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Zhang C, Xiong B, Wang J, Li Y, Xie B, Liu D, Zhang G, Chen W, He H. Factors influencing the survival status of the hip joint in post-collapse femoral head necrosis. J Orthop Surg Res 2024; 19:472. [PMID: 39127688 DOI: 10.1186/s13018-024-04964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Despite hip function typically deteriorating in the post-collapse stage of osteonecrosis of the femoral head (ONFH), some patients can still demonstrate long-term favorable hip function, a state termed "survival with collapse". This study aims to identify the characteristics of patients suitable for "survival with collapse" in cases of ONFH. METHODS This cross-sectional study included 65 patients (87 hips) diagnosed with post-collapse ONFH for ≥ 3 years (average 9.1 years, range 3-23 years). Hip function was assessed using the Harris Hip Score (HHS). Demographic, clinical, and radiographic data were compared between the favorable group (HHS > 80) and the poor group (HHS ≤ 80). Independent protective factors for hip function were identified by multivariate analysis and receiver operating characteristic (ROC) curve analysis was further applied to evaluate these factors' diagnostic efficacy. RESULTS The favorable and poor groups included 46 and 41 hips, respectively. Significant differences were found in body mass index (BMI), Association Research Circulation Osseous (ARCO) stage, collapse degree, Japanese Investigation Committee (JIC) classification, necrotic size, and hip subluxation between the two groups (p < 0.05). Multivariate logistic regression identified collapse < 3 mm(OR:14.49, 95%CI: 3.52-59.68, p < 0.001), JIC types B (OR: 11.08, 95% CI: 1.07-115.12, p < 0.05) and C1(OR: 5.18, 95% CI: 1.47-18.20, p < 0.05) as independent protective factors for hip function, while BMI (OR: 0.76, 95% CI: 0.59-0.97, p = 0.029) was an independent risk factor. ROC curve analysis demonstrated that both collapse degree (AUC = 0.798, sensitivity = 91.3%, specificity = 68.3%, p < 0.0001) and JIC classification (AUC = 0.787, sensitivity = 80.4%, specificity = 73.2%, p < 0.0001) had satisfactory diagnostic value for hip function. Combining JIC classification and collapse degree (AUC = 0.868, sensitivity = 76.1%, specificity = 85.4%, p < 0.0001) significantly enhanced diagnostic efficacy compared to using either alone (p < 0.05). CONCLUSION In ONFH, femoral head collapse does not necessarily determine a poor prognosis. Patients with mild collapse (< 3 mm) and preserved anterolateral wall are more likely to retain satisfactory hip function, making them candidates for "survival with collapse."
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Affiliation(s)
- Cheng Zhang
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Binglang Xiong
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Junyu Wang
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Yan Li
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Bin Xie
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Daobing Liu
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Guangyi Zhang
- Beijing University of Chinese Medicine, No.11 North Third Ring Road East, Chaoyang District, Beijing, 100029, China
| | - Weiheng Chen
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, No.51 Xiaoguan Street, outside Andingmen, Chaoyang District, Beijing, 100029, China
| | - Haijun He
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China.
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Huang Y, Gu C, Xi H, Chen H, Gao F, Yuan X, Guo M, Mai J, Liu X, Du B. Sclerosis rim volume ratio and Japanese Investigation Committee classification as predictive factors for femoral head collapse progression after non-vascularized fibular grafting in osteonecrosis patients. Asian J Surg 2024; 47:250-255. [PMID: 37661477 DOI: 10.1016/j.asjsur.2023.08.107] [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: 03/01/2023] [Revised: 06/22/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE The purpose of this retrospective cohort study was to determine the relationship between sclerosis rim volume ratio (SVR) and the progression of femoral head collapse after non-vascularized fibular grafting (NVFG) surgery in patients with osteonecrosis of the femoral head (ONFH), investigating risk factors associated with femoral head collapse progression and establishing a predictive model to enhance clinical decision-making. METHODS ONFH patients who underwent NVFG between January 2008 and December 2021 were analyzed retrospectively to assess the risk of post-operative collapse progression (collapse >2 mm). A logistic regression model was used to evaluate the independent risk factors associated with collapse progression, including age, sex, etiology, affected side, Japanese Investigation Committee classification (JIC), and the sclerosis rim volume ratio (SVR). SVR values was collected from three weight-bearing columns, namely SVR1, SVR2, and SVR3, respectively. RESULTS 57 patients with 64 hips who had undergone NVFG and were followed up for at least one year were included. During the follow-up, collapse>2 mm occurred in 30 hips (46.88%). Multivariable analysis revealed that JIC (p =0.037) and SVR1 (p = 0.04) were independent risk factors for collapse progression after NVFG. The results of the receiver operating characteristic (ROC) analysis indicated that the aforementioned indices provided a satisfactory prediction of early femoral head collapse progression in ONFH patients after NVFG. The regression model using the above two indicators as a composite index showed satisfactory performance in predicting early postoperative femoral head collapse progression, with an area under the curve (AUC) of 84.6%. CONCLUSIONS SVR is significant predictor of post-operative collapse progression following NVFG, and the composite index provides an optimal predictive value for femoral head collapse progression after surgery.
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Affiliation(s)
- Yixuan Huang
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Changyuan Gu
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Hongzhong Xi
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Hao Chen
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Feifei Gao
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Xinwei Yuan
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Mingbin Guo
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Jianbin Mai
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Xin Liu
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China.
| | - Bin Du
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Orthopedics, Nanjing, 210029, China; Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China.
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Lu Y, Chen X, Lu X, Sun C, Li M, Chen G, Long Z, Gao Y, Zhang H, Huang M, Ji C, Fan H, Liu D, Hao Y, Wang H, Zhang L, Zhang H, Lu J, Wang Z, Li J. Reconstructing avascular necrotic femoral head through a bioactive β-TCP system: From design to application. Bioact Mater 2023; 28:495-510. [PMID: 37408798 PMCID: PMC10318430 DOI: 10.1016/j.bioactmat.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 07/07/2023] Open
Abstract
A variety of techniques have been used for treating avascular necrosis of the femoral head (ANFH), but have frequently failed. In this study, we proposed a β-TCP system for the treatment of ANFH by boosting revascularization and bone regeneration. The angio-conductive properties and concurrent osteogenesis of the highly interconnected porous β-TCP scaffold were revealed and quantified through an in vivo model that simulated the ischemic environment of ANFH. Mechanical test and finite element analysis showed that the mechanical loss caused by tissue necrosis and surgery was immediately partially compensated after implantation, and the strength of the operated femoral head was adaptively increased and eventually returned to normal bone, along with continuous material degradation and bone regeneration. For translational application, we further conducted a multi-center open-label clinical trial to assess the efficacy of the β-TCP system in treating ANFH. Two hundred fourteen patients with 246 hips were enrolled for evaluation, and 82.1% of the operated hips survived at a 42.79-month median follow-up. The imaging results, hip function, and pain scores were dramatically improved compared to preoperative levels. ARCO stage Ⅱ disease outperformed stage Ⅲ in terms of clinical effectiveness. Thus, bio-adaptive reconstruction using the β-TCP system is a promising hip-preserving strategy for the treatment of ANFH.
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Affiliation(s)
- Yajie Lu
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
- The State Key Laboratory of Cancer Biology Biotechnology Center, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Xiantao Chen
- Department of Osteonecrosis of the Femoral Head, Luoyang Orthopedic-Traumatological Hospital of Henan Province, Luoyang, 471002, China
| | - Xiao Lu
- Shanghai Bio-lu Biomaterials Co., Ltd, Shanghai, 201100, China
- Shanghai Technology Innovation Center of Orthopedic Biomaterials, Shanghai, 201100, China
| | - Changning Sun
- State Key Laboratory for Manufacturing System Engineering, Xi'an Jiaotong University, Xi'an, 710054, China
- National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Minghui Li
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Guojing Chen
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zuoyao Long
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, 110000, China
| | - Yuan Gao
- The State Key Laboratory of Cancer Biology Biotechnology Center, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Haoqiang Zhang
- Department of Orthopedics, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou, 730000, China
| | - Mengquan Huang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Chuanlei Ji
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Hongbin Fan
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Dong Liu
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Yuewen Hao
- Department of Medical Imaging, Xi'an Children's Hospital, Xi'an, 710000, China
| | - Hong Wang
- Department of Medical Imaging, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Leilei Zhang
- Department of Osteonecrosis of the Femoral Head, Luoyang Orthopedic-Traumatological Hospital of Henan Province, Luoyang, 471002, China
| | - Hongmei Zhang
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Jianxi Lu
- Shanghai Bio-lu Biomaterials Co., Ltd, Shanghai, 201100, China
- Shanghai Technology Innovation Center of Orthopedic Biomaterials, Shanghai, 201100, China
| | - Zhen Wang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Jing Li
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
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Effect of Core Stability Training on Unstable Support Surfaces in Postoperative Rehabilitation of Thoracolumbar Vertebral Compression Fractures in the Elderly. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4480349. [PMID: 36299682 PMCID: PMC9592204 DOI: 10.1155/2022/4480349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022]
Abstract
Objective Thoracolumbar vertebral compression fractures (TVCF) are caused by anterior flexion or vertical downward violence to the spine (Sezer et al. 2021). This study is aimed at investigating the effect of core stability training (CST) on unstable support surfaces in the postoperative rehabilitation of TVCF in the elderly. Methods. Ninety-eight patients with TVCF who underwent surgical treatment in our hospital from July 2021 to April 2022 were selected as study subjects. Then, they were divided into a research group receiving unstable support surface CST and a control group with conventional rehabilitation training according to the random number table method. Before and after the training, the X-ray machine was positioned and the anterior margin and middle height ratio and the posterior convex Cobb angle of the injured vertebrae were observed, and the balance detector was used to detect patients' eye opening and closing trajectory length, Romberg rate, and to perform gait test. Patients' pain, lumbar spine function, and quality of life were subsequently assessed using the Visual Analogue Scale (VAS), Oswestry Dysfunction Index (ODI), Generic Quality of Life Inventory-74 (GQOL-74), and patient satisfaction with rehabilitation was investigated. Results. After rehabilitation training, there was no statistically marked difference in eye-opening trajectory length between both groups (P > 0.05). The research group had higher scores than the control group in all dimensions of the anterior border of the injured vertebra, middle height ratio, and GQOL-74, while the posterior convex Cobb angle, closed-eye trajectory length, Romberg rate, VAS, and ODI were lower than the control group (P < 0.05). The research group also revealed better gait improvement and higher rehabilitation satisfaction than the control group after training (P < 0.05). Conclusion Unstable support surface CST can effectively improve postoperative vertebral body rehabilitation, balance function, gait, pain conditions, and lumbar spine function in elderly TVCF patients, and enhance their quality of life and rehabilitation satisfaction. This trial is registered with ChiCTR2000014547.
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Wang P, Liu X, Xu J, Li T, Sun W, Li Z, Gao F, Shi L, Li Z, Wu X, Xu X, Fan X, Li C, Zhang Y, An Y. Deep learning for diagnosing osteonecrosis of the femoral head based on magnetic resonance imaging. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106229. [PMID: 34153870 DOI: 10.1016/j.cmpb.2021.106229] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/01/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Early-stage osteonecrosis of the femoral head (ONFH) can be difficult to detect because of a lack of symptoms. Magnetic resonance imaging (MRI) is sufficiently sensitive to detect ONFH; however, the diagnosis of ONFH requires experience and is time consuming. We developed a fully automatic deep learning model for detecting early-stage ONFH lesions on MRI. METHODS This was a single-center retrospective study. Between January 2016 and December 2019, 298 patients underwent MRI and were diagnosed with ONFH. Of these patients, 110 with early-stage ONFH were included. Using a 7:3 ratio, we randomly divided them into training and testing datasets. All 3640 segments were delineated as the ground truth definition. The diagnostic performance of our model was analyzed using the receiver operating characteristic curve with the area under the receiver operating characteristic curve (AUC) and Hausdorff distance (HD). Differences in the area between the prediction and ground truth definition were assessed using the Pearson correlation and Bland-Altman plot. RESULTS Our model's AUC was 0.97 with a mean sensitivity of 0.95 (0.95, 0.96) and specificity of 0.97 (0.96, 0.97). Our model's prediction had similar results with the ground truth definition with an average HD of 1.491 and correlation coefficient (r) of 0.84. The bias of the Bland-Altman analyses was 1.4 px (-117.7-120.5 px). CONCLUSIONS Our model could detect early-stage ONFH lesions in less time than the experts. However, future multicenter studies with larger data are required to further verify and improve our model.
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Affiliation(s)
- Peixu Wang
- Department of Orthopedics, China-Japan Friendship Hospital, China-Japan Friendship Institute of Clinical Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Graduate School of Peking Union Medical College, Beijing 100029, China; Department of Orthopedics, Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China.
| | - Xingyu Liu
- School of Life Sciences, Tsinghua University, Beijing 100084, China; Institute of Biomedical and Health Engineering (iBHE), Tsinghua Shenzhen International Graduate School, China; Longwood Valley Medical Technology Co. Ltd, China
| | - Jia Xu
- Longwood Valley Medical Technology Co. Ltd, China
| | - Tengqi Li
- Department of Orthopedics, Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China; China-Japan Friendship Hospital, Peking University, Beijing 100029, China
| | - Wei Sun
- Department of Orthopedics, China-Japan Friendship Hospital, China-Japan Friendship Institute of Clinical Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Graduate School of Peking Union Medical College, Beijing 100029, China; Department of Orthopedics, Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China.
| | - Zirong Li
- Department of Orthopedics, Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China
| | - Fuqiang Gao
- Department of Orthopedics, Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China
| | - Lijun Shi
- Department of Orthopedics, China-Japan Friendship Hospital, China-Japan Friendship Institute of Clinical Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Graduate School of Peking Union Medical College, Beijing 100029, China; Department of Orthopedics, Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China
| | - Zhizhuo Li
- Department of Orthopedics, Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China; China-Japan Friendship Hospital, Peking University, Beijing 100029, China
| | - Xinjie Wu
- Department of Orthopedics, Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China; China-Japan Friendship Hospital, Peking University, Beijing 100029, China
| | - Xin Xu
- Department of Orthopedics, China-Japan Friendship Hospital, China-Japan Friendship Institute of Clinical Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Graduate School of Peking Union Medical College, Beijing 100029, China; Department of Orthopedics, Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China
| | - Xiaoyu Fan
- Department of Orthopedics, Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China; China-Japan Friendship Hospital, Peking University, Beijing 100029, China
| | - Chengxin Li
- Department of Orthopedics, Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China; China-Japan Friendship Hospital, Peking University, Beijing 100029, China
| | - Yiling Zhang
- Institute of Biomedical and Health Engineering (iBHE), Tsinghua Shenzhen International Graduate School, China.
| | - Yicheng An
- Longwood Valley Medical Technology Co. Ltd, China
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Long-term survival and clinical outcomes of non-vascularized autologous and allogeneic fibular grafts are comparable for treating osteonecrosis of the femoral head. J Orthop Surg Res 2021; 16:109. [PMID: 33541413 PMCID: PMC7863426 DOI: 10.1186/s13018-021-02246-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Osteonecrosis of the femoral head (ONFH) is a disabling disease, which often involves young patients. Recently, various hip-preserving surgeries were recommended to delay total hip arthroplasty (THA). Questions/purposes This study aimed to compare clinical outcomes and survival rate in the long-term follow-up between core decompression combined with a non-vascularized autologous fibular graft (group A) and an allogeneic fibular graft (group B) for the treatment of ONFH. Patients and methods We retrospectively evaluated 117 patients (153 hips) with ONFH (Association Research Circulation Osseous [ARCO] stages IIa to IIIc) who underwent the abovementioned hip-preserving surgeries between January 2003 and June 2012. The mean (range) follow-up times (years) were 12.9 (7–16) and 9.3 (6–16) in groups A and B, respectively. Clinical outcomes were assessed using the Harris Hip Score (HHS), visual analog scale (VAS) score, and forgotten joint score (FJS). A survival analysis was performed using the Kaplan-Meier method. The end point was THA. Results Groups A and B showed postoperative improvements, respectively, in HHS from 65 ± 7.2 to 80.3 ± 14.5 and from 66 ± 5.9 to 82.4 ± 13.6 (p < 0.05), and in VAS score from 6.3 ± 1.1 to 2.3 ± 1.6 and from 6.1 ± 1 to 2.2 ± 2.2 (p < 0.05). However, no significant differences in the HHS, VAS score, and hip FJS at the last follow-up (p > 0.05) and 15-year survival rate (84.1% and 86%, respectively, p > 0.05) were found between groups A and B. Conclusions Autologous and allogeneic fibular grafts can attain equally good clinical outcomes and high survival rates in long-term follow-up, and thus can greatly delay THA owing to good bone osseointegration and sufficient mechanical support. Notably, the ratio of failure will increase when patients were more than 37 years old. Level of evidence Level III, therapeutic study Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02246-3.
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Mont MA, Salem HS, Piuzzi NS, Goodman SB, Jones LC. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?: A 5-Year Update. J Bone Joint Surg Am 2020; 102:1084-1099. [PMID: 32282421 PMCID: PMC7508290 DOI: 10.2106/jbjs.19.01271] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➢. Clinicians should exercise a high level of suspicion in at-risk patients (those who use corticosteroids, consume excessive alcohol, have sickle cell disease, etc.) in order to diagnose osteonecrosis of the femoral head in its earliest stage. ➢. Nonoperative treatment modalities have generally been ineffective at halting progression. Thus, nonoperative treatment is not appropriate in early stages when one is attempting to preserve the native joint, except potentially on rare occasions for small-sized, medially located lesions, which may heal without surgery. ➢. Joint-preserving procedures should be attempted in early-stage lesions to save the femoral head. ➢. Cell-based augmentation of joint-preserving procedures continues to show promising results, and thus should be considered as an ancillary treatment method that may improve clinical outcomes. ➢. The outcomes of total hip arthroplasty in the setting of osteonecrosis are excellent, with results similar to those in patients who have an underlying diagnosis of osteoarthritis.
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Affiliation(s)
- Michael A. Mont
- Lenox Hill Hospital, New York, NY,Cleveland Clinic, Cleveland, Ohio,Email address for M.A. Mont:
| | | | | | | | - Lynne C. Jones
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Yue J, Gao H, Guo X, Wang R, Li B, Sun Q, Liu W, Chen J, Li Y. Fibula allograft propping as an effective treatment for early-stage osteonecrosis of the femoral head: a systematic review. J Orthop Surg Res 2020; 15:206. [PMID: 32493388 PMCID: PMC7268760 DOI: 10.1186/s13018-020-01730-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/25/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) causes severe hip dysfunction. Left untreated, 80% of patients experience femoral head collapse, and 65-70% of patients require total hip arthroplasty (THA). Therefore, effective treatment is very important for ONFH. OBJECTIVE To examine the effectiveness of fibula allografting for the treatment of early-stage ONFH METHODS: A systematic review was conducted by searching PubMed, EMBASE, and Web of Science databases using "avascular necrosis" or "ischemic necrosis" or "osteonecrosis" and "femoral head" and "fibula*," and checking the references of primary articles and reviews. Two independent authors completed the study selection separately. We extracted the following details from each article: characteristics of the patients, clinical efficacy evaluation (Harris hip score [HSS], radiographic outcomes, the rate of conversation to total hip arthroplasty [THA], and adverse effects). RESULTS A total of 213 articles were selected from PubMed (n = 45), EMBASE (n = 77), Web of Science (n = 203), and other sources (n = 10). After checking the articles, five articles were included in the final analysis. The average age of patients involved in this review was 34.48 years. The studies investigated fibula allografts to treat ONFH in 394 hips with a mean follow-up of 49.06 months. HHS was improved from 62.73 to 86.94. Radiographic progression was found in 33.66% of hips. The failure rate of head-saving surgery by THA was 14.5%. No patients had serious postoperative complications. LIMITATIONS The number of articles included in the study was small, and all studies were single-center studies. Most studies were retrospective with a low level of evidence. Surgical procedures were not identical with different follow-up times. CONCLUSION Although there are some limitations to our approach, this systematic review supports fibula allografting as a simple, effective treatment for early-stage ONFH, which presents less postoperative complications, and has a satisfactory clinical effect. We consider it to be worthy of promotion as a therapy for ONFH.
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Affiliation(s)
- Ju'an Yue
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, AnwaiBeiyuan, Chaoyang District, Beijing, China
| | - He Gao
- Disinfection Supply Division, Aviation General Hospital, Beijing, China
| | - Xiaozhong Guo
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, AnwaiBeiyuan, Chaoyang District, Beijing, China.
| | - Randong Wang
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, AnwaiBeiyuan, Chaoyang District, Beijing, China
| | - Bing Li
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, AnwaiBeiyuan, Chaoyang District, Beijing, China
| | - Qiang Sun
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, AnwaiBeiyuan, Chaoyang District, Beijing, China
| | - Wangyan Liu
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, AnwaiBeiyuan, Chaoyang District, Beijing, China
| | - Jiao Chen
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, AnwaiBeiyuan, Chaoyang District, Beijing, China
| | - Yingnan Li
- Department of Joint Surgery, Aviation General Hospital, Courtyard 3, AnwaiBeiyuan, Chaoyang District, Beijing, China
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Changjun C, Donghai L, Xin Z, Liyile C, Qiuru W, Pengde K. Mid- to long-term results of modified non-vascularized allogeneic fibula grafting combined with core decompression and bone grafting for early femoral head necrosis. J Orthop Surg Res 2020; 15:116. [PMID: 32209127 PMCID: PMC7092607 DOI: 10.1186/s13018-020-1565-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/16/2020] [Indexed: 02/08/2023] Open
Abstract
Purpose The aim of this study was to determine mid-and-long term follow-up results of patients with early femoral head osteonecrosis who were treated by modified free vascularized fibular grafting combined with core decompression and bone grafting. Methods Forty-four patients at early ONFH were included in this study. Visual analog scale (VAS) pain scores, range of hip motion (ROM), and Harris hip score (HHS) were recorded to assess the clinical outcome; Western Ontario McMaster Osteoarthritis index (WOMAC) scores and Short Form 36 health survey (SF-36) were conducted to measure the living quality; X-ray film or magnetic resonance imaging (MRI) was used to evaluate radiographic progression; survivorship was defined as patients did not undergo the total hip arthroplasty (THA) or fusion at the last follow-up. Median follow-up was 7.4 years (6–8.2 years). Results The mean VAS score, ROM, and HHS were significantly improved at the final follow-up compared with preoperative values (p < 0.001). Health assessment including WOMAC scores and SF-36 were also better than those preoperatively (p < 0.001). Seven patients progressed to Ficat III and the four patients progressed to Ficat IV with osteoarthritis. Eight patients who cannot tolerate the pain and had poor living quality underwent THA. Conclusion Modified non-vascularized allogeneic fibula Grafting combined with core decompression and bone grafting could improve the clinical outcomes and enhance the quality of life for patients with early ONFH.
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Affiliation(s)
- Chen Changjun
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Li Donghai
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Zhao Xin
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Chen Liyile
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Wang Qiuru
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Kang Pengde
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China.
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10
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Feng W, Ye P, Ni S, Deng P, Lu L, Chen J, Zeng J, Qi X, Li J, Jie K, Cao H, Yue Z, Zhang H, Zeng Y. One-stage simultaneous hip-preserving surgeries for the management of bilateral femoral head osteonecrosis: a mean 7.0-year follow-up. J Orthop Surg Res 2019; 14:455. [PMID: 31864402 PMCID: PMC6925467 DOI: 10.1186/s13018-019-1467-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background A retrospective study was conducted to evaluate and compare the clinical and radiological outcomes of one-stage fibular impaction allografting and vascularized greater trochanter flap autografting for the treatment of bilateral osteonecrosis of the femoral head (ONFH). Methods Patients who underwent one-stage aforementioned hip-preserving surgeries due to bilateral ONFH were retrospectively reviewed from January 2008 to December 2013. Sixty-nine patients (138 hips) with a mean age of 31.5 years and mean follow-up of 7.0 years were included. Hips that underwent fibular impaction allografting and vascularized greater trochanter flap autografting were assigned as group A and group B, respectively. Harris Hip Score (HHS) and Visual Analogue Scale (VAS) were used for clinical evaluation, and a series of X-ray images were used for radiological assessment. For inter-group analysis, the paired t test was used for continuous data, and the Wilcoxon rank sum test was used for non-parametric data, while the Mann-Whitney U test was used for intra-group analysis. Results The HHS and VAS in both groups A and B had a substantial advancement when compared with the preoperative level (p < 0.01). Fibular impaction allografting can achieve more pain relief (p < 0.01), though no clinical difference was found in terms of minimal clinically important difference (MCID < 10 points). Group A showed better radiological results than group B (p = 0.04). It was discovered that the appropriate indication for each procedure was patients with Association for Research on Osseous Circulation (ARCO) stages II and III, respectively. Conclusion One-stage hip-preserving surgeries for the management of bilateral ONFH could obtain good medium and long-term outcomes. It was recommended that fibular impaction allografting is more suitable for patients in ARCO stage II, while for patients in ARCO stage III, vascularized greater trochanter flap autografting is a better preference. Trial registration Retrospectively registered.
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Affiliation(s)
- Wenjun Feng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China.
| | - Pengcheng Ye
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China
| | - Shihao Ni
- Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Peng Deng
- Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Lu Lu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Linnan Medical Research Center of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China
| | - Jinlun Chen
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China
| | - Jianchun Zeng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China
| | - Xinyu Qi
- Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Jie Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China
| | - Ke Jie
- Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China
| | - Houran Cao
- Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Zhijun Yue
- Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Haitao Zhang
- Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yirong Zeng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China.
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Sionek A, Czwojdziński A, Kowalczewski J, Okoń T, Marczak D, Sibiński M, Złotorowicz M, Czubak J. Hip osteonecroses treated with calcium sulfate-calcium phosphate bone graft substitute have different results according to the cause of osteonecrosis: alcohol abuse or corticosteroid-induced. INTERNATIONAL ORTHOPAEDICS 2018; 42:1491-1498. [PMID: 29550914 DOI: 10.1007/s00264-018-3892-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/12/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of the study was to assess the factors influencing the final results of treatment of the femoral head osteonecrosis (ONFH) with core decompression and bone substitute grafting. The special interest was focused on comparison between alcohol- and steroid-induced ONFHs. MATERIAL AND METHODS In this prospective study, a total of 53 patients (58 hips) in the mean age of 35.5 years were included: 29 had a history of alcohol use (32 hips) and 24 of steroid use (26 hips). The mean follow-up was 4.2 years (minimum 3 years). RESULTS At last follow-up, significant improvements were noted in the Harris Hip Score (HHS) (mean 44.0 vs 55.9 points, p < 0.00002) and VAS scores (mean 7.0 vs 5.8 points, p < 0.0002) for the whole ONFH cohort, comparing to pre-operative status. The degree of improvement did not differ between Ficat and Arlet grade II and grade III (mean 14.9 vs 6.2 points, respectively, p = 0.1). No change was found between the final and initial results in this group in the steroid group (HHS mean 42.2 vs 45.5 points, p = 0.5 and VAS mean 6.8 vs 6.5 points, p = 0.5), but the improvement was noted in the alcohol group (HHS mean 45.5 vs 64.4 points, p < 0.0001; VAS mean 7.1 vs 5.2 points, p < 0.0001) comparing to pre-operative status. CONCLUSIONS Presented treatment of ONFH significantly improves hip function, offers pain reduction, and gives similar functional improvement for hips scoring grade II and III on the Ficat and Arlet scale. A good response to operative treatment is seen in patients with alcohol-induced ONFH, but not in those with steroid-induced ONFH.
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Affiliation(s)
- Andrzej Sionek
- Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Medical Centre of Postgraduate Education, Warsaw-Otwock, ul. Konarskiego 13, 05-400, Otwock, Poland
| | - Adam Czwojdziński
- Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Medical Centre of Postgraduate Education, Warsaw-Otwock, ul. Konarskiego 13, 05-400, Otwock, Poland
| | - Jacek Kowalczewski
- Orthopaedic Department, Medical Centre of Postgraduate Education, Warsaw-Otwock, ul. Konarskiego 13, 05-400, Otwock, Poland
| | - Tomasz Okoń
- Orthopaedic Department, Medical Centre of Postgraduate Education, Warsaw-Otwock, ul. Konarskiego 13, 05-400, Otwock, Poland
| | - Dariusz Marczak
- Orthopaedic Department, Medical Centre of Postgraduate Education, Warsaw-Otwock, ul. Konarskiego 13, 05-400, Otwock, Poland
| | - Marcin Sibiński
- Department of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, ul. Pomorska 251, 92-213, Łódź, Poland.
| | - Marcin Złotorowicz
- Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Medical Centre of Postgraduate Education, Warsaw-Otwock, ul. Konarskiego 13, 05-400, Otwock, Poland
| | - Jarosław Czubak
- Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Medical Centre of Postgraduate Education, Warsaw-Otwock, ul. Konarskiego 13, 05-400, Otwock, Poland
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Kim SC, Lim YW, Jo WL, Park DC, Lee JW, Kang WW, Kim YS. Surgical accuracy, function, and quality of life of simultaneous versus staged bilateral Total hip Arthroplasty in patients with Osteonecrosis of the femoral head. BMC Musculoskelet Disord 2017. [PMID: 28623889 PMCID: PMC5474000 DOI: 10.1186/s12891-017-1605-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The optimal surgical option for patients requiring bilateral hip replacement remains controversial. The purpose of this study was to compare surgical accuracy; functional outcome and health-related quality of life; and prosthetic-related complications and revision surgery of a simultaneous bilateral total hip arthroplasty (THA) with those of a staged bilateral THA with an interval between procedures <12 months. METHODS A total of 123 unselected consecutive patients (mean age, 43.3 years) who underwent bilateral THAs for osteonecrosis of the femoral head (ONFH) with a minimum follow-up of two years (mean, 60.2 months) were studied retrospectively; 63 simultaneous procedures served as a test group and 60 staged procedures served as a control group. RESULTS The mean postoperative leg-length discrepancy (LLD) and the percentage of patients who had an LLD >3 mm were significantly lower in the simultaneous group (P < 0.001 and P = 0.001, respectively). A higher number of cups within the safe zones, a higher correction rate, and a lower failure rate for the cup placement in the second-operated hip were also identified in the simultaneous group. The mean Harris hip score, EuroQol-5D index, and EuroQol-visual analogue scale score were all better in the simultaneous group at the latest follow-up (P < 0.001, in all comparisons). We found that the simultaneous procedure was associated with a lower incidence of postoperative prosthetic-related complications and revision surgery. CONCLUSIONS We suggest that bilateral ONFH could be treated with a simultaneous THA rather than a staged THA to achieve a better surgical outcome.
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Affiliation(s)
- Seung-Chan Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpodae-ro 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Young-Wook Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpodae-ro 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpodae-ro 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Dong-Chul Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpodae-ro 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Jin-Woo Lee
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpodae-ro 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Won-Woo Kang
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpodae-ro 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Yong-Sik Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpodae-ro 222, Seocho-gu, Seoul, 137-701, South Korea.
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