, Sato EH, Omotowa OM, Heaton TB, Erickson JA, Blackburn BE, Peters CL, Anderson LA. Dysplastic Hips That Are Too Late for Periacetabular Osteotomy Are Not Too Early for Total Hip Arthroplasty. J Arthroplasty 2024; 39:S131-S137. [PMID: 38677342 DOI: 10.1016/j.arth.2024.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is often performed in symptomatic patients who have hip dysplasia and do not qualify for periacetabular osteotomy. The impact of osteoarthritis (OA) severity on postoperative outcomes in dysplasia patients who undergo THA is not well described. We hypothesized that dysplasia patients who have mild OA have slower initial recovery postoperatively but similar one-year patient-reported outcome measures (PROMs) compared to dysplasia patients who have severe OA. METHODS We performed a retrospective review at a single academic institution over a 6-year period of patients who have dysplasia who underwent THA compared to patients who have primary OA who underwent THA. There were 263 patients who had dysplasia, compared to 1,225 THA patients who did not have dysplasia. Within the dysplasia cohort, we compared PROMs stratified by dysplasia and OA severity. The diagnosis of dysplasia was verified using the radiographic lateral center edge angle. A minimum one-year follow-up was required. The PROMs were collected through one year postoperatively. Logistic and linear regression models were used, adjusting for age, sex, body mass index, and Charlson comorbidity index. RESULTS No significant differences were found in postoperative PROMs or revision rates (P = .58). When stratified by dysplasia severity, patients who had lower lateral center edge angle had more improvement in physical function scores from preoperative to 2 weeks (P < .01) and higher physical function scores at 2 weeks (P = .03). When stratified by OA severity, patients who had a worse Tönnis score had more improvement in physical function scores from preoperative to 2 weeks (P < .01). Recovery curves in dysplasia patients based on dysplasia and OA severity were not significantly different at 6 weeks, 1 year, and 2 years postoperative. CONCLUSIONS Patients who had hip dysplasia and mild OA had similar recovery curves compared to those who had severe OA or who did not have dysplasia. We believe that THA is a reasonable surgical intervention for symptomatic dysplasia patients who have mild arthritis and do not qualify for periacetabular osteotomy.
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Affiliation(s)
- Emily A Treu
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Eleanor H Sato
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | | | - Tanner B Heaton
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Jill A Erickson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | | | | | - Lucas A Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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Nishi M, Atsumi T, Yoshikawa Y, Nakanishi R, Watanabe M, Kudo Y. Long-term outcomes of the mayo conservative hip system in patients aged 30 years or less with osteonecrosis of the femoral head: mean follow-up of more than 10 years. Arch Orthop Trauma Surg 2024; 144:2823-2830. [PMID: 38709289 DOI: 10.1007/s00402-024-05339-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Historically, total hip arthroplasty (THA) in very young patients has been associated with lower survivorship. However, the long-term outcomes of THA using short stems for osteonecrosis of the femoral head (ONFH) in very young patients remain unclear. Therefore, this study aimed to investigate the long-term outcomes of the Mayo conservative hip system, a short metaphyseal stabilised stem, in patients with ONFH aged ≦30 years. MATERIALS AND METHODS We retrospectively reviewed 104 joints in 76 patients with ONFH who underwent THA using the Mayo conservative hip system with a minimum follow-up of 8 years. The mean follow-up period was 12.5 (range, 8-19) years. Patients were categorised into two age groups (≦30 years, n = 21 and > 30 years, n = 83). Radiographic evaluation was used to assess stem sinking, stress shielding, and spot welds. The clinical evaluations were performed using the Japanese Orthopedic Association (JOA) hip score. Postoperative major complication and revision surgery rates were also assessed. RESULTS The patient characteristics were similar between the two groups, except for the age. Revision surgeries were performed in five cases, with similar implant survival rates between the groups. Dislocations occurred in the older age group alone (four joints). One case of intra-operative periprosthetic femoral fracture was found in the younger age group. Stem sinking of > 3 mm occurred in one and seven joints in the younger and older age groups, respectively. Spot welds were observed in most joints (93.2%) in modified Gruen zones 2 and 6 without significant differences between the groups. Stress shielding showed no significant differences in the frequency of occurrence or location between the two groups. Furthermore,the JOA score showed no significant difference between the two groups. CONCLUSION The use of short stems in patients aged ≤ 30 years with ONFH showed favourable long-term outcomes.
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Affiliation(s)
- Masanori Nishi
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.
- Department of Orthopaedic Surgery, Sassa General Hospital, 4-24-15 Tanashicyo, Nishitokyo-shi, Tokyo, 188-0011, Japan.
| | - Takashi Atsumi
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
- Department of Orthopaedic Surgery, Sassa General Hospital, 4-24-15 Tanashicyo, Nishitokyo-shi, Tokyo, 188-0011, Japan
| | - Yasushi Yoshikawa
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Ryosuke Nakanishi
- Department of Orthopaedic Surgery, Sassa General Hospital, 4-24-15 Tanashicyo, Nishitokyo-shi, Tokyo, 188-0011, Japan
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City, Kanagawa, 227-8501, Japan
| | - Minoru Watanabe
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City, Kanagawa, 227-8501, Japan
| | - Yoshifumi Kudo
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
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Girardi NG, Kraeutler MJ, Lee JH, Merkle AN, Mei-Dan O. Arthroscopic Femoral Head Allograft With Proximal Femoral/Periacetabular Osteotomies for Sequelae of Perthes: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00011. [PMID: 38635784 DOI: 10.2106/jbjs.cc.23.00582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
CASE We describe the unique case of a 20-year-old man with a history of Legg-Calve-Perthes disease, hip dysplasia, and osteochondral fragmentation of the medial femoral head. We performed arthroscopic femoroplasty and femoral head allografting, followed by a valgus-producing derotational femoral osteotomy (DFO) and periacetabular osteotomy (PAO). At 1-year follow-up, the patient achieved osseous union and complete femoral head healing with return to his active hobbies. CONCLUSION We describe the successful utilization of arthroscopic allografting for medial femoral head osteochondral fragmentation. To our knowledge, this is the first report on femoral head arthroscopic allografting before DFO and PAO.
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Affiliation(s)
- Nicholas G Girardi
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Matthew J Kraeutler
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jessica H Lee
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Alex N Merkle
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Parilla FW, Anthony CA, Bartosiak KA, Pashos GE, Thapa S, Clohisy JC. Ten Year Outcomes of Contemporary Total Hip Arthroplasty in Adolescent and Young Adult Patients are Favorable. J Arthroplasty 2024; 39:754-759. [PMID: 37778641 DOI: 10.1016/j.arth.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess 10-year patient-reported outcome measures, complications, polyethylene wear-rates, and implant survivorships in patients ≤30 years of age treated with contemporary total hip arthroplasty (THA). METHODS We retrospectively assessed 121 patients (144 hips) who underwent THA at age ≤30 years (mean 23 [range, 11 to 30]) at an average follow-up duration of 10.7 years (range, 8 to 17). Highly-crosslinked polyethylene acetabular liners were used in all cases. Femoral heads were ceramic (74%) or cobalt-chrome (26%). There were 52 hips (36%) that had previous surgery and 31 hips (22%) were in patients who had associated major systemic comorbidities. We analyzed the modified Harris Hip scores, University of California Los Angeles Activity Scores, major complications, polyethylene wear-rates, and implant survivorships. RESULTS At final follow-up, the average modified Harris Hip scores improved from 47 (±15.1) to 81 (±19.5) with an average 34-point improvement. The University of California Los Angeles scores improved from 4.0 (±2.3) to 6.0 (±2.4). The major complication rate was 5.6%. There were 6 hips (4.2%) that were revised. Indications for revision included instability (3, 2.1%), late infection (1, 0.7%), liner dissociation (1, 0.7%), and acetabular loosening (1, 0.7%). Mean linear (0.0438 mm/y) and volumetric (29.07 mm3/y) wear rates were low. No periprosthetic osteolysis was detected in any hip. Survivorship free from revision for any reason was 97.2, 95.8, and 95.8% at 5, 10, and 15 years. CONCLUSIONS Contemporary THA in patients ≤30 years of age is associated with marked clinical improvements at 10-year follow-up and encouraging survivorship estimates at 15 years.
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Affiliation(s)
- Frank W Parilla
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Chris A Anthony
- Penn Orthopaedics at Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kimberly A Bartosiak
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gail E Pashos
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Susan Thapa
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Wang JC, Liu KC, Gettleman BS, Chen M, Piple AS, Yang J, Heckmann ND, Christ AB. Characteristics of Very Young Patients Undergoing Total Hip Arthroplasty: A Contemporary Assessment. Arthroplast Today 2024; 25:101268. [PMID: 38235399 PMCID: PMC10792167 DOI: 10.1016/j.artd.2023.101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 01/19/2024] Open
Abstract
Background This study aims to compare indications, patient characteristics, hospital factors, and complication rates between total hip arthroplasty (THA) patients aged 30 years or younger and those older than 30 years using a large national database. Methods The Premier Healthcare Database was utilized to identify primary THA patients from 2015 to 2021 who were aged ≤30 or >30 years. Patient demographics, hospital factors, and primary indications were compared for each cohort. Rates of complications and readmissions were assessed for each cohort by primary indication. Differences were assessed through univariate analysis. Results Overall, 539,173 primary THA patients were identified (age ≤30: 1849; >30: 537,234). Compared to the >30 cohort, the ≤30 cohort was more likely to be male (56.5% vs 44.9%, P < .001) and non-White (34.0% vs 14.2%, P < .001). The most common indications for THA in the ≤30 cohort were osteonecrosis (49.3%), osteoarthritis (17.8%), and congenital hip deformities (16.0%), and in the >30 cohort, they were osteoarthritis (77.0%), other arthritis (11.3%), and osteonecrosis (5.4%). Patients aged ≤30 years had lower rates of respiratory failure (0.16% vs 0.57%, P < .001), acute renal failure (0.32% vs 1.72%, P < .001), and urinary tract infection (0.38% vs 1.11%, P = .003) than those aged >30 years, but higher rates of wound dehiscence (0.59% vs 0.29%, P = .015) and transfusion (3.68% vs 2.21%, P < .001). There were no differences in 90-day readmission rates (P = .811) or 90-day in-hospital death (P = .173) between cohorts. Conclusions Younger patients undergoing THA differed significantly in indication, patient characteristics, and hospital factors compared to the older population on univariate analysis. Despite differences in indications, the cohorts did not differ markedly with regard to complication rates in this study.
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Affiliation(s)
- Jennifer C. Wang
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Kevin C. Liu
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | | | - Matthew Chen
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Amit S. Piple
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Jaewon Yang
- University of Washington Medical Center, Seattle, WA, USA
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Hamdi W, Ferjani H, Carlomagno R, Dusser P, Echaubard S, Belot A, Bouayed K, Wouters C, Richer O, Hentgen V, Lohse A, Dan D, Kaiser D, Barbier C, Cannizzaro E, Poignant S, Melki I, Hofer M. Factors associated with poor prognosis of hip arthritis in juvenile idiopathic arthritis: Data from the JIR cohort. Musculoskeletal Care 2023; 21:806-814. [PMID: 36896923 DOI: 10.1002/msc.1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES Hip involvement remains a predictor of severe juvenile idiopathic arthritis (JIA) course and carries a high risk of disability. This study aims to determine the factors of poor prognosis of hip involvement in patients with JIA and to assess the treatment response. METHODS This is a multicenter observational cohort study. Patients were selected from the JIR Cohort database. Hip involvement was defined as clinically suspected and confirmed by an imaging tool. Follow-up data were collected during 5 years. RESULTS Among the 2223 patients with JIA, 341(15%) patients had hip arthritis. Male gender, enthesitis-related arthritis, and North African origin were factors associated with hip arthritis. Hip inflammation was associated with disease activity parameters during the first year, particularly Physician Global Assessment, joint count, and inflammatory marks. Structural hip progression was associated with early onset of the disease, a longer time to diagnosis, geographic origin, and JIA subtypes. Anti-TNF therapy was found to be the only treatment able to effectively reduce structural damage progression. CONCLUSION The early onset diagnostic delay, origin, and systemic subtype of JIA predict a poor prognosis of hip arthritis in children with JIA. The use of anti-TNF was associated with a better structural prognosis.
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Affiliation(s)
- Wafa Hamdi
- Rheumatology Department, Kassab Orthopedics Institute, Faculty of Medicine of Tunis, University Tunis El Manar, Research Unit UR17SP0, Ksar Said, Tunis, Tunisia
| | - Hanene Ferjani
- Rheumatology Department, Kassab Orthopedics Institute, Faculty of Medicine of Tunis, University Tunis El Manar, Research Unit UR17SP0, Ksar Said, Tunis, Tunisia
| | - Raffaella Carlomagno
- Paediatric Rheumatology, University of Basel, University Children's Hospital, Basel, Switzerland
| | - Perrine Dusser
- Department of Paediatric Rheumatology, Bicêtre Hospital, APHP, National Reference Centre for Auto-inflammatory Diseases, Le Kremlin-Bicêtre, University of Paris Sud, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children (RAISE), Lyon, France
| | | | - Carine Wouters
- Pediatric Rheumatology, University Hospital Leuven, Leuven, Belgium
| | - Olivier Richer
- Pediatric Emergency Department of the University Hospital Pellegrin, Bordeaux, France
| | - Véronique Hentgen
- Reference Center for Autoinflammatory Diseases (CEREMAI), Versailles Hospital, Le Chesnay, France
| | - Anne Lohse
- Rheumatology Department, Nord France-Comité Hospital, Trevenans, France
| | - Diana Dan
- Department of Rheumatology, Immunology, and Allergology, University Hospital, University of Bern, Bern, Switzerland
| | - Daniela Kaiser
- Luzerner Kantonsspital, Kinderspital, Luzern, Switzerland
| | | | | | | | - Isabelle Melki
- Department of Infectious Disease and Internal Medicine, Reference Center for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), University Hospital, AP-HP, Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
| | - Michaël Hofer
- Pediatric Rheumatology, University Children's Hospital, Zurich, Switzerland
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Konopitski A, Okafor C, Smith B, Baldwin K, Sheth NP. Evolution of total hip arthroplasty in patients younger than 30 years of age: A systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:1081-1094. [PMID: 35129653 DOI: 10.1007/s00402-022-04357-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION While surgical technique and implant technology for total hip arthroplasty (THA) has improved over the years, it is unclear whether recent progress has translated to improved clinical outcomes for young patients. The goal of this study is to determine trends in (1) indications, (2) surgical technique (3) clinical and radiographic outcomes, and (4) survivorship for THA in patients younger than 30 years of age. METHODS MedLine, Cochrane, EMBASE, and Google Scholar were searched using several key phrases for articles focusing on THA performed on patients younger than 30 years of age between 1971 and 2020. A total of 34 qualifying articles were identified and stratified into three groups according to operative years and compared to one another on the basis of (1) indications; (2) fixation technique; (3) implant design; (4) clinical and radiographic outcomes; and (7) survivorship. RESULTS The mean patient age at index THA were 20.5 (9-30), 22.1 (11-30) and 21.5 (10-30) years, respectively, for each study group. Over time, patients underwent fewer THAs for JRA (Juvenile Rheumatoid Arthritis) (p < 0.001) but more for post-treatment and iatrogenic avascular necrosis (p < 0.001; p < 0.001). Early THAs primarily used metal on UHMWPE (Ultra high molecular weight polyethylene) (71.7%, p < 0.001), modern THA predominantly use ceramic on HXLPE (Highly cross-linked polyethylene) (42.5%, p < 0.001). Early fixation methods used cement (60.4%, p < 0.001), and modern fixation primarily use press fit technology (95.9%, p < 0.001). Prevalence of radiographic loosening decreased significantly (p < 0.001) over time. There was no significant difference in clinical improvement on HHS. Lastly, fewer patients required THA revision in recent decades (p < 0.001). CONCLUSIONS Advances in surgical technique and technology have served to improve implant longevity. Surprisingly, subjective clinical scores showed no significant improvement over time, suggesting that early iterations of THA were extremely successful.
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Affiliation(s)
- Andrew Konopitski
- Department of Orthopaedic Surgery, St. Luke's University Medical Center, 801 Ostrum St., Bethlehem, PA, 18015, USA.
| | - Chielozor Okafor
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA, 19104, USA
| | - Brendan Smith
- Department of Orthopaedic Surgery, St. Luke's University Medical Center, 801 Ostrum St., Bethlehem, PA, 18015, USA
| | - Keith Baldwin
- Penn Medicine University City, 7th Floor, 3737 Market Street, Philadelphia, PA, 19104, USA
| | - Neil P Sheth
- Pennsylvania Hospital, 1 Cathcart, 800 Spruce Street, Philadelphia, PA, 19107, USA
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Varkaneh ZK, Karampourian A, Oshvandi K, Basiri Z, Mohammadi Y. The effect of eucalyptus inhalation on pain and the quality of life in rheumatoid arthritis. Contemp Clin Trials Commun 2022; 29:100976. [PMID: 36060153 PMCID: PMC9428835 DOI: 10.1016/j.conctc.2022.100976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/16/2022] [Accepted: 08/07/2022] [Indexed: 11/25/2022] Open
Abstract
Problem considered Pain is one of the most significant symptoms of rheumatoid arthritis that reduce the quality of life. The purpose of the study was to determine the effect of eucalyptus on pain and the quality of life in patients with rheumatoid arthritis. Methods In this randomized clinical trial, 70 patients with rheumatoid arthritis were selected by random sampling. In the eucalyptus group, 1 mL of eucalyptus oil was inhaled for 5 min, 3 times a day, for one month. The control group received placebo inhalation. Both groups used routine treatments. Data were collected using a questionnaire of demographics, the numerical pain rating scale (NRS), and Quality of Life (SF-12). Statistical analysis was done using 19th edition SPSS software and applied on paired t-test, chi-square, Fisher's exact test, and analysis of covariance. Results The mean score of pain severity in the eucalyptus group significantly decreased in comparison with the control group (P < 0.001). The severity of pain there was no statistical difference in both groups before, the first, and the second weeks after the intervention, (p > 0.05); however, in the third and fourth weeks after the intervention, the mean severity of pain in the eucalyptus group was lower than in the control group, and these differences were statistically significant between the two groups (p < 0.05). Also, the patients' quality of life in the eucalyptus group was increased significantly (P < 0.001). Conclusion The eucalyptus leads to pain reduction, and consequently, improves the quality of life of patients with rheumatoid arthritis. Trial registration IRCT20160110025929N15 Registration date: 2018-10-07; https://en.irct.ir/trial/33573.
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Affiliation(s)
- Zahra Kord Varkaneh
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arezou Karampourian
- Urology and Nephrology Research Center, Chronic Diseases (Home Care) Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Chronic Diseases (Home Care) Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Basiri
- Department of Internal Medicine, School of Medicine, Shahid Beheshti Medical Educational Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Younes Mohammadi
- Department of Epidemiology, School of Public Health, Modeling of Non Communicable Diseases Research Center, Health Sciences & Technology Research Institute, Hamadan University of Medical Sciences, Hamadan, Iran
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Liu N, Zheng C, Wang Q, Huang Z. Treatment of non-traumatic avascular necrosis of the femoral head (Review). Exp Ther Med 2022; 23:321. [PMID: 35386618 PMCID: PMC8972838 DOI: 10.3892/etm.2022.11250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/26/2022] [Indexed: 11/06/2022] Open
Abstract
Non-traumatic osteonecrosis of the femoral head is the main cause of disability in young individuals and incurs major health care expenditure. The lifestyle changes in recent years, especially increased use of hormones and alcohol consumption, has greatly increased the incidence of femoral head necrosis. The underlying causes and risk factors of osteonecrosis of the femoral head are increasingly being elucidated, which has led to the development of novel surgical and non-surgical treatment options. Although the main goal of any treatment method is prevention and delaying the progression of disease, there is no common consensus on the most suitable method of treatment. The present review discussed the latest developments in the etiology and treatment methods for femoral head necrosis.
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Affiliation(s)
- Ning Liu
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | | | - Qinglong Wang
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Zhipeng Huang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, Shaanxi 710000, P.R. China
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Acetabular Coverage May Affect Radiographic and Clinical Outcomes of Osteochondral Allograft Transplantation of Focal Femoral Head Lesions: A Case Series From a Single Institution. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202110000-00008. [PMID: 34637410 DOI: 10.5435/jaaosglobal-d-20-00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/22/2021] [Indexed: 11/18/2022]
Abstract
Osteochondral lesions of the femoral head in young people are rare and present unique management challenges. Optimal treatment for these lesions is unclear. From 2009 to 2016, clinical and radiographic outcomes were prospectively collected within a series of symptomatic focal osteochondral lesions of the femoral head with a minimum follow-up of 2 years. A surgical hip dislocation followed by implantation of a size-matched fresh osteochondral femoral head allograft was performed. Nine hips in eight patients (6 female patients) underwent surgery at an average of 17 years (11 to 21 years). Individual allograft sizes ranged from 10 to 35 mm in diameter; with 2 of 9 hips receiving two allografts in a stacked or mosaicplasty technique at the time of treatment. The average graft implantation was 3536.5 mm2. Modified Harris hip scores improved by 13.4 (P = 0.018) from preoperative to final follow-up for all patients. Significant improvements in internal rotation (12° versus 23°, P = 0.011), external rotation (32° versus 50°, P = 0.041), and abduction (28° versus 40°, P = 0.042) were also achieved. Three patients (four hips) demonstrated poor radiographic healing (<50% incorporation at 2 years), which correlated with worse clinical outcomes and was associated with a lower preoperative lateral center edge angle (21.5° versus 30.4°, P = 0.049). Fresh osteochondral allograft treatment is a good option for focal osteochondral lesions of the femoral head with improved outcomes and motion; however, higher failure rates may be seen in those with a lower center edge angle.
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A case report of femoral head fracture with osteochondral lesion treated by osteosynthesis and biomimetic scaffold: 2-year clinical and radiological follow-up. J Exp Orthop 2021; 8:48. [PMID: 34212301 PMCID: PMC8249539 DOI: 10.1186/s40634-021-00362-x] [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: 03/23/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
The aim of the present study was to present clinical and radiological outcome of a hip fracture-dislocation of the femoral head treated with biomimetic osteochondral scaffold. An 18-year-old male was admitted to the hospital after a motorcycle-accident. He presented with an obturator hip dislocation with a type IVA femoral head fracture according to Brumback classification system. The patient underwent surgery 5 days after accident. The largest osteochondral fragment was reduced and stabilized with 2 screws, and the small fragments were removed. The residual osteochondral area was replaced by a biomimetic nanostructured osteochondral scaffold. At 1-year follow-up the patient did not complain of hip pain and could walk without limp. At 2-year follow-up he was able to run with no pain and he returned to practice sports. Repeated radiographs and magnetic resonance imaging studies of the hip showed no signs of osteoarthritis or evidence of avascular necrosis. A hyaline-like signal on the surface of the scaffold was observed with restoration of the articular surface and progressive decrease of the subchondral edema. The results of the present study showed that the biomimetic nanostructured osteochondral scaffold could be a promising and safe option for the treatment of traumatic osteochondral lesions of the femoral head. Study Design: Case report.
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[Therapeutic options in juvenile idiopathic arthritis : Surgical and conservative orthopedic rheumatological treatment]. Z Rheumatol 2021; 80:467-480. [PMID: 33881586 DOI: 10.1007/s00393-021-00996-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
The treatment of juvenile idiopathic arthritis (JIA) has made substantial progress within the last 25 years. Modern medicinal treatment enables inflammatory activity of the disease to be controlled in most of the cases. Mutilating courses of disease, which were formerly the rule have now become the exception. Today remission of disease is the aim of pediatric rheumatological treatment. Apart from effective control of inflammation this includes complete restoration of functional abilities of affected joints and the surrounding structures also affected. To achieve this goal a holistic and foresighted view of each patient's course is required. Therefore, even in an apparently uncomplicated course of disease in some cases of JIA it is advisable to plan an early interdisciplinary consultation including the pediatric rheumatologist and the orthopedic surgeon, in order to discuss an early surgical intervention, which can then be carried out in a timely manner, if necessary. This article provides an overview of the orthopedic rheumatological indications and options.
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Goodman SB. The Hip in Juvenile Idiopathic Arthritis. Open Orthop J 2020. [DOI: 10.2174/1874325002014010088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
The hip joint is commonly affected in Juvenile Idiopathic Arthritis (JIA), especially in cases of systemic polyarticular disease. Chronic synovitis of the hip leads to joint destruction, therefore, systemic and local control of the disease is of paramount importance. Non-steroidal anti-inflammatory drugs, Disease Modifying Anti-Rheumatic Drugs (DMARDs), biologics, intra-articular corticosteroid injections, and physical therapy are the mainstay for controlling ongoing inflammation and hip joint contractures. Synovectomy with soft tissue releases is useful in the early stages of the disease, when the joint cartilage is largely preserved. Total joint arthroplasty (THA) is successful in relieving pain, and improving function, ambulation and range of motion in end-stage degenerative arthritis. With improved designs of smaller prostheses and modern bearing couples, it is hoped that the longevity of THA will facilitate a more normal and enduring lifestyle.
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